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

BMJ, The - Trang m1923
Joseph A. Lewnard1,2,3, Vincent X. Liu4, Michael L. Jackson5, Mark A. Schmidt6, Britta L. Jewell7,8, Jean P. Flores9, Chris Jentz9, Graham R. Northrup1, Ayesha S. Mahmud10, Arthur Reingold2, Maya Petersen2, Nicholas P. Jewell11,2, Scott North9,12, Jim Bellows9
1Center for Computational Biology, College of Engineering, University of California, Berkeley, Berkeley, CA, USA
2Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA 94720, USA
3Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
4Division of Research, Kaiser Permanente, Oakland, CA, USA
5Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
6Center for Health Research, Kaiser Permanente Northwest, Portland, OR USA
7Department of Infectious Disease Epidemiology, Imperial College London, London, UK
8MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, UK
9The Care Management Institute, Kaiser Permanente, Oakland, California 94612
10Department of Demography, University of California, Berkeley, Berkeley, CA, USA
11Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
12The Permanente Federation, Kaiser Permanente, Oakland, CA, USA

Tóm tắt

AbstractObjectiveTo 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.DesignProspective cohort study.SettingKaiser Permanente integrated healthcare delivery systems serving populations in northern California, southern California, and Washington state.Participants1840 people with a first acute hospital admission for confirmed covid-19 by 22 April 2020, among 9 596 321 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 measuresCumulative 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.ResultsAs of 22 April 2020, cumulative incidences of a first acute hospital admission for covid-19 were 15.6 per 100 000 cohort members in northern California, 23.3 per 100 000 in southern California, and 14.7 per 100 000 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.ConclusionsAmong 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.

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