General Features Of Death Cases In Henan Province
Since February 5, deaths continued to be reported in Henan, but no deaths in Zhejiang until February 19. A total of 19 deaths was announced in Henan by February 19, and the general features of 16 death cases (3 deaths with unknown information) were placed in Table 1. The average age of these 16 deaths was (72 ± 12.42) years old with a gender ratio (male/female) of 5:3, and 93.75% (15), 56.25% (9), 31.25% (5), 6.25% (1) of them were ≥ 60-year-old, ≥ 70-year-old, ≥ 80-year-old, < 60-year-old, respectively. The common symptom of 9 cases with known information was fever (6, 66.7%). 6 cases (37.5%) lived in rural areas, and 9 cases (56.25%) lived in urban areas. The time interval from onset to hospitalization was (2.58 ± 2.71) days, and the time interval from onset to diagnosis was (6.77 ± 2.89) days, and time interval from onset to death was (12.08 ± 5.95) days (Figure.3). There were 3 imported cases (18.75%) coming from Wuhan, Hubei, and 10 (62.50%) non-imported cases including 8 confirmed cases (80.00%) having a history of close contact with patients. Additionally, underlying basic diseases, such as respiratory disorders, hypertension, cardiovascular diseases, diabetes and cancer were reported in 8 cases with detail information.
Table 1
General features of death cases in Henan Province
ID | Gender (F/M) | Age | Place of residence | Symptoms | Onset time | Admission time | Time of Diagnosis | Date of death | Imported case? | Wuhan travel history? | Hubei travel history? | Case contact history? | Basic diseases |
1 | Male | 79 | Tanghe county, Nanyang | Cough/ asthma | 2020/1/16 | 2020/1/22 | 2020/1/25 | 2020/1/25 | Yes | Yes | Yes | UN | Chronic bronchitis |
2 | Male | 85 | Tanghe county, Nanyang | Fever/cough/sputum /asthma | 2020/1/24 | 2020/1/24 | 2020/1/27 | 2020/1/28 | Yes | Yes | Yes | UN | Chronic bronchitis/CVD |
3 | Male | 69 | Lushan county, Pingdingshan | UN | 2020/1/29 | UN | 2020/2/4 | 2020/2/5 | No | No | No | Yes | Diabetes/hypertension/CVD |
4 | Female | 83 | Shanyang county, Jiaozuo | UN | 2020/1/31 | 2020/1/31 | 2020/2/3 | 2020/2/7 | No | No | No | Yes | UN |
5 | Female | 74 | Weihui city, Xinxiang | UN | UN | UN | 2020/1/31 | 2020/2/8 | No | No | No | Yes | UN |
6 | Male | 74 | Weihui city, Xinxiang | UN | UN | UN | 2020/1/31 | 2020/1/31 | No | No | No | Yes | UN |
7 | Female | 80 | Jinshui county, Zhengzhou | UN | 2020/1/24 | 2020/1/29 | 2020/1/31 | 2020/2/11 | No | No | No | Yes | Diabetes/CVD/hypothyroidism |
8 | Male | 72 | Liangyuan county, Shangqiu | Diarrhea/nausea/ vomiting | 2020/1/25 | 2020/1/25 | 2020/2/3 | 2020/2/12 | UN | UN | UN | UN | Hypertension/diabetes |
9 | Male | 68 | Guangshan county, Xinyang | Fever | 2020/2/3 | 2020/2/10 | 2020/2/11 | 2020/2/13 | No | No | No | Yes | Lung cancer |
10 | Male | 68 | UN | UN | UN | 2020/1/22 | 2020/1/23 | 2020/2/13 | UN | UN | UN | UN | UN |
11 | Male | 65 | Huaibin county, Xinyang | Fever | 2020/1/27 | 2020/1/28 | 2020/1/30 | 2020/2/14 | Yes | Yes | Yes | UN | UN |
12 | Male | 33 | Zhengzhou | Fever | 2020/1/28 | 2020/1/28 | 2020/2/6 | 2020/2/16 | No | No | No | UN | UN |
