Risk Factors for Coronavirus Disease 2019 (COVID-19) Death in a Population Cohort Study from the Western Cape Province, South Africa

Andrew Boulle,Mary-Ann Davies,Hannah Hussey,Muzzammil Ismail,Erna Morden, Ziyanda Vundle,Virginia Zweigenthal,Hassan Mahomed,Masudah Paleker,David Pienaar,Yamanya Tembo,Charlene Lawrence,Washiefa Isaacs,Hlengani Mathema, Derick Allen,Taryn Allie,Jamy-Lee Bam, Kasturi Buddiga,Pierre Dane,Alexa Heekes, Boitumelo Matlapeng,Themba Mutemaringa, Luckmore Muzarabani,Florence Phelanyane, Rory Pienaar, Catherine Rode,Mariette Smith,Nicki Tiffin,Nesbert Zinyakatira,Carol Cragg,Frederick Marais,Vanessa Mudaly,Jacqueline Voget, Jody Davids,Francois Roodt, Nellis van Zyl Smit, Alda Vermeulen,Kevin Adams,Gordon Audley,Kathleen Bateman,Peter Beckwith,Marc Bernon,Dirk Blom,Linda Boloko,Jean Botha,Adam Boutall,Sean Burmeister,Lydia Cairncross,Gregory Calligaro, Cecilia Coccia, Chadwin Corin,Remy Daroowala,Joel A. Dave, Elsa De Bruyn, Martin De Villiers, Mimi Deetlefs,Sipho Dlamini,Thomas Du Toit, Wilhelm Endres, Tarin Europa, Graham Fieggan,Anthony Figaji, Petro Frankenfeld, Elizabeth Gatley,Phindile Gina, Evashan Govender, Rochelle Grobler, Manqoba Vusumuzi Gule, Christoff Hanekom,Michael Held, Alana Heynes, Sabelo Hlatswayo,Bridget Hodkinson, Jeanette Holtzhausen, Shakeel Hoosain, Ashely Jacobs, Miriam Kahn, Thania Kahn, Arvin Khamajeet, Joubin Khan, Riaasat Khan, Alicia Khwitshana,Lauren Knight, Sharita Kooverjee, Rene Krogscheepers, Jean Jacque Kruger, Suzanne Kuhn, Kim Laubscher, John Lazarus, Jacque Le Roux, Scott Lee Jones,Dion Levin,Gary Maartens,Thina Majola,Rodgers Manganyi,David Marais,Suzaan Marais, Francois Maritz,Deborah Maughan, Simthandile Mazondwa, Luyanda Mbanga,Nomonde Mbatani, Bulewa Mbena,Graeme Meintjes,Marc Mendelson, Ernst Moller, Allison Moore, Babalwa Ndebele,Marc Nortje,Ntobeko Ntusi, Funeka Nyengane,Chima Ofoegbu,Nectarios Papavarnavas,Jonny Peter, Henri Pickard, Kent Pluke,Peter J. Raubenheimer, Gordon Robertson, Julius Rozmiarek, A. Sayed, Matthias Scriba, Hennie Sekhukhune, Prasun Singh, Elsabe Smith, Vuyolwethu Soldati,Cari Stek, Robert van den Berg, Le Roux van der Merwe, Pieter Venter, Barbra Vermooten, Gerrit Viljoen, Santhuri Viranna, Jonno Vogel, Nokubonga Vundla,Sean Wasserman, Eddy Zitha, Vanessa Lomas-Marais, Annie Lombard, Katrin Stuve,Werner Viljoen, De Vries Basson,Sue Le Roux, Ethel Linden-Mars, Lizanne Vic Tor, Mark Wates, Elbe Zwanepoel,Nabilah Ebrahim,Sa'ad Lahri,Ayanda Mnguni,Thomas Crede, Martin de Man,Katya Evans,Clint Hendrikse,Jonathan Naude, Moosa Parak, Patrick Szymanski,Candice Van Koningsbruggen,Riezaah Abrahams,Brian Allwood, Christoffel Botha, Matthys Henndrik Botha,Alistair Broadhurst, Dirkie Claasen, Che Daniel, Riyaadh Dawood, Marie du Preez, Nicolene Du Toit, Kobie Erasmus,Coenraad F. N. Koegelenberg,Shiraaz Gabriel,Susan Hugo, Thabiet Jardine, Clint Johannes,Sumanth Karamchand,Usha Lalla,Eduard Langenegger, Eize Louw, Boitumelo Mashigo, Nonte Mhlana, Chizama Mnqwazi,Ashley Moodley,Desiree Moodley,Saadiq Moolla,Abdurasiet Mowlana,Andre Nortje, Elzanne Olivier,Arifa Parker, Chane Paulsen,Hans Prozesky,Jacques Rood,Tholakele Sabela,Neshaad Schrueder, Nokwanda Sithole, Sthembiso Sithole,Jantjie J. Taljaard, Gideon Titus, Tian Van der Merwe,Marije van Schalkwyk, Luthando Vazi,Abraham J. Viljoen,Mogamat Yazied Chothia, Vanessa Naidoo, Lee Alan Wallis, Mumtaz Abbass,Juanita Arendse, Rizqa Armien, Rochelle Bailey,Muideen Bello, Rachel Carelse, Sheron Forgus, Nosi Kalawe,Saadiq Kariem, Mariska Kotze, Jonathan Lucas, Juanita McClaughlin, Kathleen Murie, Leilah Najjaar, Liesel Petersen,James Porter, Melanie Shaw,Dusica Stapar, Michelle Williams, Linda Aldum,Natacha Berkowitz, Raakhee Girran, Kevin Lee, Lenny Naidoo, Caroline Neumuller,Kim Anderson,Kerrin Begg, Lisa Boerlage,Morna Cornell,Renee de Waal,Lilian Dudley,Rene English,Jonathan Euvrard,Pam Groenewald,Nisha Jacob,Heather Jaspan,Emma Kalk,Naomi Levitt,Thoko Malaba,Patience Nyakato,Gabriela Patten,Helen Schneider, Maylene Shung King,Priscilla Tsondai, James Van Duuren,Lucille Blumberg,Cheryl Cohen,Nelesh Govender,Waasila Jassat,Tendesayi Kufa,Kerrigan McCarthy,Lynn Morris,Nei-yuan Hsiao, Ruan Marais,Jon Ambler,Olina Ngwenya,Richard Osei-Yeboah,Leigh Johnson,Reshma Kassanjee,Tsaone Tamuhla

