Analyses of Risk, Racial Disparity, and Outcomes Among US Patients With Cancer and COVID-19 Infection
Analyses of Risk, Racial Disparity, and Outcomes Among US Patients With Cancer and COVID-19 Infection
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DOI：
10.1001/jamaoncol.2020.6178
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发表时间：
2020-12-10
期刊：
影响因子：
28.4
通讯作者：
Xu, Rong
中科院分区：
文献类型：
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作者：
Wang, QuanQiu;Berger, Nathan A.;Xu, Rong
本病例对照研究调查了特定类型癌症患者感染2019冠状病毒病及其不良后果的风险如何，以及是否存在癌症特异性种族感染差异。问题癌症患者感染2019冠状病毒病（COVID-19）及其不良后果的风险是否增加？在这项对7340万独特患者的电子病历进行的病例对照分析中，最近诊断为癌症的患者感染COVID-19及其不良后果的风险显著增加，特别是在非洲裔美国人中。根据这些发现，密切监测癌症患者并保护他们免受严重急性呼吸系统综合征冠状病毒2和COVID-19严重后果的影响非常重要。重要性患有特定癌症的患者可能比没有癌症的患者面临更高的2019冠状病毒病（COVID-19）及其严重后果的风险。目前，关于癌症患者COVID-19疾病的风险、种族差异和结局的数据有限。目的研究特定类型癌症患者感染COVID-19的风险及其不良后果，以及COVID-19感染是否存在癌症特异性种族差异。这项对患者电子健康记录的回顾性病例对照分析包括截至2020年8月14日来自美国50个州的360家医院和31.7万名临床医生的7340万例患者。评估了13种常见癌症类型的COVID-19感染几率和不良结局。暴露组是被诊断患有特定癌症的患者，而未暴露组是没有特定癌症的患者。主要结局和指标使用Cochran-Mantel-Haenszel检验估计COVID-19感染风险的校正比值比（aOR）和95%CI。在纳入分析的7340万例患者中（53.6%为女性），2523920例患者至少诊断出13种常见癌症中的1种（所有癌症均在过去一年内或之前诊断），273140例患者近期患有癌症（癌症在过去一年内诊断）。在16570名确诊为COVID-19的患者中，1200人被诊断患有癌症，690人最近被诊断患有13种常见癌症中的至少一种。最近诊断出癌症的人感染COVID-19的风险显著增加（aOR，7.14 [95%CI，6.91-7.39]; P < .001），与近期诊断的白血病相关性最强（aOR，12.16 [95% CI，11.03-13.40]; P < .001），非霍奇金淋巴瘤（aOR，8.54 [95% CI，7.80-9.36]; P < .001），肺癌（aOR，7.66 [95% CI，7.07-8.29]; P < .001），甲状腺癌最弱（aOR，3.10 [95% CI，2.47-3.87]; P < .001）。在最近诊断出癌症的患者中，非洲裔美国人感染COVID-19的风险显著高于白色患者;这种种族差异在乳腺癌中最大（aOR，5.44 [95%CI，4.69-6.31]; P < .001），其次是前列腺癌（aOR，5.10 [95%CI，4.34-5.98]; P < .001），结直肠癌（aOR，3.30 [95%CI，2.55-4.26]; P < .001）和肺癌（aOR，2.53 [95%CI，2.10-3.06]; P < .001）。患有癌症和COVID-19的患者的结局（住院率，47.46%;死亡率，14.93%）显著差于患有COVID-19的非癌症患者（住院率，24.26%;死亡率，5.26%）（P < .001）和患有癌症的非COVID-19患者（住院率，12.39%;死亡率，4.03%）（P < .001）。结论和相关性在这项病例对照研究中，癌症患者感染COVID-19的风险显著增加，结果更糟，这在非洲裔美国人中进一步加剧。这些发现强调了保护和监测癌症患者的必要性，这是控制大流行战略的一部分。
This case-control study investigates how patients with specific types of cancer are at risk for coronavirus disease 2019 infection and its adverse outcomes and whether there are cancer-specific racial disparities for infection.Question Are patients with cancer at increased risk for coronavirus disease 2019 (COVID-19) infection and its adverse outcomes? Findings In this case-control analysis of electronic medical records from 73.4 million unique patients, patients with a recent diagnosis of cancer were at significantly increased risk for COVID-19 infection and its adverse outcomes, especially in African Americans. Meaning Based on these findings, it is important to closely monitor patients with cancer and protect them from exposure to severe acute respiratory syndrome coronavirus 2 and the severe outcomes of COVID-19.Importance Patients with specific cancers may be at higher risk than those without cancer for coronavirus disease 2019 (COVID-19) and its severe outcomes. At present, limited data are available on the risk, racial disparity, and outcomes for COVID-19 illness in patients with cancer. Objectives To investigate how patients with specific types of cancer are at risk for COVID-19 infection and its adverse outcomes and whether there are cancer-specific race disparities for COVID-19 infection. Design, Setting, and Participants This retrospective case-control analysis of patient electronic health records included 73.4 million patients from 360 hospitals and 317 000 clinicians across 50 US states to August 14, 2020. The odds of COVID-19 infections for 13 common cancer types and adverse outcomes were assessed. Exposures The exposure groups were patients diagnosed with a specific cancer, whereas the unexposed groups were patients without the specific cancer. Main Outcomes and Measures The adjusted odds ratio (aOR) and 95% CI were estimated using the Cochran-Mantel-Haenszel test for the risk of COVID-19 infection. Results Among the 73.4 million patients included in the analysis (53.6% female), 2 523 920 had at least 1 of the 13 common cancers diagnosed (all cancer diagnosed within or before the last year), and 273 140 had recent cancer (cancer diagnosed within the last year). Among 16 570 patients diagnosed with COVID-19, 1200 had a cancer diagnosis and 690 had a recent cancer diagnosis of at least 1 of the 13 common cancers. Those with recent cancer diagnosis were at significantly increased risk for COVID-19 infection (aOR, 7.14 [95% CI, 6.91-7.39]; P < .001), with the strongest association for recently diagnosed leukemia (aOR, 12.16 [95% CI, 11.03-13.40]; P < .001), non-Hodgkin lymphoma (aOR, 8.54 [95% CI, 7.80-9.36]; P < .001), and lung cancer (aOR, 7.66 [95% CI, 7.07-8.29]; P < .001) and weakest for thyroid cancer (aOR, 3.10 [95% CI, 2.47-3.87]; P < .001). Among patients with recent cancer diagnosis, African Americans had a significantly higher risk for COVID-19 infection than White patients; this racial disparity was largest for breast cancer (aOR, 5.44 [95% CI, 4.69-6.31]; P < .001), followed by prostate cancer (aOR, 5.10 [95% CI, 4.34-5.98]; P < .001), colorectal cancer (aOR, 3.30 [95% CI, 2.55-4.26]; P < .001), and lung cancer (aOR, 2.53 [95% CI, 2.10-3.06]; P < .001). Patients with cancer and COVID-19 had significantly worse outcomes (hospitalization, 47.46%; death, 14.93%) than patients with COVID-19 without cancer (hospitalization, 24.26%; death, 5.26%) (P < .001) and patients with cancer without COVID-19 (hospitalization, 12.39%; death, 4.03%) (P < .001). Conclusions and Relevance In this case-control study, patients with cancer were at significantly increased risk for COVID-19 infection and worse outcomes, which was further exacerbated among African Americans. These findings highlight the need to protect and monitor patients with cancer as part of the strategy to control the pandemic.