Estimates of the severity of coronavirus disease 2019: a model-based analysis.
Estimates of the severity of coronavirus disease 2019: a model-based analysis.
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DOI：
10.1016/s1473-3099(20)30243-7
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发表时间：
2020-06-01
期刊：
影响因子：
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通讯作者：
Ferguson, Neil M
中科院分区：
文献类型：
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作者：
Verity, Robert;Okell, Lucy C;Ferguson, Neil M
背景技术背景：面对快速变化的数据，2019冠状病毒病（COVID-19）的一系列病死率估计值在幅度上存在很大差异。我们的目标是提供稳健的估计，考虑删失和确定偏差。我们收集了中国大陆湖北省死于COVID-19的患者的个案数据（由国家和省级卫生委员会报告至2020年2月8日），以及中国大陆以外的病例（来自37个国家以及香港和澳门的政府或卫生部网站和媒体报道，截至2020年2月25日）。这些个体病例数据用于估计症状发作和结局（死亡或出院）之间的时间。接下来，我们通过将中国病例的总体分布与观察到的累积死亡联系起来，假设各年龄的发病率恒定，并对人口统计学以及基于年龄和基于位置的不确定性进行调整，获得了病死率的年龄分层估计值。我们还根据中国大陆以外地区发现的1334例病例的个体行列表数据估计了病死率。利用从中国遣返的国际居民中PCR确诊病例的流行率数据，我们获得了感染死亡率的年龄分层估计值。此外，我们还使用了来自中国的3665例病例的年龄分层严重程度数据来估计可能需要住院治疗的感染者比例。使用中国大陆24例死亡和中国境外165例康复的数据，我们估计从出现症状到死亡的平均时间为17.8天（95%可信区间[CrI] 16.9 - 19.2），到出院的平均时间为24.7天（22.9 - 28.1）。在所有来自中国大陆的实验室确诊和临床诊断病例（n=70 117）中，我们估计粗病死率（经删失调整）为3.67%（95%CrI 3.56 - 3.80）。 然而，在进一步调整人口统计学和不确定因素后，我们得到了中国病死率的最佳估计值为1.38%（1.23 - 1.53），老年组的病死率明显更高（0.32%[0.27 - 0.38
BACKGROUND: In the face of rapidly changing data, a range of case fatality ratio estimates for coronavirus disease 2019 (COVID-19) have been produced that differ substantially in magnitude. We aimed to provide robust estimates, accounting for censoring and ascertainment biases.METHODS: We collected individual-case data for patients who died from COVID-19 in Hubei, mainland China (reported by national and provincial health commissions to Feb 8, 2020), and for cases outside of mainland China (from government or ministry of health websites and media reports for 37 countries, as well as Hong Kong and Macau, until Feb 25, 2020). These individual-case data were used to estimate the time between onset of symptoms and outcome (death or discharge from hospital). We next obtained age-stratified estimates of the case fatality ratio by relating the aggregate distribution of cases to the observed cumulative deaths in China, assuming a constant attack rate by age and adjusting for demography and age-based and location-based under-ascertainment. We also estimated the case fatality ratio from individual line-list data on 1334 cases identified outside of mainland China. Using data on the prevalence of PCR-confirmed cases in international residents repatriated from China, we obtained age-stratified estimates of the infection fatality ratio. Furthermore, data on age-stratified severity in a subset of 3665 cases from China were used to estimate the proportion of infected individuals who are likely to require hospitalisation.FINDINGS: Using data on 24 deaths that occurred in mainland China and 165 recoveries outside of China, we estimated the mean duration from onset of symptoms to death to be 17·8 days (95% credible interval [CrI] 16·9-19·2) and to hospital discharge to be 24·7 days (22·9-28·1). In all laboratory confirmed and clinically diagnosed cases from mainland China (n=70 117), we estimated a crude case fatality ratio (adjusted for censoring) of 3·67% (95% CrI 3·56-3·80). However, after further adjusting for demography and under-ascertainment, we obtained a best estimate of the case fatality ratio in China of 1·38% (1·23-1·53), with substantially higher ratios in older age groups (0·32% [0·27-0·38] in those aged