CLINICAL INFECTIOUS DISEASES（2021）

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摘要

Background. Risk factors for coronavirus disease 2019 (COVID-19) death in sub-Saharan Africa and the effects of human immunodeficiency virus (HIV) and tuberculosis on COVID-19 outcomes are unknown. Methods. We conducted a population cohort study using linked data from adults attending public-sector health facilities in the Western Cape, South Africa. We used Cox proportional hazards models, adjusted for age, sex, location, and comorbidities, to examine the associations between HIV, tuberculosis, and COVID-19 death from 1 March to 9 June 2020 among (1) public-sector "active patients" (>= 1 visit in the 3 years before March 2020); (2) laboratory-diagnosed COVID-19 cases; and (3) hospitalized COVID-19 cases. We calculated the standardized mortality ratio (SMR) for COVID-19, comparing adults living with and without HIV using modeled population estimates. Results. Among 3 460 932 patients (16% living with HIV), 22 308 were diagnosed with COVID-19, of whom 625 died. COVID-19 death was associated with male sex, increasing age, diabetes, hypertension, and chronic kidney disease. HIV was associated with COVID-19 mortality (adjusted hazard ratio [aHR], 2.14; 95% confidence interval [CI], 1.70-2.70), with similar risks across strata of viral loads and immunosuppression. Current and previous diagnoses of tuberculosis were associated with COVID-19 death (aHR, 2.70 [95% CI, 1.81-4.04] and 1.51 [95% CI, 1.18-1.93], respectively). The SMR for COVID-19 death associated with HIV was 2.39 (95% CI, 1.96-2.86); population attributable fraction 8.5% (95% CI, 6.1-11.1). Conclusions. While our findings may overestimate HIV- and tuberculosis-associated COVID-19 mortality risks due to residual confounding, both living with HIV and having current tuberculosis were independently associated with increased COVID-19 mortality. The associations between age, sex, and other comorbidities and COVID-19 mortality were similar to those in other settings.

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COVID-19, HIV, tuberculosis, sub-Saharan Africa, antiretroviral

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