COVID-19 admission risk tools should include multiethnic age structures, multimorbidity and deprivation metrics for air pollution, household overcrowding, housing quality and adult skills.
COVID-19 admission risk tools should include multiethnic age structures, multimorbidity and deprivation metrics for air pollution, household overcrowding, housing quality and adult skills.
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DOI：
10.1136/bmjresp-2021-000951
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发表时间：
2021-08
影响因子：
4.1
通讯作者：
Thickett DR
中科院分区：
文献类型：
--
作者：
Soltan MA;Varney J;Sutton B;Melville CR;Lugg ST;Parekh D;Carroll W;Dosanjh DP;Thickett DR
少数民族占英国人口的14%，但在COVID-19危重患者中占34%。在国际上，研究人员呼吁进行研究，了解恶化的风险因素，为临床风险工具的开发提供信息。对住院的COVID-19患者（n=3671）进行多中心队列研究，探讨按种族划分的健康决定因素，包括多重剥夺指数（IMD）子域，作为表现、恶化和死亡的危险因素。根据种族和计算的曲线下面积（AUC）绘制CURB65和ISARIC4C的接收算子特征。与年龄、性别和贫困相匹配的对照组相比，少数民族住院时的查尔森合并症得分更高，并且至少有一个IMD子领域最贫困的五分之一：室内生活环境（LE）、室外LE、成人技能、更大的住房和服务障碍。这些剥夺形式中最剥夺的五分之一的入院与多叶性肺炎的出现和ICU入院有关。CURB65或ISARIC4C在除印度患者ISARIC4C外的任何种族的AUC均未超过0.7 （0.83,95% CI 0.73至0.93）。以肺炎和低CURB65（0-1）表现的少数民族患者的死亡率高于白人患者（22.6% vs 9.4%, p<0.001）；非洲人的风险最高（38.5%,p=0.006），其次是加勒比人（26.7%,p=0.008），印度人（23.1%,p=0.007）和巴基斯坦人（21.2%,p=0.004）。少数民族表现出更高的多病发病率，尽管其年龄结构较年轻，暴露在肥胖和贫困等未评分的风险因素中比例过高。家庭过度拥挤、空气污染、住房质量和成人技能剥夺与多叶性肺炎有关，这些都是死亡危险因素。风险工具需要反映主要影响少数民族的风险。
Ethnic minorities account for 34% of critically ill patients with COVID-19 despite constituting 14% of the UK population. Internationally, researchers have called for studies to understand deterioration risk factors to inform clinical risk tool development. Multicentre cohort study of hospitalised patients with COVID-19 (n=3671) exploring determinants of health, including Index of Multiple Deprivation (IMD) subdomains, as risk factors for presentation, deterioration and mortality by ethnicity. Receiver operator characteristics were plotted for CURB65 and ISARIC4C by ethnicity and area under the curve (AUC) calculated. Ethnic minorities were hospitalised with higher Charlson Comorbidity Scores than age, sex and deprivation matched controls and from the most deprived quintile of at least one IMD subdomain: indoor living environment (LE), outdoor LE, adult skills, wider barriers to housing and services. Admission from the most deprived quintile of these deprivation forms was associated with multilobar pneumonia on presentation and ICU admission. AUC did not exceed 0.7 for CURB65 or ISARIC4C among any ethnicity except ISARIC4C among Indian patients (0.83, 95% CI 0.73 to 0.93). Ethnic minorities presenting with pneumonia and low CURB65 (0–1) had higher mortality than White patients (22.6% vs 9.4%; p<0.001); Africans were at highest risk (38.5%; p=0.006), followed by Caribbean (26.7%; p=0.008), Indian (23.1%; p=0.007) and Pakistani (21.2%; p=0.004). Ethnic minorities exhibit higher multimorbidity despite younger age structures and disproportionate exposure to unscored risk factors including obesity and deprivation. Household overcrowding, air pollution, housing quality and adult skills deprivation are associated with multilobar pneumonia on presentation and ICU admission which are mortality risk factors. Risk tools need to reflect risks predominantly affecting ethnic minorities.
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影响因子：
4.4
作者：
Raisi-Estabragh, Zahra;McCracken, Celeste;Petersen, Steffen E.
通讯作者：
Petersen, Steffen E.
影响因子：
10
作者：
Lim, WS;van der Eerden, MM;Macfarlane, JT
通讯作者：
Macfarlane, JT
影响因子：
10.8
作者：
Pozzer A;Dominici F;Haines A;Witt C;Münzel T;Lelieveld J
通讯作者：
Lelieveld J
DOI：
10.1016/s2213-2600(20)30559-2
发表时间：
2021-04
期刊：
The Lancet. Respiratory medicine
影响因子：
--
作者：
Gupta RK;Harrison EM;Ho A;Docherty AB;Knight SR;van Smeden M;Abubakar I;Lipman M;Quartagno M;Pius R;Buchan I;Carson G;Drake TM;Dunning J;Fairfield CJ;Gamble C;Green CA;Halpin S;Hardwick HE;Holden KA;Horby PW;Jackson C;Mclean KA;Merson L;Nguyen-Van-Tam JS;Norman L;Olliaro PL;Pritchard MG;Russell CD;Scott-Brown J;Shaw CA;Sheikh A;Solomon T;Sudlow C;Swann OV;Turtle L;Openshaw PJM;Baillie JK;Semple MG;Noursadeghi M;ISARIC4C Investigators
通讯作者：
ISARIC4C Investigators
DOI：
10.1136/sbmj.i6718
发表时间：
2017-01-27
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Soltan, Marina;Westacott, Rachel
通讯作者：
Westacott, Rachel