Case fatality risk of the first pandemic wave of novel coronavirus disease 2019 (COVID-19) in China
Identifieur interne : 000199 ( Main/Merge ); précédent : 000198; suivant : 000200Case fatality risk of the first pandemic wave of novel coronavirus disease 2019 (COVID-19) in China
Auteurs : Xiaowei Deng [République populaire de Chine] ; Juan Yang [République populaire de Chine] ; Wei Wang [République populaire de Chine] ; Xiling Wang [République populaire de Chine] ; Jiaxin Zhou [République populaire de Chine] ; Zhiyuan Chen [République populaire de Chine] ; Jing Li [République populaire de Chine] ; Yinzi Chen [République populaire de Chine] ; Han Yan [République populaire de Chine] ; Juanjuan Zhang [République populaire de Chine] ; Yongli Zhang [République populaire de Chine] ; Yan Wang [République populaire de Chine] ; Qi Qiu [République populaire de Chine] ; Hui Gong [République populaire de Chine] ; Xianglin Wei [République populaire de Chine] ; Lili Wang [République populaire de Chine] ; Kaiyuan Sun [États-Unis] ; Peng Wu [République populaire de Chine] ; Marco Ajelli [Italie, États-Unis] ; Benjamin J. Cowling [République populaire de Chine] ; Cecile Viboud [États-Unis] ; Hongjie Yu [République populaire de Chine]Source :
- Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America [ 1058-4838 ] ; 2020.
Abstract
To assess the case fatality risk (CFR) of COVID-19 in mainland China, stratified by region and clinical category, and estimate key time-to-event intervals.
We collected individual information and aggregated data on COVID-19 cases from publicly available official sources from December 29, 2019 to April 17, 2020. We accounted for right-censoring to estimate the CFR and explored the risk factors for mortality. We fitted Weibull, gamma, and lognormal distributions to time-to-event data using maximum-likelihood estimation.
We analyzed 82,719 laboratory-confirmed cases reported in mainland China, including 4,632 deaths, and 77,029 discharges. The estimated CFR was 5.65% (95%CI: 5.50%-5.81%) nationally, with highest estimate in Wuhan (7.71%), and lowest in provinces outside Hubei (0.86%). The fatality risk among critical patients was 3.6 times that of all patients, and 0.8-10.3 fold higher than that of mild-to-severe patients. Older age (OR 1.14 per year; 95%CI: 1.11-1.16), and being male (OR 1.83; 95%CI: 1.10-3.04) were risk factors for mortality. The time from symptom onset to first healthcare consultation, time from symptom onset to laboratory confirmation, and time from symptom onset to hospitalization were consistently longer for deceased patients than for those who recovered.
Our CFR estimates based on laboratory-confirmed cases ascertained in mainland China suggest that COVID-19 is more severe than the 2009 H1N1 influenza pandemic in hospitalized patients, particularly in Wuhan. Our study provides a comprehensive picture of the severity of the first wave of the pandemic in China. Our estimates can help inform models and the global response to COVID-19.
