Age-adjusted associations between comorbidity and outcomes of COVID-19: a review of the evidence
Age-adjusted associations between comorbidity and outcomes of COVID-19: a review of the evidence
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COVID-19 合并症与结果之间经年龄调整的关联：证据审查
DOI：
10.1101/2020.05.06.20093351
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Mason K
中科院分区：
文献类型：
--
作者：
Mason K
背景目前的证据表明，老年人和有潜在合并症的人在使用新冠肺炎住院后患严重疾病和死亡的风险增加。由于合并症随着年龄的增长而增加，有必要了解年龄调整后的合并症和新冠肺炎预后之间的关系，以便提高规划能力和我们对COVID-19的理解。方法我们对截至2020年4月10日的文献进行了快速、全面的回顾，在考虑了年龄因素后，评估了在住院的COVID-19患者中，关于COVID-19的合并症和重症监护结果之间关系的国际经验证据。都是中国的人。新出现的证据大多表明，在对年龄(在某些情况下还包括其他潜在的混杂因素)进行调整后，肥胖、高血压、糖尿病、慢性阻塞性呼吸道疾病(COPD)和癌症都与较差的预后相关。这项最大规模的研究使用了全国范围内的中国新冠肺炎患者样本，发现在调整了年龄和吸烟因素后，患有多种并发症的患者发生严重后果或死亡的风险是没有合并疾病的患者的两倍以上(HR=2.59，95%CI 1.61，4.17)。结论本综述为临床医生、政策制定者和学者总结了迄今为止关于这一主题的最有力证据，为患者管理和应对疫情的控制措施提供参考。鉴于共病与种族和社会劣势的交集，这些发现也对健康不平等具有重要影响。随着疫情的发展，进一步的研究应该会证实中国以外的其他环境中的这些趋势，并探索各种潜在的健康状况增加严重新冠肺炎风险的机制。
BackgroundCurrent evidence suggests that older people and people with underlying comorbidities are at increased risk of severe disease and death following hospitalisation with COVID-19. As comorbidity increases with age, it is necessary to understand the age-adjusted relationship between comorbidity and COVID-19 outcomes, in order to enhance planning capabilities and our understanding of COVID-19.MethodsWe conducted a rapid, comprehensive review of the literature up to 10 April 2020, to assess the international empirical evidence on the association between comorbidities and severe or critical care outcomes of COVID-19, after accounting for age, among hospitalised patients with COVID-19.ResultsAfter screening 579 studies, we identified seven studies eligible for inclusion and these were synthesised narratively. All were from China. The emerging evidence base mostly indicates that after adjustment for age (and in some cases other potential confounders), obesity, hypertension, diabetes mellitus, chronic obstructive airways disease (COPD), and cancer are all associated with worse outcomes. The largest study, using a large nationwide sample of COVID-19 patients in China, found that those with multiple comorbidities had more than twice the risk of a severe outcome or death compared with patients with no comorbidities, after adjusting for age and smoking (HR=2.59, 95% CI 1.61, 4.17).ConclusionsThis review summarises for clinicians, policymakers, and academics the most robust evidence to date on this topic, to inform the management of patients and control measures for tackling the pandemic. Given the intersection of comorbidity with ethnicity and social disadvantage, these findings also have important implications for health inequalities. As the pandemic develops, further research should confirm these trends in other settings outside China and explore mechanisms by which various underlying health conditions increase risk of severe COVID-19.