Prevalence of SARS-CoV-2 antibodies in a large nationwide sample of patients on dialysis in the USA: a cross-sectional study.
Prevalence of SARS-CoV-2 antibodies in a large nationwide sample of patients on dialysis in the USA: a cross-sectional study.
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DOI：
10.1016/s0140-6736(20)32009-2
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发表时间：
2020-10-24
期刊：
影响因子：
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通讯作者：
Chertow GM
中科院分区：
文献类型：
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作者：
Anand S;Montez-Rath M;Han J;Bozeman J;Kerschmann R;Beyer P;Parsonnet J;Chertow GM
在美国，许多接受透析的患者具有服务不足社区的社会经济特征，并每月接受常规实验室检测，有助于对严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)血清阳性率进行实用、公正和可重复的评估。在这项横断面研究中，我们与一个中心实验室合作，从美国各地约1,300家透析机构接收样本，我们使用SPEKE蛋白受体结合域总抗体化学发光分析法检测了2020年7月随机选择的28名 503名接受透析的成年患者的剩余血浆(100%敏感性，99.8%特异性)。我们从匿名的电子健康记录中提取了关于年龄、性别、种族和民族以及居住和设施邮政编码的数据，将患者级别的居住数据与每10万 000人口的累积和每日病例和死亡人数以及鼻拭子测试阳性率联系起来。我们根据美国总体透析和成人人口对患病率进行了标准化估计，并提出了对四个预先指定的阶层(年龄、性别、地区、种族和民族)的估计。抽样人群的年龄、性别、种族和民族分布与美国透析人口相似，老年人、男性以及居住在黑人和西班牙裔占多数的社区的人所占比例高于美国成年人口。SARS-CoV-2在样本中的血清阳性率为8.0%(95%可信区间为7·7~8·4)，标准化后为8.3%(8·0~8·6)，标准化后为9.3%(8·8~9·9)。对美国透析人群进行标准化后，西部的血清阳性率为3.5%(3.1-3.9%)，东北部为27.2%(25.928.5%)。比较每100000 人群的血清流行率和病例数，我们发现9.2%(8.7-9.8)的血清阳性患者被诊断出来。与SARS-CoV-2传播的其他指标相比，血清阳性与每100000 人口死亡的相关性最好(Spearman‘sρ=0.77)。非西班牙裔黑人和西班牙裔社区的居民与以非西班牙裔白人为主的社区居民相比，血清阳性的几率更高(优势比分别为3·9[95%CI 3·4-4·6]和2·3[1.9-2·6])。与人口密度最低的五分位数的居民相比，人口密度最高的五分位数社区居民的血清阳性几率(10·3[8·7-12·2])更高。县流动限制在2020年3月初减少了至少5%的工作场所访问，与减少不到5%相比，2020年7月血清阳性的几率较低(0·4[0·3-0·5])。在新冠肺炎大流行的第一波期间，只有不到10%的美国成年人形成了针对SARS-CoV-2的抗体，并且只有不到10%的人被诊断出有抗体。限制SARS-CoV-2传播的公共卫生努力需要特别针对种族和少数民族以及人口稠密的社区。阿森德临床实验室。
Many patients receiving dialysis in the USA share the socioeconomic characteristics of underserved communities, and undergo routine monthly laboratory testing, facilitating a practical, unbiased, and repeatable assessment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence. For this cross-sectional study, in partnership with a central laboratory that receives samples from approximately 1300 dialysis facilities across the USA, we tested the remainder plasma of 28 503 randomly selected adult patients receiving dialysis in July, 2020, using a spike protein receptor binding domain total antibody chemiluminescence assay (100% sensitivity, 99·8% specificity). We extracted data on age, sex, race and ethnicity, and residence and facility ZIP codes from the anonymised electronic health records, linking patient-level residence data with cumulative and daily cases and deaths per 100 000 population and with nasal swab test positivity rates. We standardised prevalence estimates according to the overall US dialysis and adult population, and present estimates for four prespecified strata (age, sex, region, and race and ethnicity). The sampled population had similar age, sex, and race and ethnicity distribution to the US dialysis population, with a higher proportion of older people, men, and people living in majority Black and Hispanic neighbourhoods than in the US adult population. Seroprevalence of SARS-CoV-2 was 8·0% (95% CI 7·7–8·4) in the sample, 8·3% (8·0–8·6) when standardised to the US dialysis population, and 9·3% (8·8–9·9) when standardised to the US adult population. When standardised to the US dialysis population, seroprevalence ranged from 3·5% (3·1–3·9) in the west to 27·2% (25·9–28·5) in the northeast. Comparing seroprevalent and case counts per 100 000 population, we found that 9·2% (8·7–9·8) of seropositive patients were diagnosed. When compared with other measures of SARS-CoV-2 spread, seroprevalence correlated best with deaths per 100 000 population (Spearman's ρ=0·77). Residents of non-Hispanic Black and Hispanic neighbourhoods experienced higher odds of seropositivity (odds ratio 3·9 [95% CI 3·4–4·6] and 2·3 [1·9–2·6], respectively) compared with residents of predominantly non-Hispanic white neighbourhoods. Residents of neighbourhoods in the highest population density quintile experienced increased odds of seropositivity (10·3 [8·7–12·2]) compared with residents of the lowest density quintile. County mobility restrictions that reduced workplace visits by at least 5% in early March, 2020, were associated with lower odds of seropositivity in July, 2020 (0·4 [0·3–0·5]) when compared with a reduction of less than 5%. During the first wave of the COVID-19 pandemic, fewer than 10% of the US adult population formed antibodies against SARS-CoV-2, and fewer than 10% of those with antibodies were diagnosed. Public health efforts to limit SARS-CoV-2 spread need to especially target racial and ethnic minority and densely populated communities. Ascend Clinical Laboratories.