13 | Male | 68 | Shihe county, Xinyang | Astriction | 2020/2/8 | 2020/2/8 | 2020/2/15 | 2020/2/16 | UN | UN | UN | UN | UN |
14 | Female | 68 | Suiyang county, Shangqiu | UN | 2020/1/27 | 2020/1/27 | 2020/2/3 | 2020/2/16 | No | No | No | UN | Hypertension/CVD |
15 | Female | 86 | Xinan county, Luoyang | Fever/ cough | 2020/2/10 | 2020/2/10 | 2020/2/14 | 2020/2/17 | No | No | No | Yes | UN |
16 | Female | 80 | Yima county, Sanmenxia | Fever | 2020/1/24 | 2020/1/24 | 2020/1/24 | ND | No | No | No | Yes | Hypertension |
Note: unknown (UN); cardiovascular diseases (CVD); |
Presentation of initial symptoms of laboratory-confirmed cases in Henan and Zhejiang
Due to individual differences in different patients or factors such as viral virulence and quantity, the initial symptoms of patients after infection often differ. The different initial symptoms may indicate different disease progression and outcomes. Based on the above considerations, we briefly describe and compare the initial symptoms of patients in the two provinces. We finally collected 939 cases in Zhejiang province and 676 cases in Henan province with the data of initial symptoms. As is shown in Figure.4, there were many differences in the initial symptoms of patients between the two provinces. Markedly, the results showed that 87.4% of the patients in Henan had fever in their initial symptoms, compared with Zhejiang Province (75.1%), with significant significances (P < 0.001). However, 37.8% of patients in Zhejiang Province had more cough than that in Henan Province (17.2%), with significant significances (P < 0.001). Most other initial symptoms are statistically different (Table 2). It was worth noting that 2.1% of infected persons were asymptomatic in Henan, while 7.2% of patients were asymptomatic in Zhejiang (P < 0.001). However, potential information bias should be considered here. For instance, most of the data reported by Henan didn’t include CT imaging performance, and fever and asymptomatic were commonly information reported by both provinces. Herein, the above data indicate that Henan has a higher proportion of patients with fever and lower proportion of patients with asymptomatic.
Table 2
Presentation of initial symptoms of laboratory-confirmed cases in Henan and Zhejiang
Province and symptoms | Zhejiang (n = 939) | Henan (n = 676) | χ2 | P |
Fever | | | | |
Yes | 705(75.1%) | 591(87.4%) | 37.797 | < 0.001 |
No | 234(24.9%) | 85(12.6%) |
Cough | | | | |
Yes | 355(37.8%) | 116(17.2%) | 81.101 | < 0.001 |
No | 584(62.2%) | 560(82.2%) |
Expectoration | | | | |
Yes | 83(8.8%) | 24(3.69%) | 17.772 | < 0.001 |
No | 856(91.2%) | 652(96.4%) |
Rhinobyonh or rhinorrhea | | | | |
Yes | 41(4.4%) | 17(2.5%) | 3.892 | 0.049 |
No | 898(95.6%) | 659(97.5%) |
Sore throat | | | | |
Yes | 87(9.3%) | 26(3.8%) | 17.737 | < 0.001 |
No | 852(90.7%) | 650(96.2%) |
Chest pain or shortness of breath | | | | |
Yes | 26(2.8%) | 27(4.0%) | 1.859 | 0.173 |
No | 913(97.2%) | 649(96.0%) |
Muscle ache or fatigue | | | | |
Yes | 125(13.3%) | 61(9.0%) | 7.093 | 0.008 |
No | 814(86.7%)) | 615(91.0%) |
Headache or dizziness | | | | |
Yes | 95(10.1%) | 22(3.3%) | 27.547 | < 0.001 |
No | 844(89.9%)) | 654(96.7%) |
Nausea and vomiting | | | | |
