Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study
Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study
复制标题
DOI：
10.1016/s2214-109x(20)30264-3
复制
发表时间：
2020-08-01
影响因子：
34.3
通讯作者：
Eggo, Rosalind M.
中科院分区：
文献类型：
--
作者：
Clark, Andrew;Jit, Mark;Eggo, Rosalind M.
背景如果一个人感染了严重的COVID-19，已知老年人和有基础健康状况的人患上严重COVID-19的风险更高。了解严重COVID-19风险增加的个体数量以及各国之间的差异，应该为设计可能的策略提供信息，以保护或接种高风险人群。方法我们估计了严重疾病风险增加的个体数量（定义为在现行指南中至少有一种被列为“严重COVID-19风险增加”的情况）（5岁年龄组），性别和国家，使用2017年全球疾病，伤害和风险因素研究（GBD）的患病率数据和2020年联合国人口估计。与COVID-19相关的基础疾病清单是通过将GBD 2017中列出的疾病与世卫组织以及英国和美国公共卫生机构发布的指南中列出的疾病进行映射而确定的。我们分析了两项大型多变量研究的数据，以确定聚类和多变量的适当调整因子。为帮助解释高风险人群的风险程度，我们亦使用中国大陆估计的COVID-19感染与住院的年龄别比率估计高风险人群（定义为感染后需要住院的人群）的人数，并作出调整以反映国家在基础疾病和虚弱患病率方面的差异。我们假设男性处于高风险的可能性是女性的两倍。我们还计算了没有潜在疾病的人的数量，这些人可以被认为是因为他们的年龄而增加了风险，使用的最低年龄从50岁到70岁。我们通过运行低情景和高情景，使用国家人口规模、疾病患病率、多发病率和感染住院率的95%置信下限和上限，以及聚类程度的合理低估计和高估计，为我们的估计生成了不确定性区间（UI）。我们估计，1个中心点70亿，（UI 1中心点0-2中心点4）人，占22%（UI 15-28）全球人口，至少有一种潜在的疾病，使他们在感染后患严重COVID-19的风险增加（70岁或以上的人中有66%）。我们估计有3.49亿（186-787）人（占全球人口的4% [3-9]）处于严重COVID-19的高风险中，如果感染，将需要住院治疗（范围从
Background The risk of severe COVID-19 if an individual becomes infected is known to be higher in older individuals and those with underlying health conditions. Understanding the number of individuals at increased risk of severe COVID-19 and how this varies between countries should inform the design of possible strategies to shield or vaccinate those at highest risk.Methods We estimated the number of individuals at increased risk of severe disease (defined as those with at least one condition listed as "at increased risk of severe COVID-19" in current guidelines) by age (5-year age groups), sex, and country for 188 countries using prevalence data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 and UN population estimates for 2020. The list of underlying conditions relevant to COVID-19 was determined by mapping the conditions listed in GBD 2017 to those listed in guidelines published by WHO and public health agencies in the UK and the USA. We analysed data from two large multimorbidity studies to determine appropriate adjustment factors for clustering and multimorbidity. To help interpretation of the degree of risk among those at increased risk, we also estimated the number of individuals at high risk (defined as those that would require hospital admission if infected) using age-specific infection-hospitalisation ratios for COVID-19 estimated for mainland China and making adjustments to reflect country-specific differences in the prevalence of underlying conditions and frailty. We assumed males were twice at likely as females to be at high risk. We also calculated the number of individuals without an underlying condition that could be considered at increased risk because of their age, using minimum ages from 50 to 70 years. We generated uncertainty intervals (UIs) for our estimates by running low and high scenarios using the lower and upper 95% confidence limits for country population size, disease prevalences, multimorbidity fractions, and infection-hospitalisation ratios, and plausible low and high estimates for the degree of clustering, informed by multimorbidity studies.Findings We estimated that 1 center dot 7 billion (UI 1 center dot 0-2 center dot 4) people, comprising 22% (UI 15-28) of the global population, have at least one underlying condition that puts them at increased risk of severe COVID-19 if infected (ranging from 66% of those aged 70 years or older). We estimated that 349 million (186-787) people (4% [3-9] of the global population) are at high risk of severe COVID-19 and would require hospital admission if infected (ranging from