Url:
DOI: 10.1093/cid/ciaa578
PubMed: 32409826
PubMed Central: 7239217
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<author><name sortKey="Yang, Juan" sort="Yang, Juan" uniqKey="Yang J" first="Juan" last="Yang">Juan Yang</name>
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<author><name sortKey="Wang, Wei" sort="Wang, Wei" uniqKey="Wang W" first="Wei" last="Wang">Wei Wang</name>
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<author><name sortKey="Wang, Xiling" sort="Wang, Xiling" uniqKey="Wang X" first="Xiling" last="Wang">Xiling Wang</name>
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<author><name sortKey="Zhou, Jiaxin" sort="Zhou, Jiaxin" uniqKey="Zhou J" first="Jiaxin" last="Zhou">Jiaxin Zhou</name>
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<author><name sortKey="Chen, Zhiyuan" sort="Chen, Zhiyuan" uniqKey="Chen Z" first="Zhiyuan" last="Chen">Zhiyuan Chen</name>
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<author><name sortKey="Li, Jing" sort="Li, Jing" uniqKey="Li J" first="Jing" last="Li">Jing Li</name>
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<author><name sortKey="Chen, Yinzi" sort="Chen, Yinzi" uniqKey="Chen Y" first="Yinzi" last="Chen">Yinzi Chen</name>
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<author><name sortKey="Yan, Han" sort="Yan, Han" uniqKey="Yan H" first="Han" last="Yan">Han Yan</name>
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<author><name sortKey="Zhang, Juanjuan" sort="Zhang, Juanjuan" uniqKey="Zhang J" first="Juanjuan" last="Zhang">Juanjuan Zhang</name>
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<author><name sortKey="Zhang, Yongli" sort="Zhang, Yongli" uniqKey="Zhang Y" first="Yongli" last="Zhang">Yongli Zhang</name>
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Beijing,<country country="CN">China</country>
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Shanghai,<country country="CN">China</country>
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<author><name sortKey="Gong, Hui" sort="Gong, Hui" uniqKey="Gong H" first="Hui" last="Gong">Hui Gong</name>
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Shanghai,<country country="CN">China</country>
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<author><name sortKey="Wei, Xianglin" sort="Wei, Xianglin" uniqKey="Wei X" first="Xianglin" last="Wei">Xianglin Wei</name>
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Shanghai,<country country="CN">China</country>
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<author><name sortKey="Wang, Lili" sort="Wang, Lili" uniqKey="Wang L" first="Lili" last="Wang">Lili Wang</name>
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Shanghai,<country country="CN">China</country>
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<author><name sortKey="Sun, Kaiyuan" sort="Sun, Kaiyuan" uniqKey="Sun K" first="Kaiyuan" last="Sun">Kaiyuan Sun</name>
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Bethesda, MD,<country country="US">USA</country>
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<author><name sortKey="Wu, Peng" sort="Wu, Peng" uniqKey="Wu P" first="Peng" last="Wu">Peng Wu</name>
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Hong Kong Special Administrative Region,<country country="CN">China</country>
</nlm:aff>
<country xml:lang="fr">République populaire de Chine</country>
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<author><name sortKey="Ajelli, Marco" sort="Ajelli, Marco" uniqKey="Ajelli M" first="Marco" last="Ajelli">Marco Ajelli</name>
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Trento,<country country="IT">Italy</country>
</nlm:aff>
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<affiliation wicri:level="1"><nlm:aff id="AF0006"><institution>Department of Epidemiology and Biostatistics, Indiana University School of Public Health,</institution>
Bloomington, IN,<country country="US">USA</country>
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<author><name sortKey="Viboud, Cecile" sort="Viboud, Cecile" uniqKey="Viboud C" first="Cecile" last="Viboud">Cecile Viboud</name>
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Bethesda, MD,<country country="US">USA</country>
</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
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<author><name sortKey="Yu, Hongjie" sort="Yu, Hongjie" uniqKey="Yu H" first="Hongjie" last="Yu">Hongjie Yu</name>
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Shanghai,<country country="CN">China</country>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Case fatality risk of the first pandemic wave of novel coronavirus disease 2019 (COVID-19) in China</title>
<author><name sortKey="Deng, Xiaowei" sort="Deng, Xiaowei" uniqKey="Deng X" first="Xiaowei" last="Deng">Xiaowei Deng</name>
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Shanghai,<country country="CN">China</country>
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<author><name sortKey="Yang, Juan" sort="Yang, Juan" uniqKey="Yang J" first="Juan" last="Yang">Juan Yang</name>
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Shanghai,<country country="CN">China</country>
