Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study
Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study
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DOI：
10.1016/s2468-2667(20)30164-x
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发表时间：
2020-09-01
影响因子：
50
通讯作者：
Chan, Andrew T.
中科院分区：
文献类型：
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作者：
Nguyen, Long H.;Drew, David A.;Chan, Andrew T.
一线医护人员和COVID-19风险的背景数据有限。我们试图评估一线卫生保健工作者与一般社区相比的COVID-19风险以及个人防护设备（PPE）对风险的影响。方法我们在英国和美国对一般社区进行了一项前瞻性观察性队列研究，包括一线卫生保健工作者，使用2020年3月24日（英国）和3月29日（美国）至4月23日的COVID症状研究智能手机应用程序（应用程序）的自我报告数据。参与者是该应用程序的自愿用户，首次使用时提供了有关人口统计学因素（包括年龄，性别，种族或民族背景，身高和体重以及职业）和病史的信息，随后报告了任何COVID-19症状。我们使用考克斯比例风险模型来估计我们的主要结局的多变量调整的风险比（HR），这是一个积极的COVID-19测试。COVID Symptom Study应用程序已在ClinicalTrials.gov注册，NCT 04331509。调查结果在2 035 395名社区个人和99 795名一线医护人员中，我们在34 435 272人天内记录了5545起COVID-19阳性检测事件报告。与一般社区相比，一线医护人员报告COVID-19检测阳性的风险增加（调整后HR 11.61，95%CI 10.93-12.33）。为了解释一线医护人员和一般社区之间检测频率的差异以及可能的选择偏倚，使用逆概率加权模型来调整接受COVID-19检测的可能性（调整后HR 3.40，95% CI 3.37-3.43）。二次和事后分析显示，个人防护装备的充足性、临床环境和种族背景也是重要因素。解读在英国和美国，前线医护人员报告COVID-19检测呈阳性的风险增加。卫生保健系统应确保个人防护设备的充足供应，并制定额外的战略，以保护卫生保健工作者免受COVID-19的影响，特别是那些来自黑人，亚洲和少数民族背景的人。需要对这些观察结果进行额外的随访。版权所有（C）2020作者。爱思唯尔有限公司出版
Background Data for front-line health-care workers and risk of COVID-19 are limited. We sought to assess risk of COVID-19 among front-line health-care workers compared with the general community and the effect of personal protective equipment (PPE) on risk.Methods We did a prospective, observational cohort study in the UK and the USA of the general community, including front-line health-care workers, using self-reported data from the COVID Symptom Study smartphone application (app) from March 24 (UK) and March 29 (USA) to April 23, 2020. Participants were voluntary users of the app and at first use provided information on demographic factors (including age, sex, race or ethnic background, height and weight, and occupation) and medical history, and subsequently reported any COVID-19 symptoms. We used Cox proportional hazards modelling to estimate multivariate-adjusted hazard ratios (HRs) of our primary outcome, which was a positive COVID-19 test. The COVID Symptom Study app is registered with ClinicalTrials.gov, NCT04331509.Findings Among 2 035 395 community individuals and 99 795 front-line health-care workers, we recorded 5545 incident reports of a positive COVID-19 test over 34 435 272 person-days. Compared with the general community, front-line health-care workers were at increased risk for reporting a positive COVID-19 test (adjusted HR 11.61, 95% CI 10.93-12.33). To account for differences in testing frequency between front-line health-care workers and the general community and possible selection bias, an inverse probability-weighted model was used to adjust for the likelihood of receiving a COVID-19 test (adjusted HR 3.40, 95% CI 3.37-3.43). Secondary and post-hoc analyses suggested adequacy of PPE, clinical setting, and ethnic background were also important factors.Interpretation In the UK and the USA, risk of reporting a positive test for COVID-19 was increased among front-line health-care workers. Health-care systems should ensure adequate availability of PPE and develop additional strategies to protect health-care workers from COVID-19, particularly those from Black, Asian, and minority ethnic backgrounds. Additional follow-up of these observational findings is needed. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.