Association Between Statewide School Closure and COVID-19 Incidence and Mortality in the US
Association Between Statewide School Closure and COVID-19 Incidence and Mortality in the US
复制标题
DOI：
10.1001/jama.2020.14348
复制
发表时间：
2020-09-01
影响因子：
120.7
通讯作者：
Thomson, Joanna E.
中科院分区：
文献类型：
--
作者：
Auger, Katherine A.;Shah, Samir S.;Thomson, Joanna E.
这项人口流行病学研究估计了美国学校关闭的关联以及2020年3月关闭学校的时间与2019年每日冠状病毒疾病的变化（COVID-19）的发病率和死亡率，占同期其他公共卫生干预措施的比例。重要性在美国，各州颁布了非药物干预措施，包括关闭学校，减少2019冠状病毒病（COVID-19）的传播。所有50个州都在2020年3月关闭了学校，尽管不确定学校关闭是否有效。目的确定学校关闭及其时间是否与COVID-19发病率和死亡率下降相关。设计、设置和参与者是一项在2020年3月9日至2020年5月7日期间进行的基于美国人群的观察性研究，使用中断时间序列分析，其中包含滞后期，以允许发生潜在的政策相关变化。为了隔离学校关闭与结果的关联，将州一级的非药物干预措施和属性纳入负二项回归模型。根据学校关闭时每10万居民的州级COVID-19累积发病率，对各州进行了四分位数检查。使用模型得出关闭学校和继续开放学校之间的估计绝对差异，以及当COVID-19的累积发病率处于最低四分位数与最高四分位数相比时，如果各州关闭学校，病例和死亡人数。中小学关闭。主要成果和措施COVID-19每日每10万居民发病率和死亡率。结果学校关闭时各州COVID-19累计发病率范围为每10万人口0至14. 75例。学校关闭与COVID-19的发病率（每周调整的相对变化，-62% [95%CI，-71%至-49%]）和死亡率（每周调整的相对变化，-58% [95%CI，-68%至-46%]）显著下降相关。这两种关联在学校关闭时COVID-19累积发病率较低的州最大。例如，COVID-19发病率最低的州的发病率相对变化为-72%（95%CI，-79%至-62%），而累积发病率最高的州的发病率相对变化为-49%（95%CI，-62%至-33%）。在这项分析得出的模型中，估计当COVID-19累积发病率处于最低四分位数与最高四分位数相比时，关闭学校将使26天内每100000人的病例减少128.7例，并使每100000人的死亡人数减少1.5人。16天。2020年3月9日至2020年5月7日期间，美国学校关闭与COVID-19发病率和死亡率下降存在时间相关性;在COVID-19累计发病率较低时，较早关闭学校的州的发病率和死亡率相对下降幅度最大。然而，仍然有可能的是，一些减少可能与其他并发的非药物干预有关。问题全州范围内的学校关闭是否与2019冠状病毒病（COVID-19）的发病率和死亡率下降有关？在2020年3月9日至2020年5月7日期间进行的这项基于美国人口的时间序列分析中，学校关闭与COVID-19发病率（每周调整的相对变化，-62%）和死亡率（每周调整的相对变化，-58%）的显著下降相关。在从该分析得出的模型中，据估计，当COVID-19的累积发病率与最高四分位数相比处于最低四分位数时，关闭学校与26天内每10万人口减少128.7例病例和16天内每10万人口减少1.5例死亡相关。全州学校关闭与COVID-19发病率和死亡率降低之间存在时间关联，尽管其中一些减少可能与其他并发的非药物干预有关。
This population epidemiology study estimates associations of school closures in the US and the timing of those closures in March 2020 with change in daily coronavirus disease 2019 (COVID-19) incidence and mortality through the first week of May, accounting for other contemporaneous public health interventions.Importance In the US, states enacted nonpharmaceutical interventions, including school closure, to reduce the spread of coronavirus disease 2019 (COVID-19). All 50 states closed schools in March 2020 despite uncertainty if school closure would be effective. Objective To determine if school closure and its timing were associated with decreased COVID-19 incidence and mortality. Design, Setting, and Participants US population-based observational study conducted between March 9, 2020, and May 7, 2020, using interrupted time series analyses incorporating a lag period to allow for potential policy-associated changes to occur. To isolate the association of school closure with outcomes, state-level nonpharmaceutical interventions and attributes were included in negative binomial regression models. States were examined in quartiles based on state-level COVID-19 cumulative incidence per 100000 residents at the time of school closure. Models were used to derive the estimated absolute differences between schools that closed and schools that remained open as well as the number of cases and deaths if states had closed schools when the cumulative incidence of COVID-19 was in the lowest quartile compared with the highest quartile. Exposures Closure of primary and secondary schools. Main Outcomes and Measures COVID-19 daily incidence and mortality per 100000 residents. Results COVID-19 cumulative incidence in states at the time of school closure ranged from 0 to 14.75 cases per 100000 population. School closure was associated with a significant decline in the incidence of COVID-19 (adjusted relative change per week, -62% [95% CI, -71% to -49%]) and mortality (adjusted relative change per week, -58% [95% CI, -68% to -46%]). Both of these associations were largest in states with low cumulative incidence of COVID-19 at the time of school closure. For example, states with the lowest incidence of COVID-19 had a -72% (95% CI, -79% to -62%) relative change in incidence compared with -49% (95% CI, -62% to -33%) for those states with the highest cumulative incidence. In a model derived from this analysis, it was estimated that closing schools when the cumulative incidence of COVID-19 was in the lowest quartile compared with the highest quartile was associated with 128.7 fewer cases per 100000 population over 26 days and with 1.5 fewer deaths per 100000 population over 16 days. Conclusions and Relevance Between March 9, 2020, and May 7, 2020, school closure in the US was temporally associated with decreased COVID-19 incidence and mortality; states that closed schools earlier, when cumulative incidence of COVID-19 was low, had the largest relative reduction in incidence and mortality. However, it remains possible that some of the reduction may have been related to other concurrent nonpharmaceutical interventions.Question Was statewide school closure associated with decreased incidence and mortality for coronavirus disease 2019 (COVID-19)? Findings In this US population-based time series analysis conducted between March 9, 2020, and May 7, 2020, school closure was associated with a significant decline in both incidence of COVID-19 (adjusted relative change per week, -62%) and mortality (adjusted relative change per week, -58%). In a model derived from this analysis, it was estimated that closing schools when the cumulative incidence of COVID-19 was in the lowest quartile compared with the highest quartile was associated with 128.7 fewer cases per 100000 population over 26 days and with 1.5 fewer deaths per 100000 population over 16 days. Meaning There was a temporal association between statewide school closure and lower COVID-19 incidence and mortality, although some of the reductions may have been related to other concurrent nonpharmaceutical interventions.