Excess mortality in the first COVID pandemic peak: cross-sectional analyses of the impact of age, sex, ethnicity, household size, and long-term conditions in people of known SARS-CoV-2 status in England.
Excess mortality in the first COVID pandemic peak: cross-sectional analyses of the impact of age, sex, ethnicity, household size, and long-term conditions in people of known SARS-CoV-2 status in England.
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DOI：
10.3399/bjgp20x713393
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发表时间：
2020-12
期刊：
影响因子：
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通讯作者：
de Lusignan S
中科院分区：
文献类型：
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作者：
Joy M;Hobbs FR;Bernal JL;Sherlock J;Amirthalingam G;McGagh D;Akinyemi O;Byford R;Dabrera G;Dorward J;Ellis J;Ferreira F;Jones N;Oke J;Okusi C;Nicholson BD;Ramsay M;Sheppard JP;Sinnathamby M;Zambon M;Howsam G;Williams J;de Lusignan S
SARS-CoV-2大流行在欧洲已经度过了第一个高峰期。描述英国的死亡率及其与SARS-CoV-2状态和其他人口统计学和风险因素的关系。对牛津RCGP研究和监测中心（RSC）哨兵网络中已知SARS-CoV-2状态的人进行横断面分析。从这个全国代表性网络的志愿全科医生成员上传了假名化、编码的临床数据（n = 4 413 734）。使用相对生存模型将全因死亡率与2019年的全国死亡率进行比较，报告相对风险比（RHR）和95%置信区间（CI）。对已知SARS-CoV-2状态的患者（n = 56 628，1.3%）进行多变量调整后比值比（OR）分析，包括多重插补和逆概率分析，以及完整的病例敏感性分析。死亡率在第16周达到峰值。居住在≥9岁家庭的人的相对死亡率增加了5倍（RHR = 5.1，95%CI = 4.87至5.31，P<0.0001）。以病毒学和临床诊断病例为例，以病毒学和临床诊断阴性者为参照，死亡OR分别为8.9（95% CI = 6.7 ~ 11.8，P<0.0001）和9.7（95% CI = 7.1 ~ 13.2，P<0.0001）。病毒学证实组的校正死亡率为18.1%（95% CI = 17.6 - 18.7）。男性、人口密度、黑人种族（与白色相比）和有长期疾病（包括学习障碍）的人（OR = 1.96，95%CI = 1.22至3.18，P = 0.0056）的死亡率更高。英国的第一个SARS-CoV-2高峰与死亡率过高有关。规划随后的高峰期需要更好地管理男性、黑人、老年人、有学习障碍的人和居住在多人住宅中的人的风险。
The SARS-CoV-2 pandemic has passed its first peak in Europe. To describe the mortality in England and its association with SARS-CoV-2 status and other demographic and risk factors. Cross-sectional analyses of people with known SARS-CoV-2 status in the Oxford RCGP Research and Surveillance Centre (RSC) sentinel network. Pseudonymised, coded clinical data were uploaded from volunteer general practice members of this nationally representative network (n = 4 413 734). All-cause mortality was compared with national rates for 2019, using a relative survival model, reporting relative hazard ratios (RHR), and 95% confidence intervals (CI). A multivariable adjusted odds ratios (OR) analysis was conducted for those with known SARS-CoV-2 status (n = 56 628, 1.3%) including multiple imputation and inverse probability analysis, and a complete cases sensitivity analysis. Mortality peaked in week 16. People living in households of ≥9 had a fivefold increase in relative mortality (RHR = 5.1, 95% CI = 4.87 to 5.31, P<0.0001). The ORs of mortality were 8.9 (95% CI = 6.7 to 11.8, P<0.0001) and 9.7 (95% CI = 7.1 to 13.2, P<0.0001) for virologically and clinically diagnosed cases respectively, using people with negative tests as reference. The adjusted mortality for the virologically confirmed group was 18.1% (95% CI = 17.6 to 18.7). Male sex, population density, black ethnicity (compared to white), and people with long-term conditions, including learning disability (OR = 1.96, 95% CI = 1.22 to 3.18, P = 0.0056) had higher odds of mortality. The first SARS-CoV-2 peak in England has been associated with excess mortality. Planning for subsequent peaks needs to better manage risk in males, those of black ethnicity, older people, people with learning disabilities, and people who live in multi-occupancy dwellings.