Yes | 19(2.0%) | 12(1.8%) | 0.129 | 0.720 |
No | 920(98.0%)) | 664(98.2%) |
Diarrhoea | | | | |
Yes | 20(2.1%) | 4(0.6%) | 6.325 | 0.012 |
No | 919(97.9%)) | 672(99.4%) |
Abnormal CT image | | | | |
Yes | 263(28.0%) | 2(0.3%) | 220.070 | < 0.001 |
No | 676(72.0%)) | 674(99.7%) |
Asymptomatic | | | | |
Yes | 68(7.2%) | 14(2.1%) | 21.804 | < 0.001 |
No | 871(92.8%)) | 662(97.9%) |
Overall Comparison Of Laboratory-confirmed Cases In Henan And Zhejiang
Of total confirmed cases, the proportion of male and female was 50.5%, 49.5% in Zhejiang, and 54.4%, 45.6% in Henan. The proportion of male in Henan was higher, but the difference had no statistically significance (P > 0.05). The mean age of the confirmed cases in Zhejiang was (47.25 ± 15.30), which was higher than that in Henan (44.31 ± 16.06) with significant difference (P < 0.001). Next, we performed a stratified analysis of age distribution. The proportion of 19 ~ 35-year-old confirmed cases (28.9%) in Henan was higher than that in Zhejiang (20.7%) (P < 0.001). The proportion of 36 ~ 59-year-old (56.2%) and ≥ 60-year-old confirmed cases (20.3%) in Zhejiang was higher than that in Henan (51.8%, 15.1%), with significant significances (P = 0.033, P = 0.001) (Supplementary materials: Table 1). 79.6% of confirmed cases lived in urban areas of Zhejiang, which was higher than that in Henan (49.7%) with a significant difference (P < 0.001). Compared with Zhejiang (46.3%), the proportion of imported cases in Henan (54.4%) was higher, and the difference had a statistically significance (P < 0.001). 41.9% and 44.0% of the confirmed cases in Zhejiang had Hubei and Wuhan travel history, which was lower than that in Henan (57.4%, 54.6%). 85.5% of the confirmed cases in Zhejiang had a history of contact with case, which was lower than that in Henan (91.6%). The above differences were statistically significant (P < 0.001). The time interval from onset to diagnosis in Henan was (7.35 ± 4.20) days, which was 0.4 day longer than that in Zhejiang (6.95 ± 4.09) days, but the difference was not statistically significant (P > 0.05) (Table 3). These results suggest the laboratory-confirmed cases in Henan mainly come from young, rural and imported infected persons with a Hubei or Wuhan travel history, relative to Zhejiang.
Table 3
Comparison of laboratory-confirmed cases in Henan and Zhejiang
Province and variables | Zhejiang n (%) | Henan n (%) | χ2/t | P |
Gender | | | | |
Male | 542(50.5%) | 686(54.4%) | 3.603 | 0.058 |
Female | 532(49.5%) | 575(45.6%) |
Total | 1074(100%) | 1261(100%) | | |
Age (year) | | | | |
(0–18) | 30(2.8%) | 53(4.2%) | 29.781 | < 0.001 |
(19–35) | 220(20.7%) | 363(28.9%) |
(36–59) | 604(56.2%) | 652(51.8%) |
(≥ 60) | 218(20.3%) | 190(15.1%) |
Total | 1074(100%) | 1258(100%) | | |
Place of residence | | | | |
Urban areas | 848(79.6%) | 622(49.7%) | 222.483 | < 0.001 |
Rural areas | 217(20.4%) | 630(50.3%) |
Total | 1065(100%) | 1252(100%) | | |
Imported case | | | | |
Yes | 483(46.3%) | 673(54.4%) | 14.839 | < 0.001 |
No | 559(53.6%) | 563(45.6%) |
Total | 1042(100%) | 1236(100%) | | |
From Hubei Province | | | | |
Yes | 392(41.9%) | 596(57.4%) | 46.914 | < 0.001 |
No | 543(58.1%) | 443(42.6%) |
