目的:Paxlovid可有效降低COVID-19的住院率和死亡率。这项研究描述了Paxlovid的使用情况,并评估了社区居住的成年人随着时间的推移种族/族裔差异,这些成年人有很高的进展为严重的COVID-19疾病的风险。
方法:这项回顾性队列研究使用了国家COVID队列协作(N3C)数据,包括2022年1月至2023年12月期间诊断为COVID-19的18岁或以上的个体。研究队列包括COVID-19进展高风险的非住院个体,并选择了每个季度的第一集COVID-19,包括再感染事件.Paxlovid的使用定义为在COVID-19诊断后±5天内接受Paxlovid。我们使用描述性统计数据来描述Paxlovid的总体使用以及日历季度和种族/种族。我们使用广义估计方程(GEE)模型来量化种族/种族与Paxlovid使用控制年龄的关联,性别,和临床特征。
结果:在1264215名处于疾病进展高风险的个体中(1404607次发作),Paxlovid的使用量从2022年1月至3月的1.2%增加到2023年10月至12月的35.1%。Paxlovid的使用在非西班牙裔白人患者(23.9%)比非西班牙裔黑人(16.5%)和Latinx/e(16.7%)患者更常见。调整年龄后,性别,和临床特征,与非西班牙裔白人患者相比,非西班牙裔黑人患者使用Paxlovid的可能性较小(比值比[OR]0.69,95%置信区间[CI]0.68-0.70)和Latinx/e(OR0.72,CI0.71-0.73)。
结论:在大型,不同的社区居住的COVID-19个体队列,近三分之二的合格个体没有接受Paxlovid,与非西班牙裔白人相比,少数民族/种族群体使用Paxlovid的可能性较小。
OBJECTIVE: Paxlovid is effective in reducing COVID-19 hospitalization and mortality. This study characterized Paxlovid use and evaluated racial/ethnic disparities over time among community-dwelling adults at high risk of progression to severe COVID-19 disease.
METHODS: This retrospective cohort study used the National COVID Cohort Collaborative (N3C) data and included individuals aged 18 years or older diagnosed with COVID-19 between January 2022 and December 2023. The study cohort included nonhospitalized individuals who were at high risk of COVID-19 progression, and selected the first COVID-19 episode in each quarter, including reinfection episodes. Paxlovid use was defined as receiving Paxlovid within ±5 days of a COVID-19 diagnosis. We used descriptive statistics to characterize Paxlovid use overall and by calendar quarter and race/ethnicity. We used a generalized estimating equations (GEE) models to quantify the association of race/ethnicity with Paxlovid use controlling for age, gender, and clinical characteristics.
RESULTS: Among 1 264 215 individuals at high risk of disease progression (1 404 607 episodes), Paxlovid use increased from 1.2% in January-March 2022 to 35.1% in October-December 2023. Paxlovid use was more common among non-Hispanic White individuals (23.9%) than non-Hispanic Black (16.5%) and Latinx/e (16.7%) patients. After adjusting age, gender, and clinical characteristics, Paxlovid use was less likely among non-Hispanic Black (odds ratio [OR] 0.69, 95% confidence interval [CI] 0.68-0.70) and Latinx/e (OR 0.72, CI 0.71-0.73) patients than non-Hispanic White patients.
CONCLUSIONS: Among a large, diverse cohort of community-dwelling individuals with COVID-19, nearly two out of three eligible individuals did not receive Paxlovid, and minoritized racial/ethnic groups were less likely to use Paxlovid than their non-Hispanic White individuals.