Understanding inequalities in COVID-19 outcomes following hospital admission for people with intellectual disability compared to the general population: a matched cohort study in the UK.
Understanding inequalities in COVID-19 outcomes following hospital admission for people with intellectual disability compared to the general population: a matched cohort study in the UK.
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DOI：
10.1136/bmjopen-2021-052482
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发表时间：
2021-10-04
期刊：
影响因子：
2.9
通讯作者：
Strydom A
中科院分区：
文献类型：
--
作者：
Baksh RA;Pape SE;Smith J;Strydom A
本研究探讨了在第一波大流行期间（当时对住院资源的需求很高）智力障碍 (ID) 患者与普通人群入院后的智障 (ID) 患者的住院历程（当时对住院资源的需求很高），以确定治疗和结果的差异。匹配队列研究；根据年龄、性别和种族，将 506 名 ID 患者与对照组按照 1:3 的比例进行匹配，以比较国际严重急性呼吸系统疾病和新发感染联盟 WHO 临床特征协议英国的结果。英国医院因 COVID-19 入院的情况；提取了有关症状、严重程度、获得干预措施、并发症、死亡率和住院时间的数据。无创呼吸支持、插管、气管切开术、通气和入住重症监护病房 (ICU)。在智力障碍患者中，味觉/嗅觉丧失等主观症状较少见，而意识改变和癫痫发作等更严重疾病的指标则更为常见。对照组的心血管危险因素、哮喘、风湿病和吸烟的比例较高。入院时的 ID 患者呼吸频率较高（中位数=22，范围=10-48），并且更有可能需要氧疗（35.1% vs 28.9%）。尽管如此，ID 患者在住院期间接受无创呼吸支持的可能性较小（37%（95%CI 13% 至 57%））、接受插管的可能性较小（40%（95%CI 7% 至 63%））、进入 ICU 的可能性较小（50%（95%CI 30% 至 66%））。与对照组相比，他们住院后死于 COVID-19 的风险增加了 56%（95%CI 17% 至 102%），并且死亡速度快 1.44 倍（95%CI 1.13 至 1.84）。在 COVID-19 大流行期间，智力障碍患者与普通人群之间的医疗保健存在显着差异，这可能导致该群体的死亡率过高。
This study explores the hospital journey of patients with intellectual disabilities (IDs) compared with the general population after admission for COVID-19 during the first wave of the pandemic (when demand on inpatient resources was high) to identify disparities in treatment and outcomes. Matched cohort study; an ID cohort of 506 patients were matched based on age, sex and ethnicity with a control group using a 1:3 ratio to compare outcomes from the International Severe Acute Respiratory and emerging Infections Consortium WHO Clinical Characterisation Protocol UK. Admissions for COVID-19 from UK hospitals; data on symptoms, severity, access to interventions, complications, mortality and length of stay were extracted. Non-invasive respiratory support, intubation, tracheostomy, ventilation and admission to intensive care units (ICU). Subjective presenting symptoms such as loss of taste/smell were less frequently reported in ID patients, whereas indicators of more severe disease such as altered consciousness and seizures were more common. Controls had higher rates of cardiovascular risk factors, asthma, rheumatological disorder and smoking. ID patients were admitted with higher respiratory rates (median=22, range=10–48) and were more likely to require oxygen therapy (35.1% vs 28.9%). Despite this, ID patients were 37% (95% CI 13% to 57%) less likely to receive non-invasive respiratory support, 40% (95% CI 7% to 63%) less likely to receive intubation and 50% (95% CI 30% to 66%) less likely to be admitted to the ICU while in hospital. They had a 56% (95% CI 17% to 102%) increased risk of dying from COVID-19 after they were hospitalised and were dying 1.44 times faster (95% CI 1.13 to 1.84) compared with controls. There have been significant disparities in healthcare between people with ID and the general population during the COVID-19 pandemic, which may have contributed to excess mortality in this group.
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影响因子：
5.3
作者：
Firth NC;Startin CM;Hithersay R;Hamburg S;Wijeratne PA;Mok KY;Hardy J;Alexander DC;LonDownS Consortium;Strydom A
通讯作者：
Strydom A
影响因子：
3.5
作者：
Illouz T;Biragyn A;Frenkel-Morgenstern M;Weissberg O;Gorohovski A;Merzon E;Green I;Iulita F;Flores-Aguilar L;Dierssen M;De Toma I;Lifshitz H;Antonarakis SE;Yu E;Herault Y;Potier MC;Botté A;Roper R;Sredni B;Sarid R;London J;Mobley W;Strydom A;Okun E
通讯作者：
Okun E
影响因子：
4.5
作者：
Landes, Scott D.;Turk, Margaret A.;Stevens, J. Dalton
通讯作者：
Stevens, J. Dalton
DOI：
10.1001/jama.2020.6775
发表时间：
2020-01-01
期刊：
JAMA, Journal of the American Medical Association
影响因子：
--
作者：
Richardson, Safiya;Hirsch, Jamie S.;,
通讯作者：
,
影响因子：
2.7
作者：
De Cauwer, Harald;Spaepen, Ann
通讯作者：
Spaepen, Ann