Total | 935(100%) | 1039(100%) | | |
From Wuhan city | | | | |
Yes | 404(44.0%) | 567(54.6%) | 21.753 | < 0.001 |
No | 514(56.0%) | 472(45.4%) |
Total | 918(100%) | 1039(100%) | | |
Contact cases | | | | |
Yes | 511(85.5%) | 514(91.6%) | 10.779 | 0.001 |
No | 87(14.5%)) | 47(8.4%) |
Total | 598(100%) | 561(100%) | | |
Age (year) | 47.25 ± 15.30 | 44.31 ± 16.06 | 4.505 | < 0.001 |
Time interval (day) | 6.95 ± 4.09 | 7.35 ± 4.20 | 1.871 | 0.061 |
Comparison of laboratory confirmed cases in Henan and Zhejiang after adjusting for gender
Latest studies suggest that the male confirmed cases may have a higher case-fatality rate(6, 9). Nevertheless, the gender is a common confounding factor for other research factors. Than the stratified χ2 test was performed. 60.3% of male were imported cases in Henan, which were higher than that in Zhejiang (49.0%) with a significant difference (P < 0.001). The proportion of male confirmed cases with a case contact history in Henan (92.5%) was higher than that in Zhejiang (83.1%), with a statistically significant difference (P = 0.001). The differences of age in male/female confirmed cases between Henan and Zhejiang had statistically significance (P < 0.05). Compared to Zhejiang, the proportion of male/female confirmed cases living in rural areas of Henan was higher with statistically significant differences (P < 0.001). The proportion of male confirmed cases with a Hubei or Wuhan travel history was higher than that in Zhejiang, and all differences had statistically significances (P < 0.001). The time interval from onset to diagnosis of confirmed cases in Henan was higher than that in Zhejiang whatever male or female, but had no statistically significance (P > 0.05) (Table 4). Above results indicate that Henan has a higher proportion of male cases coming from rural areas, or imported cases with epidemiological history, relative to Zhejiang.
Table 4
Comparison of laboratory-confirmed cases in Henan and Zhejiang after adjusting for gender
Gender | Province | Variables | Total (n) | χ2 | P |
| | Imported case n (%) | | | |
| | No | Yes | | | |
Female | Zhejiang | 293(56.8%) | 223(43.2%) | 516 | 2.022 | 0.155 |
Henan | 297(52.5%) | 269(47.5%) | 566 |
Male | Zhejiang | 266(51%) | 256(49.0%) | 522 | 15.044 | < 0.001 |
Henan | 266(39.7%) | 404(60.3%) | 670 |
| | Age n (%) | | | |
| | (0–18) | (19–35) | (36–59) | (≥ 60) | | | |
Female | Zhejiang | 12(2.3%) | 104(19.5%) | 297(55.8%) | 119(22.4%) | 532 | 13.856 | 0.003 |
Henan | 21(3.7%) | 148(25.8%) | 317(55.2%) | 88(15.3%) | 574 |
Male | Zhejiang | 18(3.3%) | 118(21.8%) | 307(56.6%) | 99(18.3%) | 542 | 17.225 | 0.001 |
Henan | 32(4.7%) | 215(31.4%) | 335(49.0%) | 102(14.9%) | 684 |
| | Place of residence n (%) | | | |
| | Urban areas | Rural areas |
Female | Zhejiang | 430(81.9%) | 95(18.1%) | 525 | 103.612 | < 0.001 |
Henan | 301(52.9%) | 268(47.1%) | 569 |
Male | Zhejiang | 404(77.1%) | 120(22.9%) | 524 | 111.466 | < 0.001 |
Henan | 321(47.1%) | 361(52.9%) | 682 |
| | Hubei travel history n (%) | | | |
| | No | Yes |
Female | Zhejiang | 271(60.5%) | 177(39.5%) | 448 | 13.058 | < 0.001 |
Henan | 230(48.6%) | 243(51.4%) | 473 |
Male | Zhejiang | 272(56.3%) | 211(43.7%) | 483 | 36.591 | < 0.001 |
