Incidence, clinical outcomes, and transmission dynamics of severe coronavirus disease 2019 in California and Washington: prospective cohort study
Incidence, clinical outcomes, and transmission dynamics of severe coronavirus disease 2019 in California and Washington: prospective cohort study
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DOI：
10.1136/bmj.m1923
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发表时间：
2020-05-22
影响因子：
105.7
通讯作者：
Bellows, Jim
中科院分区：
文献类型：
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作者：
Lewnard, Joseph A.;Liu, Vincent X.;Bellows, Jim
了解2019年严重冠状病毒病的流行病学和负担（covid-19）在美国西海岸的第一波流行期间。UGN前瞻性队列研究。设置Kaiser Permanente综合医疗保健提供系统服务于北方加州、南方加州、和华盛顿州。参与者在9596321名医疗保健计划参与者中，截至2020年4月22日，1840名因确诊的COVID-19首次急性入院。住院时间和临床结果分析包括截至2020年4月9日的1328人（北方加州534例，加州南部711例，华盛顿83例）。主要结局指标确诊新冠肺炎首次急性住院的累积发生率，以及随后入住重症监护病房（ICU）的概率和死亡率，以及住院时间和ICU停留时间。根据2020年4月22日的CRTSA，北方加州、南方加州和华盛顿的COVID-19首次急性住院累积发生率分别为15.6/10万队列成员、23.3/10万队列成员和14.7/10万队列成员。考虑到截至2020年4月9日入院的患者中不完整住院时间的删失，幸存者的估计中位住院时间为9. 3天（95%为0. 8至32. 9天），而非幸存者为12. 7天（1. 6至37. 7天）。男性患者入住ICU的删失校正概率为48.5%（95%置信区间为41.8%至56.3%），女性患者为32.0%（26.6%至38.4%）。对于需要重症监护的患者，ICU停留的中位时间为10.6天（95%的患者停留1.3至30.8天）。男性住院患者的删失校正病死率为23.5%（95%置信区间为19.6%至28.2%），女性住院患者为14.9%（11.8%至18.6%）;男性和女性患者的死亡风险均随年龄增加而增加。在研究期间，每个地区的R-E都有所减少。结论加州和华盛顿州参加Kaiser Permanente医疗计划的居民中，许多人因COVID-19入院，ICU入院、长期住院和死亡的概率都很高。随着社会距离干预措施的实施，新入院的发生率已经稳定或下降。
OBJECTIVETo understand the epidemiology and burden of severe coronavirus disease 2019 (covid-19) during the first epidemic wave on the west coast of the United States.DESIGNProspective cohort study.SETTINGKaiser Permanente integrated healthcare delivery systems serving populations in northern California, southern California, and Washington state.PARTICIPANTS1840 people with a first acute hospital admission for confirmed covid-19 by 22 April 2020, among 9596321 healthcare plan enrollees. Analyses of hospital length of stay and clinical outcomes included 1328 people admitted by 9 April 2020 (534 in northern California, 711 in southern California, and 83 in Washington).MAIN OUTCOME MEASURESCumulative incidence of first acute hospital admission for confirmed covid-19, and subsequent probabilities of admission to an intensive care unit (ICU) and mortality, as welt as duration of hospital stay and ICU stay. The effective reproduction number (R-E) describing transmission dynamics was estimated for each region.RESULTSAs of 22 April 2020, cumulative incidences of a first acute hospital admission for covid-19 were 15.6 per 100000 cohort members in northern California, 23.3 per 100000 in southern California, and 14.7 per 100000 in Washington. Accounting for censoring of incomplete hospital stays among those admitted by 9 April 2020, the estimated median duration of stay among survivors was 9.3 days (with 95% staying 0.8 to 32.9 days) and among non-survivors was 12.7 days (1.6 to 37.7 days). The censoring adjusted probability of ICU admission for male patients was 48.5% (95% confidence interval 41.8% to 56.3%) and for female patients was 32.0% (26.6% to 38.4%). For patients requiring critical care, the median duration of ICU stay was 10.6 days (with 95% staying 1.3 to 30.8 days). The censoring adjusted case fatality ratio was 23.5% (95% confidence interval 19.6% to 28.2%) among male inpatients and 14.9% (11.8% to 18.6%) among female inpatients; mortality risk increased with age for both male and female patients. Reductions in R-E were identified over the study period within each region.CONCLUSIONSAmong residents of California and Washington state enrolled in Kaiser Permanente healthcare plans who were admitted to hospital with covid-19, the probabilities of ICU admission, of long hospital stay, and of mortality were identified to be high. Incidence rates of new hospital admissions have stabilized or declined in conjunction with implementation of social distancing interventions.