A case-control and cohort study to determine the relationship between ethnic background and severe COVID-19.
A case-control and cohort study to determine the relationship between ethnic background and severe COVID-19.
复制标题
DOI：
10.1016/j.eclinm.2020.100574
复制
发表时间：
2020-11
影响因子：
15.1
通讯作者：
Shah AM
中科院分区：
文献类型：
--
作者：
Zakeri R;Bendayan R;Ashworth M;Bean DM;Dodhia H;Durbaba S;O'Gallagher K;Palmer C;Curcin V;Aitken E;Bernal W;Barker RD;Norton S;Gulliford M;Teo JTH;Galloway J;Dobson RJB;Shah AM
少数族裔背景的人可能会不成比例地受到严重的 COVID-19 的影响。这是否与感染风险增加、疾病进展更严重或院内生存率更差有关尚不清楚。合并症或社会经济剥夺对结果的种族模式的影响也不清楚。我们在内城区的初级和二级护理机构中进行了病例对照和队列研究，以研究种族背景是否会影响重症 COVID-19 入院风险和/或院内死亡率。将入院的确诊为 COVID-19 的内城区成年居民（n = 872 例）与从初级医疗保健数据库中随机抽取的 3,488 名匹配对照进行比较，该数据库包含居住在同一地区的 344,083 人。在队列研究中，我们研究了连续入院的 1827 名患有 COVID-19 的成年人。主要暴露变量是自定义的种族。根据社会人口统计和临床变量调整分析。 872 例患者中，48.1% 为黑人，33.7% 为白人，12.6% 为混血/其他人群，5.6% 为亚裔患者。在条件逻辑回归分析中，黑人和混血/其他种族的入院风险高于白人（OR 分别为 3.12 [95% CI 2.63–3.71] 和 2.97 [2.30–3.85]）。对合并症和剥夺的调整适度减弱了这种关联（黑人为 2.24 [1.83–2.74]，混合/其他为 2.70 [2.03–3.59]）。亚洲种族与较高的入院风险无关（调整后 OR 1.01 [0.70–1.46]）。在 1827 名患者的队列研究中，455 名患者 (28.9%) 在中位 (IQR) 为 8 (4-16) 天的时间内死亡。年龄和男性，而非黑人（调整后的 HR 1.06 [0.82–1.37]）或混血/其他种族（调整后的 HR 0.72 [0.47–1.10]）与院内死亡率相关。亚裔种族与较高的院内死亡率相关，但置信区间较大（调整后的 HR 1.71 [1.15–2.56]）。黑人和混血种族与 COVID-19 的较高入院风险独立相关，并且可能是发展为严重疾病的风险因素，但不影响院内死亡风险。合并症和社会经济因素只是部分原因，其他种族相关因素可能发挥重要作用。 COVID-19 对亚洲人的影响可能有所不同。英国心脏基金会；国家健康研究所；英国健康数据研究。
People of minority ethnic backgrounds may be disproportionately affected by severe COVID-19. Whether this relates to increased infection risk, more severe disease progression, or worse in-hospital survival is unknown. The contribution of comorbidities or socioeconomic deprivation to ethnic patterning of outcomes is also unclear. We conducted a case-control and a cohort study in an inner city primary and secondary care setting to examine whether ethnic background affects the risk of hospital admission with severe COVID-19 and/or in-hospital mortality. Inner city adult residents admitted to hospital with confirmed COVID-19 (n = 872 cases) were compared with 3,488 matched controls randomly sampled from a primary healthcare database comprising 344,083 people residing in the same region. For the cohort study, we studied 1827 adults consecutively admitted with COVID-19. The primary exposure variable was self-defined ethnicity. Analyses were adjusted for socio-demographic and clinical variables. The 872 cases comprised 48.1% Black, 33.7% White, 12.6% Mixed/Other and 5.6% Asian patients. In conditional logistic regression analyses, Black and Mixed/Other ethnicity were associated with higher admission risk than white (OR 3.12 [95% CI 2.63–3.71] and 2.97 [2.30–3.85] respectively). Adjustment for comorbidities and deprivation modestly attenuated the association (OR 2.24 [1.83–2.74] for Black, 2.70 [2.03–3.59] for Mixed/Other). Asian ethnicity was not associated with higher admission risk (adjusted OR 1.01 [0.70–1.46]). In the cohort study of 1827 patients, 455 (28.9%) died over a median (IQR) of 8 (4–16) days. Age and male sex, but not Black (adjusted HR 1.06 [0.82–1.37]) or Mixed/Other ethnicity (adjusted HR 0.72 [0.47–1.10]), were associated with in-hospital mortality. Asian ethnicity was associated with higher in-hospital mortality but with a large confidence interval (adjusted HR 1.71 [1.15–2.56]). Black and Mixed ethnicity are independently associated with greater admission risk with COVID-19 and may be risk factors for development of severe disease, but do not affect in-hospital mortality risk. Comorbidities and socioeconomic factors only partly account for this and additional ethnicity-related factors may play a large role. The impact of COVID-19 may be different in Asians. British Heart Foundation; the National Institute for Health Research; Health Data Research UK.
登录
查看更多内容
影响因子：
15.1
作者：
Leeds, John S.;Raviprakash, Veena;Leeds, Clare M.
通讯作者：
Leeds, Clare M.
DOI：
10.1136/bmj.i969
发表时间：
2016-02-25
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Pearce N
通讯作者：
Pearce N
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：
120.7
作者：
Brancati, FL;Kao, WHL;Szklo, M
通讯作者：
Szklo, M
影响因子：
64.5
作者：
Nedelec, Yohann;Sanz, Joaquin;Barreiro, Luis B.
通讯作者：
Barreiro, Luis B.