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BMJ发表中国疾控大规模研究,疫情初期武汉死亡率较预期增加56%!

2021-03-02 K.K MedSci原创

每一个超额死亡数字背后都是一个生命。

2月24日,由中国疾控中心和湖北省疾控中心、武汉市疾控中心以及英国牛津大学研究人员共同合作,共同在《英国医学杂志》(BMJ)发表重要论文。团队通过全国超3亿人代表性数据,评估了新冠疫情当初在中国爆发的三个月里,武汉和中国其他地区的多种原因的超额死亡。“超额死亡”是一个经常被用来评估异常事件影响的指标,它计算了比预期平均水平多出多少死亡人数。

团队分析了2020年1月1日至3月31日期间中国官方死亡登记报告系统的数据,并将其与既往5年同期的数据进行了比较,期待能够对各国政府制定相关防控措施和疫苗接种策略提供参考。

 

Zhang Lan, et al., (2021). Excess mortality in Wuhan city and other parts of China during the three months of the covid-19 outbreak: findings from nationwide mortality registries. BMJ, DOI: https://doi.org/10.1136/bmj.n415

在所有605个监测地区,2020年1月-3月共记录到580819例死亡。在武汉3个DSP地区(疾病监测站),全因死亡率比预测的死亡率高56%(每10万例有1147例死亡vs预测死亡735例)。 相比预测,实际由肺炎导致的死亡人数增加了8倍以上(275 vs 33每10万例),包括新冠肺炎和不明病毒性肺炎等。就新冠肺炎而言,大部分超额死亡病例发生在2020年2月中旬之前。

2020年1月1日~3月31日期间,与2019年相比,中国武汉市不同地区每周因各种原因、肺炎和其他疾病造成的住院和非住院死亡率的趋势。橙色虚线表示2020年观察到的死亡率,蓝色实线表示2019年观察到的死亡率

Zhang Lan, et al., (2021). Excess mortality in Wuhan city and other parts of China during the three months of the covid-19 outbreak: findings from nationwide mortality registries. BMJ, DOI: https://doi.org/10.1136/bmj.n415

非传染性疾病的死亡率增加,高出预估92%

除肺炎外,某些非传染性疾病的死亡率也有所增加,包括血管疾病和糖尿病等。在因伤致死方面,观察到的死亡率比预测的死亡率低了16%,其中,道路交通事故的死亡率较低,自杀和跌倒的死亡率较高。如果将其他疾病的死亡情况汇总,实际死亡率高出预测的92%(共263例;46 VS 24每10万人)。但是,如果将2020年的死亡率与2015-19年的平均死亡率比较,结果大致相似,但略高一些。

除开湖北省,虽然与新冠肺炎(133例)以及不明病毒性肺炎造成的死亡人数过多,但实际所有类型的肺炎死亡率比预估的死亡率低28%,主要是由于非病毒性肺炎的死亡率较低。在其他方面,道路交通事故死亡率明显低于预测,而自杀死亡率则明显高于预测。

观察到的总死亡率比预测的死亡率低6%(每10万人中675人vs 715人)。少数特定疾病(慢性阻塞性肺疾病和道路交通事故)观察到的死亡率明显低于预估。

在武汉DSP地区,除了肺炎死亡人数先快速上升后快速下降外,心肌梗死、缺血性脑卒中、慢性阻塞性肺病和糖尿病死亡人数也有一定上升,上升幅度较小。

在湖北其他地区,2020年1-3月期间,除了慢性阻塞性肺病和道路交通事故死亡率在封锁期间较低外,观察到的周死亡率与预测的周死亡率没有明显差异。然而,在中国其他地区,在2020年第一季度肺炎的周死亡率始终低于2015-19年的平均死亡率。

不同年龄,死亡率趋势不同

在武汉DSP 地区,50岁或以上人群的总死亡率呈上升趋势,这不仅是由肺炎引起的,也是由其他疾病引起的。武汉市老年人死于covid-19和其他肺病的超额死亡人数明显多于年轻人。

