癌症患者患有SARS-CoV-2相关的不良结果的风险增加。为了确定肿瘤类型与SARS-CoV-2感染、住院、重症监护室（ICU）入院和死亡之间的关联性，本回顾性、以人群为基础的队列研究在加拿大安大略省的社区居民中进行，研究对象为18岁以上的成年人，研究使用了自2020年1月1日至2021年11月30日的ICES医疗健康数据库的相关数据，分析于2021年12月1日至2022年11月1日期间完成。癌症诊断为本研究的关键结果，主要结果是SARS-CoV-2感染，次要结果包括SARS-CoV-2感染后14天内的全因住院、21天内的ICU入院和28天内的死亡。使用Cox比例风险模型计算了调整后的风险比（aHR）和95%的置信区间（CI）。 在ICES相关健康数据库的11,732,108名人群中，有279,287人患有癌症（57.2%为女性；平均[SD]年龄为65.9 [16.1]岁），而11,452,821人没有癌症（45.7%为女性；平均[SD]年龄为65.9 [16.0]岁）。总体上，464,574人（4.1%）感染了SARS-CoV-2。血液恶性肿瘤患者（33,901人）的SARS-CoV-2感染风险增加（aHR为1.19；95% CI为1.13-1.25），14天住院风险增大（aHR为1.75；95% CI为1.57-1.96），28天死亡率也增加（aHR为2.03；95% CI为1.74-2.38），与整体人群相比；而固体肿瘤患者（245,386人）的SARS-CoV-2感染风险较低（aHR为0.93；95% CI为0.91-0.95），但14天住院风险增加（aHR为1.11；95% CI为1.05-1.18），28天死亡率也增加（aHR为1.31；95% CI为1.19-1.44）。在血液恶性肿瘤患者（321名住院患者中的163例[50.7%]）和固体肿瘤患者（1060名住院患者中的486例[45.8%]）中，28天死亡率较高。然而，血液恶性肿瘤患者（aHR为1.14；95% CI为0.93-1.40）或固体肿瘤患者（aHR为0.93；95% CI为0.82-1.05）与没有癌症的个体相比，在21天ICU入院风险上没有显著差异。SARS-CoV-2感染风险随COVID-19疫苗接种剂量的增加而逐步降低（接种1剂：aHR为0.63；95% CI为0.62-0.63；接种2剂：aHR为0.16；95% CI为0.16-0.16；接种3剂：aHR为0.05；95% CI为0.04-0.06）。这些发现强调了优先考虑ICU资源的战略在减少癌症等高风险人群死亡风险方面的重要性。

Patients with cancer are at increased risk of SARS-CoV-2-associated adverse outcomes.To determine the associations of tumor type with SARS-CoV-2 infection, hospitalization, intensive care unit (ICU) admission, and death.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.Cancer diagnosis.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.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).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.