Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study

被引：854

作者：

Nguyen, Long H. ^{[1
,2
,6
]}

Drew, David A. ^{[1
,2
]}

Graham, Mark S. ^{[11
]}

Joshi, Amit D. ^{[1
,2
]}

Guo, Chuan-Guo ^{[1
,2
,13
]}

Ma, Wenjie ^{[1
,2
,6
]}

Mehta, Raaj S. ^{[1
,2
,6
]}

Warner, Erica T. ^{[2
,3
]}

Sikavi, Daniel R. ^{[4
,5
]}

Lo, Chun-Han ^{[1
,2
,7
]}

Kwon, Sohee ^{[1
,2
]}

Song, Mingyang ^{[1
,2
,7
,8
]}

Mucci, Lorelei A. ^{[7
]}

Stampfer, Meir J. ^{[7
,14
]}

Willett, Walter C. ^{[7
,8
]}

Eliassen, A. Heather ^{[7
,14
]}

Hart, Jaime E. ^{[9
,14
]}

Chavarro, Jorge E. ^{[7
,8
,14
]}

Rich-Edwards, Janet W. ^{[5
,7
,15
]}

Davies, Richard ^{[16
]}

Capdevila, Joan ^{[16
]}

Lee, Karla A. ^{[12
]}

Lochlainn, Mary Ni ^{[12
]}

Varsavsky, Thomas ^{[11
]}

Sudre, Carole H. ^{[11
]}

Cardoso, M. Jorge ^{[11
]}

Wolf, Jonathan ^{[16
]}

Spector, Tim D. ^{[12
]}

Ourselin, Sebastien ^{[11
]}

Steves, Claire J. ^{[12
]}

Chan, Andrew T. ^{[1
,2
,10
,17
,18
]}

机构：

[1] Massachusetts Gen Hosp, Div Gastroenterol, Boston, MA 02114 USA

[2] Massachusetts Gen Hosp, Clin & Translat Epidemiol Unit, Boston, MA 02114 USA

[3] Massachusetts Gen Hosp, Ctr Gen Vulnerable Populat & Hlth Dispar, Boston, MA 02114 USA

[4] Massachusetts Gen Hosp, Dept Med, Boston, MA 02114 USA

[5] Harvard Med Sch, Boston, MA 02114 USA

[6] Harvard TH Chan Sch Publ Hlth, Dept Biostat, Boston, MA USA

[7] Harvard TH Chan Sch Publ Hlth, Dept Epidemiol, Boston, MA USA

[8] Harvard TH Chan Sch Publ Hlth, Dept Nutr, Boston, MA USA

[9] Harvard TH Chan Sch Publ Hlth, Dept Environm Hlth, Boston, MA USA

[10] Harvard TH Chan Sch Publ Hlth, Dept Immunol & Infect Dis, Boston, MA USA

[11] Kings Coll London, Sch Biomed Engn & Imaging Sci, London, England

[12] Kings Coll London, Dept Twin Res & Genet Epidemiol, London, England

[13] Univ Hong Kong, Li Ka Shing Fac Med, Dept Med, Hong Kong, Peoples R China

[14] Brigham & Womens Hosp, Dept Med, Channing Div Network Med, 75 Francis St, Boston, MA 02115 USA

[15] Brigham & Womens Hosp, Dept Med, Div Womens Hlth, 75 Francis St, Boston, MA 02115 USA

[16] Zoe Global, London, England

[17] Broad Inst MIT & Harvard, Cambridge, MA 02142 USA

[18] Massachusetts Consortium Pathogen Readiness, Cambridge, MA USA

来源：

LANCET PUBLIC HEALTH | 2020年 / 5卷 / 09期

基金：

英国科研创新办公室; 英国医学研究理事会; 英国惠康基金; 英国工程与自然科学研究理事会; 美国国家卫生研究院;

关键词：

TRANSMISSION; SARS;

D O I：

10.1016/S2468-2667(20)30164-X

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

摘要：

Background Data for front-line health-care workers and risk of COVID-19 are limited. We sought to assess risk of COVID-19 among front-line health-care workers compared with the general community and the effect of personal protective equipment (PPE) on risk. Methods We did a prospective, observational cohort study in the UK and the USA of the general community, including front-line health-care workers, using self-reported data from the COVID Symptom Study smartphone application (app) from March 24 (UK) and March 29 (USA) to April 23, 2020. Participants were voluntary users of the app and at first use provided information on demographic factors (including age, sex, race or ethnic background, height and weight, and occupation) and medical history, and subsequently reported any COVID-19 symptoms. We used Cox proportional hazards modelling to estimate multivariate-adjusted hazard ratios (HRs) of our primary outcome, which was a positive COVID-19 test. The COVID Symptom Study app is registered with ClinicalTrials.gov, NCT04331509. Findings Among 2 035 395 community individuals and 99 795 front-line health-care workers, we recorded 5545 incident reports of a positive COVID-19 test over 34 435 272 person-days. Compared with the general community, front-line health-care workers were at increased risk for reporting a positive COVID-19 test (adjusted HR 11.61, 95% CI 10.93-12.33). To account for differences in testing frequency between front-line health-care workers and the general community and possible selection bias, an inverse probability-weighted model was used to adjust for the likelihood of receiving a COVID-19 test (adjusted HR 3.40, 95% CI 3.37-3.43). Secondary and post-hoc analyses suggested adequacy of PPE, clinical setting, and ethnic background were also important factors. Interpretation In the UK and the USA, risk of reporting a positive test for COVID-19 was increased among front-line health-care workers. Health-care systems should ensure adequate availability of PPE and develop additional strategies to protect health-care workers from COVID-19, particularly those from Black, Asian, and minority ethnic backgrounds. Additional follow-up of these observational findings is needed. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.

