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- Title
SARS-CoV-2 Infection, Hospitalization, and Mortality in Adults With and Without Cancer.
- Authors
Hosseini-Moghaddam, Seyed M.; Shepherd, Frances A.; Swayze, Sarah; Kwong, Jeffrey C.; Chan, Kelvin K. W.
- Abstract
Key Points: Question: Were there associations of tumor type with SARS-CoV-2 infection, hospitalization, intensive care unit admission, and mortality compared with individuals without cancer? Findings: In this cohort study including 11 732 108 adults in Ontario, Canada, population-level health databases, SARS-CoV-2–associated hospitalization and mortality rates were significantly higher in individuals with cancer than individuals without cancer. However, intensive care unit admission rates were not significantly different between hospitalized patients with vs without cancer. Meaning: These findings suggest that the absence of a prioritization strategy for access to critical care treatment may be a factor in significantly greater SARS-CoV-2–associated mortality in patients with cancer. This cohort study assesses associations of tumor type with SARS-CoV-2 infection, hospitalization, intensive care unit admission, and death in Ontario, Canada. Importance: Patients with cancer are at increased risk of SARS-CoV-2–associated adverse outcomes. Objective: To determine the associations of tumor type with SARS-CoV-2 infection, hospitalization, intensive care unit (ICU) admission, and death. Design, Setting, and Participants: This retrospective, population-based cohort study included community-dwelling adults aged at least 18 years in Ontario, Canada, ICES-linked provincial health databases from January 1, 2020, to November 30, 2021. Data were analyzed from December 1, 2021, to November 1, 2022. Exposures: Cancer diagnosis. Main Outcomes and Measures: The primary outcome was SARS-CoV-2 infection, and secondary outcomes included all-cause 14-day hospitalization, 21-day ICU admission, and 28-day death following SARS-CoV-2 infection. Cox proportional hazards models were used to obtain adjusted hazard ratios (aHRs) and 95% CIs. Results: Of 11 732 108 people in the ICES-linked health databases, 279 287 had cancer (57.2% female; mean [SD] age, 65.9 [16.1] years) and 11 452 821 people did not have cancer (45.7% female; mean [SD] age, 65.9 [16.0] years). Overall, 464 574 individuals (4.1%) developed SARS-CoV-2 infection. Individuals with hematologic malignant neoplasms (33 901 individuals) were at increased risk of SARS-CoV-2 infection (aHR, 1.19; 95% CI, 1.13-1.25), 14-day hospitalization (aHR, 1.75; 95% CI, 1.57-1.96), and 28-day mortality (aHR, 2.03; 95% CI, 1.74-2.38) compared with the overall population, while individuals with solid tumors (245 386 individuals) were at lower risk of SARS-CoV-2 infection (aHR, 0.93; 95% CI, 0.91-0.95) but increased risk of 14-day hospitalization (aHR, 1.11; 95% CI, 1.05-1.18) and 28-day mortality (aHR, 1.31; 95% CI, 1.19-1.44). The 28-day mortality rate was high in hospitalized patients with hematologic malignant neoplasms (163 of 321 hospitalized patients [50.7%]) or solid tumors (486 of 1060 hospitalized patients [45.8%]). However, the risk of 21-day ICU admission in patients with hematologic malignant neoplasms (aHR, 1.14; 95% CI, 0.93-1.40) or solid tumors (aHR, 0.93; 95% CI, 0.82-1.05) was not significantly different from that among individuals without cancer. The SARS-CoV-2 infection risk decreased stepwise with increasing numbers of COVID-19 vaccine doses received (1 dose: aHR, 0.63; 95% CI, 0.62-0.63; 2 doses: aHR, 0.16; 95% CI, 0.16-0.16; 3 doses: aHR, 0.05; 95% CI, 0.04-0.06). Conclusions and Relevance: These findings highlight the importance of prioritization strategies regarding ICU access to reduce the mortality risk in increased-risk populations, such as patients with cancer.
- Subjects
ONTARIO; TUMOR classification; INTENSIVE care units; REVERSE transcriptase polymerase chain reaction; STATISTICAL significance; COVID-19; SOCIAL determinants of health; CONFIDENCE intervals; RETROSPECTIVE studies; PATIENTS; HEALTH outcome assessment; CANCER patients; RISK assessment; HOSPITAL admission &; discharge; HOSPITAL care; DESCRIPTIVE statistics; RESEARCH funding; SOCIODEMOGRAPHIC factors; DATA analysis software; ODDS ratio; LONGITUDINAL method; PROPORTIONAL hazards models; ADULTS
- Publication
JAMA Network Open, 2023, Vol 6, Issue 8, pe2331617
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.31617