Rapid Epidemiological Analysis of Comorbidities and Treatments as risk factors for COVID-19 in Scotland (REACT-SCOT): A population-based case-control study.
Rapid Epidemiological Analysis of Comorbidities and Treatments as risk factors for COVID-19 in Scotland (REACT-SCOT): A population-based case-control study.
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DOI：
10.1371/journal.pmed.1003374
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发表时间：
2020-10
期刊：
影响因子：
15.8
通讯作者：
Public Health Scotland COVID-19 Health Protection Study Group
中科院分区：
文献类型：
--
作者：
McKeigue PM;Weir A;Bishop J;McGurnaghan SJ;Kennedy S;McAllister D;Robertson C;Wood R;Lone N;Murray J;Caparrotta TM;Smith-Palmer A;Goldberg D;McMenamin J;Ramsay C;Hutchinson S;Colhoun HM;Public Health Scotland COVID-19 Health Protection Study Group
本研究的目的是确定2019年严重冠状病毒病（COVID-19）的风险因素，并根据人口统计数据和健康记录为风险分层奠定基础。研究设计为配对病例对照研究。严重COVID-19定义为国家数据库中严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）核酸检测阳性，随后进入重症监护室或在28天内死亡，或死亡证明以COVID-19为根本原因。从国家人口登记册中选择性别、年龄和初级保健实践相匹配的每个病例最多10个对照。根据截至2020年6月6日的阳性检测结果，截至2020年6月14日的重症监护和截至2020年6月14日的死亡登记，有36，948例对照和4，272例病例，其中1，894例（44%）是护理院居民。提取了过去5年住院记录中的所有诊断代码和过去240天内处方中的所有药物代码。通过条件logistic回归估计重度COVID-19的比率。在使用全国人口的年龄-性别分布的逻辑回归中，年龄增加10岁的严重疾病的优势比为2.87，男性为1.63。在病例对照分析中，最强的风险因素是居住在养老院，率比为21.4（95% CI 19.1-23.9，p = 8 × 10−644）。公共卫生机构列出的高风险疾病的单变量率比为2.75（95% CI 1.96-3.88，p = 6 × 10−9）1型糖尿病，1.60（95% CI 1.48-1.74，p = 8 × 10−30）2型糖尿病，1.49（95% CI 1.37-1.61，p = 3 × 10−21）缺血性心脏病，2.23（95% CI 2.08-2.39，p = 4 × 10−109）其他心脏病，1.96（95% CI 1.83-2.10，p = 2 × 10−78）慢性下呼吸道疾病，4.06（95% CI 3.15-5.23，p = 3 × 10−27）慢性肾脏疾病，5.4（95% CI 4.9-5.8，p = 1 × 10−354）对于神经系统疾病，3.61（95% CI 2.60-5.00，p = 2 × 10−14），免疫缺陷或抑制为2.66（95% CI 1.86-3.79，p = 7 × 10−8）。78%的病例和52%的对照至少有一种列出的疾病（51%的病例和11%的对照年龄在40岁以下）。重度疾病与过去9个月内至少一次处方兑现和过去5年内至少一次住院相关（率比分别为3. 10 [95% CI 2. 59 - 3. 71]和2. 75 [95% CI 2. 53 - 2. 99]），即使在调整了列出的疾病后。在那些没有列出的条件下，在许多医院诊断和药物类别中观察到与严重疾病的显着关联。年龄和性别为歧视提供了2.58位信息。基于人口统计学变量、列出的条件、医院诊断和处方的模型提供了额外的1.07位（C统计量0.804）。这项研究的一个局限性是没有初级保健的记录。我们已经证明，沿着年龄较大和男性，重度COVID-19与所有年龄组的既往病史密切相关。公共卫生机构指定的风险条件之外的许多合并症对此有贡献。风险分类器使用健康记录中可用的所有信息，而不是仅使用有限的一组条件，将更准确地区分低风险和高风险个体，这些个体可能需要防护，直到流行病结束。Paul McKeigue及其同事研究了合并症和药物治疗作为苏格兰严重COVID-19的风险因素。大多数感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的人不会患重病：严重或致命疾病的风险与年龄较大，男性和公共卫生机构指定的疾病有关，包括哮喘，糖尿病和心脏病。到目前为止，报告的研究主要集中在这些“列出的条件”上，但尚未系统地检查医疗记录，以确定2019年严重冠状病毒病（COVID-19）的可能风险因素。本研究的目的是确定严重COVID-19的风险因素，并为基于电子健康记录的风险分层奠定基础。利用苏格兰连接电子健康记录的能力，我们报告了第一项关于严重或致命的COVID-19与先前存在的健康状况和其他风险因素之间关系的系统研究。护理院的居民患严重疾病的可能性是同龄和性别的人的21倍，而不是住在护理院。与风险增加相关的疾病不仅包括那些已经被公共卫生机构指定的疾病哮喘、糖尿病、心脏病、致残性神经系统疾病、肾脏疾病，还包括其他与虚弱和健康状况不佳相关的疾病，如中风和福尔斯跌倒史。在没有任何列出的条件下，使用作用于消化系统或神经系统的处方药与严重COVID-19的风险增加有关。没有任何近期住院史或使用处方药的年轻人的风险非常低。这项研究为基于人口中每个人的电子健康记录计算风险评分奠定了基础，并使用它来建议那些处于严重疾病高风险的人在当地发生COVID-19疫情时保护自己。
The objectives of this study were to identify risk factors for severe coronavirus disease 2019 (COVID-19) and to lay the basis for risk stratification based on demographic data and health records. The design was a matched case-control study. Severe COVID-19 was defined as either a positive nucleic acid test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the national database followed by entry to a critical care unit or death within 28 days or a death certificate with COVID-19 as underlying cause. Up to 10 controls per case matched for sex, age, and primary care practice were selected from the national population register. For this analysis—based on ascertainment of positive test results up to 6 June 2020, entry to critical care up to 14 June 2020, and deaths registered up to 14 June 2020—there were 36,948 controls and 4,272 cases, of which 1,894 (44%) were care home residents. All diagnostic codes from the past 5 years of hospitalisation records and all drug codes from prescriptions dispensed during the past 240 days were extracted. Rate ratios for severe COVID-19 were estimated by conditional logistic regression. In a logistic regression using the age-sex distribution of the national population, the odds ratios for severe disease were 2.87 for a 10-year increase in age and 1.63 for male sex. In the case-control analysis, the strongest risk factor was