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美国加州大学伯克利分校Joseph A Lewnard团队对加州和华盛顿州covid-19的发病率、临床结局和传播动力学进行了分析。2020年5月22日，《英国医学杂志》发表了这一成果。

为了了解美国西海岸covid-19第一波流行的流行病学和负担，研究组在加利福尼亚州和华盛顿州进行了一项前瞻性队列研究。2020年4月22日，在9596321名医保计划参与者中，已经有1840人首次确诊了covid-19并入院。研究组对2020年4月9日住院的1328人（北加州534人，南加州711人，华盛顿州83人）的住院时间和临床结局进行分析。对每个地区描述传播动力学的有效繁殖数（RE）进行估计。

截至2020年4月22日，加州北部首次发生covid-19急诊入院的累计发病率为每10万名15.6例，南加州为23.3例，华盛顿州则高达104.7例。考虑到2020年4月9日收治的住院患者的不完整检查，研究组估计幸存者的平均住院时间为9.3天，非幸存者的平均住院时间为12.7天 。

男性患者被收入ICU的可能性为48.5％，女性患者为32.0％。需要重症监护的患者在ICU停留的中位时间为10.6天。男性住院患者校正后的病死率为23.5％，女性住院患者为14.9％。男性和女性患者的死亡风险都随着年龄的增长而增加。在研究期内，每个地区的RE均减少。

总之，加州和华盛顿州covid-19住院患者，入住ICU、长期住院和死亡的风险较高。但由于社交疏离的实施，新发病住院率已趋于稳定或下降。

附：英文原文

Title: Incidence, clinical outcomes, and transmission dynamics of severe coronavirus disease 2019 in California and Washington: prospective cohort study

Author: Joseph A Lewnard, Vincent X Liu, Michael L Jackson, Mark A Schmidt, Britta L Jewell, Jean P Flores, Chris Jentz, Graham R Northrup, Ayesha Mahmud, Arthur L Reingold, Maya Petersen, Nicholas P Jewell, Scott Young, Jim Bellows

Issue&Volume: 2020/05/22

Abstract: Objective To understand the epidemiology and burden of severe coronavirus disease 2019 (covid-19) during the first epidemic wave on the west coast of the United States.

Design Prospective cohort study.

Setting Kaiser Permanente integrated healthcare delivery systems serving populations in northern California, southern California, and Washington state.

Participants 1840 people with a first acute hospital admission for confirmed covid-19 by 22 April 2020, among 9596321 healthcare plan enrollees. Analyses of hospital length of stay and clinical outcomes included 1328 people admitted by 9 April 2020 (534 in northern California, 711 in southern California, and 83 in Washington).

Main outcome measures Cumulative incidence of first acute hospital admission for confirmed covid-19, and subsequent probabilities of admission to an intensive care unit (ICU) and mortality, as well as duration of hospital stay and ICU stay. The effective reproduction number (RE) describing transmission dynamics was estimated for each region.

Results As of 22 April 2020, cumulative incidences of a first acute hospital admission for covid-19 were 15.6 per 100000 cohort members in northern California, 23.3 per 100000 in southern California, and 14.7 per 100000 in Washington. Accounting for censoring of incomplete hospital stays among those admitted by 9 April 2020, the estimated median duration of stay among survivors was 9.3 days (with 95% staying 0.8 to 32.9 days) and among non-survivors was 12.7 days (1.6 to 37.7 days). The censoring adjusted probability of ICU admission for male patients was 48.5% (95% confidence interval 41.8% to 56.3%) and for female patients was 32.0% (26.6% to 38.4%). For patients requiring critical care, the median duration of ICU stay was 10.6 days (with 95% staying 1.3 to 30.8 days). The censoring adjusted case fatality ratio was 23.5% (95% confidence interval 19.6% to 28.2%) among male inpatients and 14.9% (11.8% to 18.6%) among female inpatients; mortality risk increased with age for both male and female patients. Reductions in RE were identified over the study period within each region.

Conclusions Among residents of California and Washington state enrolled in Kaiser Permanente healthcare plans who were admitted to hospital with covid-19, the probabilities of ICU admission, of long hospital stay, and of mortality were identified to be high. Incidence rates of new hospital admissions have stabilized or declined in conjunction with implementation of social distancing interventions.

DOI: 10.1136/bmj.m1923

Source: https://www.bmj.com/content/369/bmj.m1923

BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
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