Henan | 213(37.6%) | 353(62.4%) | 566 |
| | Wuhan travel history n (%) | | | |
| | No | Yes |
Female | Zhejiang | 257(58.8%) | 180(41.2%) | 437 | 5.364 | 0.021 |
Henan | 242(51.2%) | 231(48.8%) | 473 |
Male | Zhejiang | 257(53.9%) | 220(46.1%) | 477 | 18.237 | < 0.001 |
Henan | 230(40.6%) | 336(59.4%) | 566 |
| | Cases contact history n (%) | | | |
| No | Yes |
Female | Zhejiang | 37(12.2%) | 266(87.8%) | 303 | 1.429 | 0.232 |
Henan | 27(9.2%) | 267(90.8%) | 294 |
Male | Zhejiang | 50(16.9%) | 245(83.1%) | 297 | 11.499 | 0.001 |
Henan | 20(7.5%) | 247(92.5%) | 267 |
| | Time interval (day) | | t | P |
Female | Henan | 7.20 ± 4.43 | | -1.285 | 0.199 |
Zhejiang | 6.80 ± 3.95 | |
Male | Henan | 7.48 ± 4.01 | | -1.247 | 0.213 |
Zhejiang | 7.11 ± 4.23 | |
Comparison of laboratory-confirmed cases in Henan and Zhejiang after adjusting age
Age is an important factor for COVID-19 related severity or deaths, and most of deaths are elderly based on data from Chinese center for disease control and prevention (CDC)(6). Our results showed that the proportions of cases living in rural areas at different ages of Henan were higher than that in Zhejiang, with statistically significant differences (P < 0.05). Notably, the proportion of elderly cases living in rural areas in Henan is about 3 times of Zhejiang. 68.3% of 19 ~ 35-year-old cases in Henan were imported, which was higher than that in Zhejiang and the difference was statistically significant (P < 0.001). The proportion of young cases (19 ~ 35-year-old) who had a Hubei (69.8%) or Wuhan travel history (68.2%) in Henan was higher than that in Zhejiang (46.3%, 45.7%) with statistically significant differences (P < 0.001). 55.9% of cases at the age of 36 ~ 59 had a Hubei travel history in Henan, which was higher than that in Zhejiang (43.8%) with statistically significant difference (P < 0.001). The proportion of cases at 19 ~ 35 (95.4%) or 36 ~ 59-year-old (91.5%) who had a case contact history in Henan was higher than that in Zhejiang (84.5%, 82.4%) with statistically significant difference (P < 0.05). The time interval (from onset to diagnosis) of cases at 36 ~ 59-year-old (7.86 ± 4.45) days in Henan was longer than that in Zhejiang (7.16 ± 4.12) days, with statistically significant difference (P < 0.05) (Table 5). These results indicate that more older cases lived in rural areas of Henan predicting a low medical level, may be related to high case-fatality rate. Additionally, more young cases linked to an exposure of Hubei or Wuhan in Henan may be migrant workers, resulting in more imported cases at the same age level. The higher proportions of 36 ~ 59-year-old cases with a case contact history or longer interval from onset to diagnosis may be related to high severe rate or deaths in Henan.
Table 5
Comparison of laboratory-confirmed cases in Henan and Zhejiang after adjusting for age
Age | Province | Variables | Total (n) | χ2 | P |
| | Gender n (%) | | | |
| | Female | Male | | | |
(0–18) | Zhejiang | 12(40.0%) | 18(60.0%) | 30 | 0.001 | 0.937 |
Henan | 21(39.6%) | 32(60.4%) | 53 |
(19–35) | Zhejiang | 104(46.8%) | 118(53.2%) | 222 | 2.074 | 0.150 |
Henan | 148(40.8%) | 215(59.2%) | 363 |