residence in a care home, with rate ratio 21.4 (95% CI 19.1–23.9, p = 8 × 10−644). Univariate rate ratios for conditions listed by public health agencies as conferring high risk were 2.75 (95% CI 1.96–3.88, p = 6 × 10−9) for type 1 diabetes, 1.60 (95% CI 1.48–1.74, p = 8 × 10−30) for type 2 diabetes, 1.49 (95% CI 1.37–1.61, p = 3 × 10−21) for ischemic heart disease, 2.23 (95% CI 2.08–2.39, p = 4 × 10−109) for other heart disease, 1.96 (95% CI 1.83–2.10, p = 2 × 10−78) for chronic lower respiratory tract disease, 4.06 (95% CI 3.15–5.23, p = 3 × 10−27) for chronic kidney disease, 5.4 (95% CI 4.9–5.8, p = 1 × 10−354) for neurological disease, 3.61 (95% CI 2.60–5.00, p = 2 × 10−14) for chronic liver disease, and 2.66 (95% CI 1.86–3.79, p = 7 × 10−8) for immune deficiency or suppression. Seventy-eight percent of cases and 52% of controls had at least one listed condition (51% of cases and 11% of controls under age 40). Severe disease was associated with encashment of at least one prescription in the past 9 months and with at least one hospital admission in the past 5 years (rate ratios 3.10 [95% CI 2.59–3.71] and 2.75 [95% CI 2.53–2.99], respectively) even after adjusting for the listed conditions. In those without listed conditions, significant associations with severe disease were seen across many hospital diagnoses and drug categories. Age and sex provided 2.58 bits of information for discrimination. A model based on demographic variables, listed conditions, hospital diagnoses, and prescriptions provided an additional 1.07 bits (C-statistic 0.804). A limitation of this study is that records from primary care were not available. We have shown that, along with older age and male sex, severe COVID-19 is strongly associated with past medical history across all age groups. Many comorbidities beyond the risk conditions designated by public health agencies contribute to this. A risk classifier that uses all the information available in health records, rather than only a limited set of conditions, will more accurately discriminate between low-risk and high-risk individuals who may require shielding until the epidemic is over. Paul McKeigue and co-workers study comorbidities and medical treatments as risk factors for severe COVID-19 in Scotland. Most people infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) do not become seriously ill: risk of severe or fatal disease is associated with older age, male sex, and conditions designated by public health agencies, including asthma, diabetes, and heart disease. Studies reported so far have focused on these “listed conditions” but have not examined medical records systematically to identify possible risk factors for severe coronavirus disease 2019 (COVID-19). The objectives of this study were to identify risk factors for severe COVID-19 and to lay the basis for risk stratification based on electronic health records. Using Scotland’s capability for linking electronic health records, we report the first systematic study of the relationship of severe or fatal COVID-19 to preexisting health conditions and other risk factors. Residents in care homes were 21 times more likely to develop severe disease than people of the same age and sex not living in care homes. The conditions associated with increased risk include not only those already designated by public health agencies—asthma, diabetes, heart disease, disabling neurological disease, kidney disease—but other diagnoses that are associated with frailty and poor health such as strokes and a history of falls. In those without any listed conditions, use of prescribed drugs acting on the digestive system or nervous system is associated with increased risk of severe COVID-19. The risk to younger individuals without any recent history of hospital admission or use of prescription drugs is very low. This study lays a basis for calculating a risk score based on electronic health records for every individual in the population and using it to advise those at high risk of severe disease to shield themselves when there is a COVID-19 epidemic in their locality.
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