PDF(Pubmed)
Abstract：
BACKGROUND: Most analyses of excess mortality during the COVID-19 pandemic have employed aggregate data. Individual-level data from the largest integrated healthcare system in the US may enhance understanding of excess mortality.
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.
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.
摘要：
背景：对COVID-19大流行期间超额死亡率的大多数分析都采用了汇总数据。来自美国最大的综合医疗保健系统的个人水平数据可能会增强对超额死亡率的理解。
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。
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。