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<author><name sortKey="Wang, Wei" sort="Wang, Wei" uniqKey="Wang W" first="Wei" last="Wang">Wei Wang</name>
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Shanghai,<country country="CN">China</country>
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<author><name sortKey="Wang, Xiling" sort="Wang, Xiling" uniqKey="Wang X" first="Xiling" last="Wang">Xiling Wang</name>
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Shanghai,<country country="CN">China</country>
</nlm:aff>
<country xml:lang="fr">République populaire de Chine</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
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<author><name sortKey="Zhou, Jiaxin" sort="Zhou, Jiaxin" uniqKey="Zhou J" first="Jiaxin" last="Zhou">Jiaxin Zhou</name>
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Shanghai,<country country="CN">China</country>
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<author><name sortKey="Chen, Zhiyuan" sort="Chen, Zhiyuan" uniqKey="Chen Z" first="Zhiyuan" last="Chen">Zhiyuan Chen</name>
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Shanghai,<country country="CN">China</country>
</nlm:aff>
<country xml:lang="fr">République populaire de Chine</country>
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<author><name sortKey="Li, Jing" sort="Li, Jing" uniqKey="Li J" first="Jing" last="Li">Jing Li</name>
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Shanghai,<country country="CN">China</country>
</nlm:aff>
<country xml:lang="fr">République populaire de Chine</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
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<author><name sortKey="Chen, Yinzi" sort="Chen, Yinzi" uniqKey="Chen Y" first="Yinzi" last="Chen">Yinzi Chen</name>
<affiliation wicri:level="1"><nlm:aff id="AF0001"><institution>School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education,</institution>
Shanghai,<country country="CN">China</country>
</nlm:aff>
<country xml:lang="fr">République populaire de Chine</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
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<author><name sortKey="Yan, Han" sort="Yan, Han" uniqKey="Yan H" first="Han" last="Yan">Han Yan</name>
<affiliation wicri:level="1"><nlm:aff id="AF0001"><institution>School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education,</institution>
Shanghai,<country country="CN">China</country>
</nlm:aff>
<country xml:lang="fr">République populaire de Chine</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Zhang, Juanjuan" sort="Zhang, Juanjuan" uniqKey="Zhang J" first="Juanjuan" last="Zhang">Juanjuan Zhang</name>
<affiliation wicri:level="1"><nlm:aff id="AF0001"><institution>School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education,</institution>
Shanghai,<country country="CN">China</country>
</nlm:aff>
<country xml:lang="fr">République populaire de Chine</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
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<author><name sortKey="Zhang, Yongli" sort="Zhang, Yongli" uniqKey="Zhang Y" first="Yongli" last="Zhang">Yongli Zhang</name>
<affiliation wicri:level="1"><nlm:aff id="AF0002"><institution>Savaid Medical School, University of Chinese Academy of Sciences,</institution>
Beijing,<country country="CN">China</country>
</nlm:aff>
<country xml:lang="fr">République populaire de Chine</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Wang, Yan" sort="Wang, Yan" uniqKey="Wang Y" first="Yan" last="Wang">Yan Wang</name>
<affiliation wicri:level="1"><nlm:aff id="AF0001"><institution>School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education,</institution>
Shanghai,<country country="CN">China</country>
</nlm:aff>
<country xml:lang="fr">République populaire de Chine</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Qiu, Qi" sort="Qiu, Qi" uniqKey="Qiu Q" first="Qi" last="Qiu">Qi Qiu</name>
<affiliation wicri:level="1"><nlm:aff id="AF0001"><institution>School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education,</institution>
Shanghai,<country country="CN">China</country>
</nlm:aff>
<country xml:lang="fr">République populaire de Chine</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Gong, Hui" sort="Gong, Hui" uniqKey="Gong H" first="Hui" last="Gong">Hui Gong</name>
<affiliation wicri:level="1"><nlm:aff id="AF0001"><institution>School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education,</institution>
Shanghai,<country country="CN">China</country>
</nlm:aff>
<country xml:lang="fr">République populaire de Chine</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Wei, Xianglin" sort="Wei, Xianglin" uniqKey="Wei X" first="Xianglin" last="Wei">Xianglin Wei</name>
<affiliation wicri:level="1"><nlm:aff id="AF0001"><institution>School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education,</institution>
Shanghai,<country country="CN">China</country>
</nlm:aff>
<country xml:lang="fr">République populaire de Chine</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Wang, Lili" sort="Wang, Lili" uniqKey="Wang L" first="Lili" last="Wang">Lili Wang</name>