(36–59) | Zhejiang | 297(49.2%) | 307(50.8%) | 604 | 0.038 | 0.845 |
Henan | 317(48.6%) | 335(51.4%) | 652 |
(≥ 60) | Zhejiang | 119(54.6%) | 99(45.4%) | 218 | 2.779 | 0.096 |
Henan | 88(46.3%) | 102(53.7%) | 190 |
| | Place of residence n (%) | | | |
| | Urban areas | Rural areas |
(0–18) | Zhejiang | 24(85.7%) | 4(14.3%) | 28 | 9.905 | 0.002 |
Henan | 26(50.0%) | 26(50.0%) | 52 |
(19–35) | Zhejiang | 169(79.0%) | 45(21.0%) | 214 | 65.899 | < 0.001 |
Henan | 160(44.3%) | 201(55.7%) | 361 |
(36–59) | Zhejiang | 461(78.0%) | 130(22.0%) | 591 | 95.993 | < 0.001 |
Henan | 331(51.2%) | 315(48.8%) | 646 |
(≥ 60) | Zhejiang | 180(83.3%) | 36(16.7%) | 216 | 38.552 | < 0.001 |
Henan | 104(55.0%) | 85(45.0%) | 189 |
| | Imported case n (%) | | | |
| | No | Yes |
(0–18) | Zhejiang | 17(56.7%) | 13(43.3%) | 30 | 0.008 | 0.928 |
Henan | 30(57.7%) | 22(42.3%) | 52 |
(19–35) | Zhejiang | 99(46.3%) | 115(53.7%) | 214 | 12.233 | < 0.001 |
Henan | 113(31.7%) | 244(68.3%) | 357 |
(36–59) | Zhejiang | 288(49.7%) | 292(50.3%) | 580 | 2.927 | 0.087 |
Henan | 286(44.8%) | 353(55.2%) | 639 |
(≥ 60) | Zhejiang | 155(72.4%) | 59(27.6%) | 214 | 0.000 | 1.000 |
Henan | 134(72.4%) | 51(27.6%) | 185 |
| | From Hubei province n (%) | | | |
| | No | Yes |
(0–18) | Zhejiang | 15(57.7%) | 11(42.3%) | 26 | 0.116 | 0.734 |
Henan | 23(53.5%) | 20(46.5%) | 43 |
(19–35) | Zhejiang | 109(53.7%) | 94(46.3%) | 203 | 28.686 | < 0.001 |
Henan | 96(30.2%) | 222(69.8%) | 318 |
(36–59) | Zhejiang | 296(56.2%) | 231(43.8%) | 527 | 15.573 | < 0.001 |
Henan | 239(44.1%) | 303(55.9%) | 542 |
(≥ 60) | Zhejiang | 123(70.3%) | 52(29.7%) | 175 | 1.401 | 0.237 |
Henan | 85(63.9%) | 48(36.1%) | 133 |
| | From Wuhan city n (%) | | | |
| | No | Yes |
(0–18) | Zhejiang | 16(61.5%) | 10(38.5%) | 26 | 0.011 | 0.917 |
Henan | 27(62.8%) | 16(37.2%) | 43 |
(19–35) | Zhejiang | 107(54.3%) | 90(45.7%) | 197 | 25.700 | < 0.001 |
Henan | 101(31.8%) | 217(68.2%) | 217 |
(36–59) | Zhejiang | 268(51.7%) | 250(48.3%) | 518 | 2.517 | 0.113 |
Henan | 254(46.9%) | 288(53.1%) | 542 |
(≥ 60) | Zhejiang | 123(71.1%) | 50(28.9%) | 173 | 0.418 | 0.518 |
Henan | 90(67.7%) | 43(32.3%) | 133 |
| | Contact the case n (%) | | | |
| | No | Yes |
(0–18) | Zhejiang | 2(10.0%) | 18(90.0%) | 20 | 0.229 | 0.632* |
Henan | 1(2.9%) | 33(97.1%) | 34 |
(19–35) | Zhejiang | 16(15.5%) | 87(84.5%) | 103 | 8.012 | 0.005 |
Henan | 6(4.6%) | 124(95.4%) | 130 |
(36–59) | Zhejiang | 56(17.6%) | 263(82.4%) | 319 | 10.822 | 0.001 |
Henan | 24(8.5%) | 260(91.5%) | 284 |
(≥ 60) | Zhejiang | 13(8.3%) | 143(91.7%) | 156 | 2.394 | 0.122 |
Henan | 16(14.3%) | 96(85.7%) | 112 |
| | Time interval (day) | | t | P |
(0–18) | Zhejiang | 4.70 ± 2.64 | | -0.320 | 0.751 |
Henan | 5.00 ± 3.55 | |
(19–35) | Zhejiang | 6.73 ± 3.69 | | 0.166 | 0.868 |
Henan | 6.67 ± 3.43 | |
(36–59) | Zhejiang | 7.16 ± 4.12 | | -2.340 | 0.020 |
Henan | 7.86 ± 4.45 | |
(≥ 60) | Zhejiang | 6.88 ± 4.45 | | -0.942 | 0.347 |
Henan | 7.39 ± 3.35 | |
Note: * indicates the P-value after correction. |
Comparison of laboratory-confirmed cases in Henan and Zhejiang after adjusting for imported cases
