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COVID-19 Case Age Distribution: Correction for Differential Testing by Age
Annals of Internal Medicine ( IF 39.2 ) Pub Date : 2021-08-17 , DOI: 10.7326/m20-7003
David N Fisman 1 , Amy L Greer 2 , Gabrielle Brankston 2 , Michael Hillmer 3 , Sheila F O'Brien 4 , Steven J Drews 5 , Ashleigh R Tuite 1
Affiliation  

Abstract

Background:

Despite expected initial universal susceptibility to a novel pandemic pathogen like SARS-CoV-2, the pandemic has been characterized by higher observed incidence in older persons and lower incidence in children and adolescents.

Objective:

To determine whether differential testing by age group explains observed variation in incidence.

Design:

Population-based cohort study.

Setting:

Ontario, Canada.

Participants:

Persons diagnosed with SARS-CoV-2 and those tested for SARS-CoV-2.

Measurements:

Test volumes from the Ontario Laboratories Information System, number of laboratory-confirmed SARS-CoV-2 cases from the Integrated Public Health Information System, and population figures from Statistics Canada. Demographic and temporal patterns in incidence, testing rates, and test positivity were explored using negative binomial regression models and standardization. Sources of variation in standardized ratios were identified and test-adjusted standardized infection ratios (SIRs) were estimated by metaregression.

Results:

Observed disease incidence and testing rates were highest in the oldest age group and markedly lower in those younger than 20 years; no differences in incidence were seen by sex. After adjustment for testing frequency, SIRs were lowest in children and in adults aged 70 years or older and markedly higher in adolescents and in males aged 20 to 49 years compared with the overall population. Test-adjusted SIRs were highly correlated with standardized positivity ratios (Pearson correlation coefficient, 0.87 [95% CI, 0.68 to 0.95]; P < 0.001) and provided a case identification fraction similar to that estimated with serologic testing (26.7% vs. 17.2%).

Limitations:

The novel methodology requires external validation. Case and testing data were not linkable at the individual level.

Conclusion:

Adjustment for testing frequency provides a different picture of SARS-CoV-2 infection risk by age, suggesting that younger males are an underrecognized group at high risk for SARS-CoV-2 infection.

Primary Funding Source:

Canadian Institutes of Health Research.



中文翻译:

COVID-19 病例年龄分布:按年龄差异测试的校正

摘要

背景:

尽管预计最初对 SARS-CoV-2 等新型大流行病原体存在普遍易感性,但该流行病的特点是老年人中观察到的发病率较高,而儿童和青少年中的发病率较低。

客观的:

确定按年龄组进行的差异测试是否可以解释观察到的发病率差异。

设计:

基于人群的队列研究。

环境:

加拿大安大略省。

参加者:

被诊断患有 SARS-CoV-2 的人员以及接受 SARS-CoV-2 检测的人员。

测量:

安大略省实验室信息系统的检测量、综合公共卫生信息系统的实验室确诊 SARS-CoV-2 病例数以及加拿大统计局的人口数据。使用负二项式回归模型和标准化探讨了发病率、检测率和检测阳性率的人口统计和时间模式。确定了标准化比率的变异来源,并通过元回归估计了测试调整的标准化感染比率(SIR)。

结果:

观察到的疾病发病率和检测率在最高年龄组中最高,在 20 岁以下组中明显较低;不同性别的发病率没有差异。调整测试频率后,与总人口相比,儿童和 70 岁或以上的成年人的 SIR 最低,而青少年和 20 至 49 岁男性的 SIR 明显较高。测试调整的 SIR 与标准化阳性率高度相关(Pearson 相关系数,0.87 [95% CI,0.68 至 0.95];P  < 0.001),并提供与血清学测试估计值相似的病例识别分数(26.7% vs. 17.2) %)。

限制:

这种新颖的方法需要外部验证。病例和测试数据在个人层面上无法链接。

结论:

对检测频率的调整提供了按年龄划分的 SARS-CoV-2 感染风险的不同情况,表明年轻男性是一个未被充分认识的 SARS-CoV-2 感染高风险群体。

主要资金来源:

加拿大健康研究所。

更新日期:2021-08-17
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