METHODS: We performed an observational cohort study following patients receiving care from the Department of Veterans Affairs (VA) between 1 March 2018 and 28 February 2022. We estimated excess mortality on an absolute scale (i.e. excess mortality rates, number of excess deaths) and a relative scale by measuring the hazard ratio (HR) for mortality comparing pandemic and pre-pandemic periods, overall and within demographic and clinical subgroups. Comorbidity burden and frailty were measured using the Charlson Comorbidity Index and Veterans Aging Cohort Study Index, respectively.
RESULTS: Of 5 905 747 patients, the median age was 65.8 years and 91% were men. Overall, the excess mortality rate was 10.0 deaths/1000 person-years (PY), with a total of 103 164 excess deaths and pandemic HR of 1.25 (95% CI 1.25-1.26). Excess mortality rates were highest among the most frail patients (52.0/1000 PY) and those with the highest comorbidity burden (16.3/1000 PY). However, the largest relative mortality increases were observed among the least frail (HR 1.31, 95% CI 1.30-1.32) and those with the lowest comorbidity burden (HR 1.44, 95% CI 1.43-1.46).
CONCLUSIONS: Individual-level data offered crucial clinical and operational insights into US excess mortality patterns during the COVID-19 pandemic. Notable differences emerged among clinical risk groups, emphasizing the need for reporting excess mortality in both absolute and relative terms to inform resource allocation in future outbreaks.
方法:我们在2018年3月1日至2022年2月28日接受退伍军人事务部(VA)护理的患者后进行了一项观察性队列研究。我们以绝对规模估计超额死亡率(即超额死亡率,超额死亡人数)和通过比较大流行和大流行前时期的死亡率危险比(HR)来衡量相对比例,总体上以及在人口统计学和临床亚组内。使用Charlson合并症指数和退伍军人老化队列研究指数测量合并症负担和虚弱,分别。
结果:在5905747名患者中,中位年龄为65.8岁,91%为男性.总的来说,超额死亡率为10.0例死亡/1000人年(PY),共有103164例超额死亡,大流行HR为1.25(95%CI1.25-1.26)。在最虚弱的患者(52.0/1000PY)和共病负担最高的患者(16.3/1000PY)中,超额死亡率最高。然而,在最不虚弱的人群(HR1.31,95%CI1.30-1.32)和合并症负担最低的人群(HR1.44,95%CI1.43-1.46)中观察到最大的相对死亡率增加.
结论:个人水平的数据为COVID-19大流行期间美国的超额死亡率模式提供了重要的临床和操作见解。临床风险组之间出现了显著差异,强调有必要报告绝对和相对的超额死亡率,以便为未来疫情的资源分配提供信息。