除湖北以外地区,80岁或以上人群的周肺炎死亡率降低,而80岁以下人群的死亡率增幅较小、50岁及以上人群的肺炎死亡率较低。

2020年1月1日至3月31日期间,中国不同疾病监测点地区每周所有情况、肺炎和其他疾病死亡率的具体趋势。橙色虚线表示2020年的观察死亡率,蓝色实线表示2015-19年的平均死亡率。

整个武汉市(包含3个DSP区和10个非DSP区),2020年1-3月比2019年同期死亡人数多了5954人,总体死亡率增加33%。在总超额死亡中,61%(3653/5954)是由新冠肺炎引起的,15%(920/5954)是由不明病毒性肺炎引起,23%(1381/5954)的死亡是由其他疾病引起(尤其是心血管疾病和糖尿病等);在因伤致死方面,交通事故死亡数显着减少、自杀和跌倒死亡数显着增加。

武汉中心六区超额全因死亡率高于郊区七区

在武汉市中心六区超额全因死亡率高于郊区七区(50% vs 15%)。在肺炎方面,中心区和郊区男性的超额死亡率均高于女性。对于其他原因导致的死亡,则出现了相反现象。具体而言,与2019年相比,2020年医院内死亡显着减少,非医院内死亡显着增加,当然这种情况只在中心地区较为明显。这表明在疫情爆发期间,患者难以获得医院服务或不愿去医院就医。

除武汉外,总体死亡率未增加

在新冠疫情爆发的3个月内武汉市的死亡人数明显增加,不仅与covid-19有关,也与其他严重疾病有关。武汉以外地区,总体死亡率没有增加。除新冠以外,慢性呼吸道疾病、道路交通事故的死亡率均低于预估,这些都与封锁措施密切相关。在全国采取的限制性防疫措施,不仅成功遏制住了疫情的蔓延,甚至还令武汉之外的许多地方在去年前三个月里的死亡率出现了一定的下降,也属于意外结果。

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    2022-02-13 gaoxiaoe
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    2021-03-14 ylz8403
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    2021-03-05 科研科研科研

    疫情初期死亡率增加56%

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1849197, encodeId=5102184919e8c, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Sun Feb 13 19:43:11 CST 2022, time=2022-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2043440, encodeId=d31a2043440ed, content=<a href='/topic/show?id=13304400293' target=_blank style='color:#2F92EE;'>#大规模#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=44002, encryptionId=13304400293, topicName=大规模)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3fce464, createdName=ylz8403, createdTime=Sun Mar 14 08:43:11 CST 2021, time=2021-03-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2048314, encodeId=b7a92048314ba, content=<a href='/topic/show?id=f8062191152' target=_blank style='color:#2F92EE;'>#中国疾控#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21911, encryptionId=f8062191152, topicName=中国疾控)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6c32257, createdName=DEXTER3139, createdTime=Sat Jan 29 22:43:11 CST 2022, time=2022-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=945683, encodeId=12e494568346, content=疫情初期死亡率增加56%, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210110/e6124a4b19bc40ce8afaae096d21126b/dd778ac260c9416eb87e7d08139507f5.jpg, createdBy=4d2f5079605, createdName=科研科研科研, createdTime=Fri Mar 05 11:33:25 CST 2021, time=2021-03-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=944951, encodeId=fb6794495182, content=内容详细。便于理解, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210302/0f3d9900c8f34f6eb824ff0079563a67/53e9a4cd6696491a98e76da69744f83e.jpg, createdBy=d2635277552, createdName=14836fc8m01暂无昵称, createdTime=Tue Mar 02 22:34:38 CST 2021, time=2021-03-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=944795, encodeId=c9a2944e953e, content=威武!, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220301/3a52d3952dde49019f1e000bb5c41d1c/0a0eb7959bb14fcd87745f869bee3c33.jpg, createdBy=46f32239729, createdName=Mia, createdTime=Tue Mar 02 14:44:20 CST 2021, time=2021-03-02, status=1, ipAttribution=)]
    2021-03-02 14836fc8m01暂无昵称

    内容详细。便于理解

    0

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    2021-03-02 Mia

    威武!

    0

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