Association of Social and Behavioral Risk Factors With Mortality Among US Veterans With COVID-19.
Association of Social and Behavioral Risk Factors With Mortality Among US Veterans With COVID-19.
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DOI：
10.1001/jamanetworkopen.2021.13031
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发表时间：
2021-06-01
影响因子：
13.8
通讯作者：
Keyhani S
中科院分区：
文献类型：
--
作者：
Kelly JD;Bravata DM;Bent S;Wray CM;Leonard SJ;Boscardin WJ;Myers LJ;Keyhani S
这项队列研究考察了住房不足、经济困难、酒精、烟草或药物使用以及种族/民族和其他协变量对有症状的SARS-CoV-2感染或新冠肺炎退伍军人的影响。社会和行为风险因素是否与新冠肺炎美国退伍军人的死亡率有关？在这项对27名新冠肺炎检测呈阳性的 640退伍军人进行的队列研究中，住房问题、经济困难、酗酒、吸烟和药物使用等风险因素与更高的死亡率无关。这项研究发现，在一个整合的退伍军人管理局健康系统中，社会和行为风险因素与新冠肺炎死亡之间没有关联；这样的系统已知可以超越社会脆弱性，并有可能成为美国家庭和高危人群支持服务的模式。美国退伍军人事务部(VA)提供了一些计划，以减少照顾退伍军人和那些住房不稳定、贫困和药物使用障碍的人的障碍。然而，在这种背景下，社会和行为风险因素在新冠肺炎结果中扮演的角色尚不清楚。研究社会和行为危险因素是否与患有新冠肺炎的美国退伍军人的死亡率相关，以及这种相关性是否可能因种族/民族而改变。这项队列研究从退伍军人事务部数据仓库获得数据，组成一个退伍军人队列，这些退伍军人在2020年3月2日至9月30日期间在退伍军人医疗机构接受了新冠肺炎检测呈阳性结果。所有符合纳入标准的退伍军人都有资格参与这项研究，并在首次确诊为SARS-CoV-2或新冠肺炎后对参与者进行了为期30天的跟踪调查。最终的跟进日期是2020年10月31日。社会风险因素包括住房问题和经济困难。行为危险因素包括当前的烟草使用、酒精使用和物质使用。主要结果是SARS-CoV-2或新冠肺炎确诊日期后30天内的全原因死亡率。使用多变量Logistic回归估计优势比，对卫生保健机构进行分组，并调整年龄、性别、种族、民族、婚姻状况、临床因素和诊断为新冠肺炎的月份。在27640名患有新冠肺炎的退伍军人中，24名 496为男性(88.6%)，平均年龄(SD)为57.2%(16.6岁)。共有3090名退伍军人(11.2%)有住房问题，4450名(16.1%)经济困难，5358名(19.4%)饮酒，3569名(12.9%)报告使用药物。7663名退伍军人(27.7%)住院，1230名退伍军人(4.5%)死亡。住房问题(调整后的优势比，0.96；95%CI，0.77-1.19；P = .70)，经济困难(优势比，1.13；95%CI，0.97-1.31；P = .11)，酗酒(优势比，0.82；95%CI，0.68-1.01；P = .06)，当前烟草使用(优势比，0.85；95%CI，0.68-1.06；P = .14)，以及药物使用(优势比，0.90；95%CI，0.71-1.15；P = .41)与较高的死亡率无关。按种族/民族进行的交互分析没有发现死亡率与社会和行为风险因素之间的关联。这项研究的结果表明，在退伍军人事务部这样的综合卫生系统中，社会和行为风险因素与新冠肺炎死亡率无关。还需要进一步研究，以证实综合卫生系统是否有潜力成为新冠肺炎家庭和有患病风险的人群提供支助服务的模式。
This cohort study examines the implications of inadequate housing; financial difficulty; and alcohol, tobacco, or substance use as well as race/ethnicity and other covariates for veterans with symptomatic SARS-CoV-2 infection or COVID-19. Are social and behavioral risk factors associated with mortality in US veterans with COVID-19? In this cohort study of 27 640 veterans who received a positive test result for COVID-19, risk factors such as housing problems, financial hardship, alcohol use, tobacco use, and substance use were not associated with higher mortality. This study found no association between social and behavioral risk factors and death from COVID-19 in an integrated VA health system; such a system is known to transcend social vulnerabilities and has the potential to be a model of support services for households and at-risk populations in the US. The US Department of Veterans Affairs (VA) offers programs that reduce barriers to care for veterans and those with housing instability, poverty, and substance use disorder. In this setting, however, the role that social and behavioral risk factors play in COVID-19 outcomes is unclear. To examine whether social and behavioral risk factors were associated with mortality among US veterans with COVID-19 and whether this association might be modified by race/ethnicity. This cohort study obtained data from the VA Corporate Data Warehouse to form a cohort of veterans who received a positive COVID-19 test result between March 2 and September 30, 2020, in a VA health care facility. All veterans who met the inclusion criteria were eligible to participate in the study, and participants were followed up for 30 days after the first SARS-CoV-2 or COVID-19 diagnosis. The final follow-up date was October 31, 2020. Social risk factors included housing problems and financial hardship. Behavioral risk factors included current tobacco use, alcohol use, and substance use. The primary outcome was all-cause mortality in the 30-day period after the SARS-CoV-2 or COVID-19 diagnosis date. Multivariable logistic regression was used to estimate odds ratios, clustering for health care facilities and adjusting for age, sex, race, ethnicity, marital status, clinical factors, and month of COVID-19 diagnosis. Among 27 640 veterans with COVID-19 who were included in the analysis, 24 496 were men (88.6%) and the mean (SD) age was 57.2 (16.6) years. A total of 3090 veterans (11.2%) had housing problems, 4450 (16.1%) had financial hardship, 5358 (19.4%) used alcohol, and 3569 (12.9%) reported substance use. Hospitalization occurred in 7663 veterans (27.7%), and 1230 veterans (4.5%) died. Housing problems (adjusted odds ratio [AOR], 0.96; 95% CI, 0.77-1.19; P = .70), financial hardship (AOR, 1.13; 95% CI, 0.97-1.31; P = .11), alcohol use (AOR, 0.82; 95% CI, 0.68-1.01; P = .06), current tobacco use (AOR, 0.85; 95% CI, 0.68-1.06; P = .14), and substance use (AOR, 0.90; 95% CI, 0.71-1.15; P = .41) were not associated with higher mortality. Interaction analyses by race/ethnicity did not find associations between mortality and social and behavioral risk factors. Results of this study showed that, in an integrated health system such as the VA, social and behavioral risk factors were not associated with mortality from COVID-19. Further research is needed to substantiate the potential of an integrated health system to be a model of support services for households with COVID-19 and populations who are at risk for the disease.
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