<affiliation wicri:level="1"><nlm:aff id="AF0001"><institution>School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education,</institution>
Shanghai,<country country="CN">China</country>
</nlm:aff>
<country xml:lang="fr">République populaire de Chine</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Sun, Kaiyuan" sort="Sun, Kaiyuan" uniqKey="Sun K" first="Kaiyuan" last="Sun">Kaiyuan Sun</name>
<affiliation wicri:level="1"><nlm:aff id="AF0003"><institution>Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health,</institution>
Bethesda, MD,<country country="US">USA</country>
</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Wu, Peng" sort="Wu, Peng" uniqKey="Wu P" first="Peng" last="Wu">Peng Wu</name>
<affiliation wicri:level="1"><nlm:aff id="AF0004"><institution>WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong,</institution>
Hong Kong Special Administrative Region,<country country="CN">China</country>
</nlm:aff>
<country xml:lang="fr">République populaire de Chine</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Ajelli, Marco" sort="Ajelli, Marco" uniqKey="Ajelli M" first="Marco" last="Ajelli">Marco Ajelli</name>
<affiliation wicri:level="1"><nlm:aff id="AF0005"><institution>Bruno Kessler Foundation,</institution>
Trento,<country country="IT">Italy</country>
</nlm:aff>
<country xml:lang="fr">Italie</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="AF0006"><institution>Department of Epidemiology and Biostatistics, Indiana University School of Public Health,</institution>
Bloomington, IN,<country country="US">USA</country>
</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Cowling, Benjamin J" sort="Cowling, Benjamin J" uniqKey="Cowling B" first="Benjamin J" last="Cowling">Benjamin J. Cowling</name>
<affiliation wicri:level="1"><nlm:aff id="AF0004"><institution>WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong,</institution>
Hong Kong Special Administrative Region,<country country="CN">China</country>
</nlm:aff>
<country xml:lang="fr">République populaire de Chine</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Viboud, Cecile" sort="Viboud, Cecile" uniqKey="Viboud C" first="Cecile" last="Viboud">Cecile Viboud</name>
<affiliation wicri:level="1"><nlm:aff id="AF0003"><institution>Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health,</institution>
Bethesda, MD,<country country="US">USA</country>
</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Yu, Hongjie" sort="Yu, Hongjie" uniqKey="Yu H" first="Hongjie" last="Yu">Hongjie Yu</name>
<affiliation wicri:level="1"><nlm:aff id="AF0001"><institution>School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education,</institution>
Shanghai,<country country="CN">China</country>
</nlm:aff>
<country xml:lang="fr">République populaire de Chine</country>
<wicri:regionArea># see nlm:aff country strict</wicri:regionArea>
</affiliation>
</author>
</analytic>
<series><title level="j">Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America</title>
<idno type="ISSN">1058-4838</idno>
<idno type="eISSN">1537-6591</idno>
<imprint><date when="2020">2020</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><title>Abstract</title>
<sec id="s1"><title>Objective</title>
<p>To assess the case fatality risk (CFR) of COVID-19 in mainland China, stratified by region and clinical category, and estimate key time-to-event intervals.</p>
</sec>
<sec id="s2"><title>Methods</title>
<p>We collected individual information and aggregated data on COVID-19 cases from publicly available official sources from December 29, 2019 to April 17, 2020. We accounted for right-censoring to estimate the CFR and explored the risk factors for mortality. We fitted Weibull, gamma, and lognormal distributions to time-to-event data using maximum-likelihood estimation.</p>
</sec>
<sec id="s3"><title>Results</title>
<p>We analyzed 82,719 laboratory-confirmed cases reported in mainland China, including 4,632 deaths, and 77,029 discharges. The estimated CFR was 5.65% (95%CI: 5.50%-5.81%) nationally, with highest estimate in Wuhan (7.71%), and lowest in provinces outside Hubei (0.86%). The fatality risk among critical patients was 3.6 times that of all patients, and 0.8-10.3 fold higher than that of mild-to-severe patients. Older age (OR 1.14 per year; 95%CI: 1.11-1.16), and being male (OR 1.83; 95%CI: 1.10-3.04) were risk factors for mortality. The time from symptom onset to first healthcare consultation, time from symptom onset to laboratory confirmation, and time from symptom onset to hospitalization were consistently longer for deceased patients than for those who recovered.</p>
</sec>
<sec id="s4"><title>Conclusions</title>
<p>Our CFR estimates based on laboratory-confirmed cases ascertained in mainland China suggest that COVID-19 is more severe than the 2009 H1N1 influenza pandemic in hospitalized patients, particularly in Wuhan. Our study provides a comprehensive picture of the severity of the first wave of the pandemic in China. Our estimates can help inform models and the global response to COVID-19.</p>
</sec>
</div>
</front>
</TEI>
</record>
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