Imported cases who have been infected at incubation, subclinical, or onset stage may lead to more severe cases or deaths, especially for the cases from Wuhan or Hubei. Our results showed 60.0% of imported cases in Henan are male, which was higher than that in Zhejiang (53.4%), with statistically significant difference (P < 0.05). Among non-imported cases, there was no difference in gender distribution between the two provinces (P > 0.05). There were also differences in age distribution in imported cases between Henan and Zhejiang (P < 0.001), and more imported cases with 19 ~ 35-year-old in Henan (P < 0.001) (Supplementary materials: Table 1). Among imported cases, the proportion of cases having a Hubei travel history in Henan (90.1%) was higher than that in Zhejiang (81.2%) with a statistically significant difference (P < 0.001). Among non-imported cases, there was no statistically significant difference in visiting Hubei (P > 0.05). Among imported cases or non-imported cases, higher proportions of cases in Henan came from rural areas, relative to Zhejiang with statistically significant differences (P < 0.001). There was no significant difference between the two provinces about the imported and non-imported cases having a Wuhan travel history (P > 0.05). Among imported cases, 96.9% of cases having a case contact history in Henan, which were higher than that in Zhejiang (23.2%) with statistically significant difference (P < 0.001). Among non-imported cases, 100.0% of cases having a history of contact with cases in Zhejiang, which was higher than that in Henan (89.9%), and the difference was statistically significant (P < 0.001) (Table 6). Together, our results indicate that higher proportions of imported cases are male or have a Hubei travel history, or live in rural areas. As mentioned above, imported cases from Hubei lived in rural areas may be migrant workers.
Table 6
Comparison of laboratory-confirmed cases in Henan and Zhejiang after adjusting for imported case
Imported case | Province | Variables | Total (n) | χ2 | P |
| | Gender n (%) | | | |
| | Female | Male | | | |
No | Zhejiang | 293(52.4%) | 266(47.6%) | 559 | 0.013 | 0.910 |
Henan | 297(52.8%) | 266(47.2%) | 563 |
Yes | Zhejiang | 223(46.6%) | 256(53.4%) | 479 | 4.959 | 0.026 |
Henan | 269(40.0%) | 404(60.0%) | 673 |
| | Age n (%) | | | |
| | (0–18) | (19–35) | (36–59) | (≥ 60) |
No | Zhejiang | 17(3%) | 99(17.7%) | 288(51.5%) | 155(27.7%) | 559 | 6.039 | 0.110 |
Henan | 30(5.3%) | 113(20.1%) | 286(50.8%) | 134(23.8%) | 563 |
Yes | Zhejiang | 13(2.7%) | 115(24%) | 292(61%) | 59(12.3%) | 479 | 23.930 | < 0.001 |
Henan | 22(3.3%) | 244(36.4%) | 353(52.7%) | 51(7.6%) | 670 |
| | Place of residence n (%) | | | |
| | Urban areas | Rural areas |
No | Zhejiang | 430(77.3%) | 126(22.7%) | 556 | 50.988 | < 0.001 |
Henan | 322(57.3%) | 240(42.7%) | 562 |
Yes | Zhejiang | 375(81.3%) | 86(18.7%) | 461 | 157.418 | < 0.001 |
Henan | 292(44.0%) | 372(56.0%) | 664 |
| | From Hubei province n (%) | | | |
| | No | Yes | |
No | Zhejiang | 452(100.0%) | 0(0.0%) | 452 | 1.747 | 0.186* |
Henan | 373(99.2%) | 3(0.8%) | 376 |
Yes | Zhejiang | 91(18.8%) | 392(81.2%) | 483 | 18.865 | < 0.001 |
Henan | 65(9.9%) | 592(90.1%) | 657 |
| | From Wuhan city n (%) | | | |
| | No | Yes | |