引用

页码：E475 / E483

页数：9

共 30 条

[1] How will country-based mitigation measures influence the course of the COVID-19 epidemic? [J].

Anderson, Roy M. ;

Heesterbeek, Hans ;

Klinkenberg, Don ;

Hollingsworth, T. Deirdre .

LANCET, 2020, 395 (10228) :931-934

[2]

[Anonymous], 2020, LANCET, V395, P922, DOI 10.1016/S0140-6736(20)30644-9

[3]

[Anonymous], 2011, Fundamentals of biostatistics

[4]

[Anonymous], 2020, COVID 19 PERS PROT E

[5] COVID-19: the case for health-care worker screening to prevent hospital transmission [J].

Black, James R. M. ;

Bailey, Chris ;

Przewrocka, Joanna ;

Dijkstra, Krijn K. ;

Swanton, Charles .

LANCET, 2020, 395 (10234) :1418-1420

[6]

CDC COVID-19 Response Team, 2020, MMWR Morb Mortal Wkly Rep, V69, P477, DOI 10.15585/mmwr.mm6915e6

[7] Putting the Public Back in Public Health - Surveying Symptoms of Covid-19 [J].

Chan, Andrew T. ;

Brownstein, John S. .

NEW ENGLAND JOURNAL OF MEDICINE, 2020, 383 (07)

[8] The COronavirus Pandemic Epidemiology (COPE) Consortium: A Call to Action [J].

Chan, Andrew T. ;

Drew, David A. ;

Nguyen, Long H. ;

Joshi, Amit D. ;

Ma, Wenjie ;

Guo, Chuan-Guo ;

Lo, Chun-Han ;

Mehta, Raaj S. ;

Kwon, Sohee ;

Sikavi, Daniel R. ;

Magicheva-Gupta, Marina V. ;

Fatehi, Zahra S. ;

Flynn, Jacqueline J. ;

Leonardo, Brianna M. ;

Albert, Christine M. ;

Andreotti, Gabriella ;

Beane-Freeman, Laura E. ;

Balasubramanian, Bijal A. ;

Brownstein, John S. ;

Bruinsma, Fiona ;

Cowan, Annie N. ;

Deka, Anusila ;

Ernst, Michael E. ;

Figueiredo, Jane C. ;

Franks, Paul W. ;

Gardner, Christopher D. ;

Ghobrial, Irene M. ;

Haiman, Christopher A. ;

Hall, Janet E. ;

Deming-Halverson, Sandra L. ;

Kirpach, Brenda ;

Lacey, James V., Jr. ;

Le Marchand, Loic ;

Marinac, Catherine R. ;

Martinez, Maria Elena ;

Milne, Roger L. ;

Murray, Anne M. ;

Nash, Denis ;

Palmer, Julie R. ;

Patel, Alpa V. ;

Rosenberg, Lynn ;

Sandler, Dale P. ;

Sharma, Shreela V. ;

Schurman, Shepherd H. ;

Wilkens, Lynne R. ;

Chavarro, Jorge E. ;

Eliassen, A. Heather ;

Hart, Jaime E. ;

Kang, Jae Hee ;

Koenen, Karestan C. .

CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION, 2020, 29 (07) :1283-1289

[9] Risk Factors for Pandemic (H1N1) 2009 Virus Seroconversion among Hospital Staff, Singapore [J].

Chen, Mark I. C. ;

Lee, Vernon J. M. ;

Barr, Ian ;

Lin, Cui ;

Goh, Rachelle ;

Lee, Caroline ;

Singh, Baldev ;

Tan, Jessie ;

Lim, Wei-Yen ;

Cook, Alex R. ;

Ang, Brenda ;

Chow, Angela ;

Tan, Boon Huan ;

Loh, Jimmy ;

Shaw, Robert ;

Chia, Kee Seng ;

Lin, Raymond T. P. ;

Leo, Yee Sin .

EMERGING INFECTIOUS DISEASES, 2010, 16 (10) :1554-1561

[10] Wearing face masks in the community during the COVID-19 pandemic: altruism and solidarity Comment [J].

Cheng, Kar Keung ;

Lam, Tai Hing ;

Leung, Chi Chiu .

LANCET, 2022, 399 (10336) :E39-E40

← 1 2 3 →