■全球COVID-19大流行仍在持续,COVID-19年龄调整后病死率(CFRs)的跨国和跨期变化尚未明确。这里,我们旨在确定加强疫苗接种的国家特定影响和其他可能影响全球范围内年龄调整的CFR异质性的特征,并预测提高加强疫苗接种率对未来CFR的益处。
■使用最新可用的数据库,在32个国家/地区确定了CFR的跨时间和跨国家变化,具有多重特征(疫苗接种覆盖率,人口特征,疾病负担,行为风险,环境风险,健康服务和信任)使用极端梯度提升(XGBoost)算法和Shapley加法扩张(SHAP)。之后,确定了影响年龄调整后CFR的特定国家风险特征。通过在每个国家将加强疫苗接种增加1-30%来模拟加强对年龄调整后的CFR的益处。
从2020年2月4日至2022年1月31日,32个国家的COVID-19年龄调整后的CFR总体范围从每100,000例110例死亡到每100,000例5112例死亡,分别分为年龄调整后的CFR高于粗CFR的国家和年龄调整后的CFR低于粗CFR的国家(n=9和n=23)。从Alpha到Omicron期,加强疫苗接种对年龄调整后的CFR的影响变得更加重要(重要性评分:0.03-0.23)。Omicron周期模型表明,年龄调整后的CFR高于粗CFR的国家的关键风险因素是人均GDP低和加强疫苗接种率低,而年龄调整后CFR高于粗CFR的国家的关键风险因素是高饮食风险和低体力活动。将加强疫苗接种率提高7%将降低所有年龄调整后的CFRs高于粗CFRs的国家的CFRs。
■加强疫苗接种在降低年龄调整后的CFR方面仍然发挥着重要作用,尽管存在多层面的并发风险因素,但精确的联合干预策略和基于特定国家风险的准备工作也至关重要。
The global COVID-19 pandemic is still ongoing, and cross-country and cross-period variation in COVID-19 age-adjusted
case fatality rates (CFRs) has not been clarified. Here, we aimed to identify the country-specific effects of booster vaccination and other features that may affect heterogeneity in age-adjusted CFRs with a worldwide scope, and to predict the benefit of increasing booster vaccination rate on future CFR.
Cross-temporal and cross-country variations in CFR were identified in 32 countries using the latest available database, with multi-feature (vaccination coverage, demographic characteristics, disease burden, behavioral risks, environmental risks, health services and trust) using Extreme Gradient Boosting (XGBoost) algorithm and SHapley Additive exPlanations (SHAP). After that, country-specific risk features that affect age-adjusted CFRs were identified. The benefit of booster on age-adjusted CFR was simulated by increasing booster vaccination by 1-30% in each country.
Overall COVID-19 age-adjusted CFRs across 32 countries ranged from 110 deaths per 100,000 cases to 5,112 deaths per 100,000 cases from February 4, 2020 to Jan 31, 2022, which were divided into countries with age-adjusted CFRs higher than the crude CFRs and countries with age-adjusted CFRs lower than the crude CFRs (n = 9 and n = 23) when compared with the crude CFR. The effect of booster vaccination on age-adjusted CFRs becomes more important from Alpha to Omicron period (importance scores: 0.03-0.23). The Omicron period model showed that the key risk factors for countries with higher age-adjusted CFR than crude CFR are low GDP per capita and low booster vaccination rates, while the key risk factors for countries with higher age-adjusted CFR than crude CFR were high dietary risks and low physical activity. Increasing booster vaccination rates by 7% would reduce CFRs in all countries with age-adjusted CFRs higher than the crude CFRs.
Booster vaccination still plays an important role in reducing age-adjusted CFRs, while there are multidimensional concurrent risk factors and precise joint intervention strategies and preparations based on country-specific risks are also essential.