No | Zhejiang | 447(99.3%) | 3(0.7%) | 450 | 0.000 | 1.000* |
Henan | 373(99.2%) | 3(0.8%) | 376 |
Yes | Zhejiang | 67(14.3%) | 401(85.7%) | 468 | 0.000 | 0.997 |
Henan | 94(14.3%) | 563(85.7%) | 657 |
| | Contact the case n (%) | | | |
| | No | Yes |
No | Zhejiang | 0(0.0%) | 477(100.0%) | 477 | 50.799 | < 0.001 |
Henan | 43(10.1%) | 381(89.9%) | 424 |
Yes | Zhejiang | 86(76.8%) | 26(23.2%) | 112 | 139.936 | < 0.001 |
Henan | 4(3.1%) | 126(96.9%) | 130 |
| | Time interval (day) | | t | P |
No | Zhejiang | 6.87 ± 4.34 | | -1.620 | 0.106 |
Henan | 7.36 ± 4.38 | |
Yes | Zhejiang | 7.01 ± 3.67 | | -0.829 | 0.408 |
Henan | 7.25 ± 3.97 | |
Note: * indicates the P-value after correction. |
Comparison of laboratory-confirmed cases in Henan and Zhejiang after adjusting place of residence
There is a big urban-rural gap in health resource allocation of public medical institutions in China(10), implying cases from rural areas may have a higher risk of developing severity or death. Our results showed that there was no statistical difference in gender after the stratification (P > 0.05). There were statistical differences in different age groups whatever rural or urban areas (P < 0.05). 21.6% of cases living in urban areas were ≥ 60-year-old in Zhejiang, which was higher than that in Henan (16.7%) with statistically significant difference (P < 0.05) (Supplementary materials: Table 1). Consistent to early analysis, more cases at the age of 36 ~ 59-year-old or ≥ 60-year-old lived in rural areas in Henan, relative to Zhejiang, and the differences were statistically significant (P < 0.001). 60.8% of rural cases were imported cases in Henan, which were higher than that in Zhejiang (40.6%) with statistically significant difference (P < 0.001). Those who lived in rural areas of Henan with Hubei (66.7%) or Wuhan travel history (65.2%) were more than that in Zhejiang (35.0%, 38.7%), and the differences were statistically significant (P < 0.001). There were 91.9% of cases in urban areas having a contact history, which were higher than that in Zhejiang 85.5% with statistically significant differences (P < 0.05). The difference of time interval from onset to diagnosis between two provinces had no statistically significance (P > 0.05), but the time interval in rural areas of Henan was 0.8 day longer than Zhejiang (Table 7). Together, our data indicate that a higher proportion of elderly cases lived in rural areas of Henan, and more young cases with epidemiological history in Henan come from rural areas, relative to Zhejiang.
Table 7
Comparison of laboratory-confirmed cases in Henan and Zhejiang after adjusting place of residence
Address | Province | Variables | Total(n) | χ2 | P |
| | Gender n (%) | | | |
| | Female | Male | | | |
Urban areas | Zhejiang | 430(51.6%) | 404(48.4%) | 834 | 1.429 | 0.232 |
Henan | 301(48.4%) | 321(51.6%) | 622 |
Rural areas | Zhejiang | 95(44.2%) | 120(55.8%) | 215 | 0.163 | 0.686 |
Henan | 268(42.6%) | 361(57.4%) | 629 |
| | Age n (%) | | | |
| | (0–18) | (19–35) | (36–59) | (≥ 60) | | | |
Urban areas | Zhejiang | 24(2.9%) | 169(20.3%) | 461(55.3%) | 180(21.6%) | 834 | 11.058 | 0.011 |
Henan | 26(4.2%) | 160(25.8%) | 331(53.3%) | 104(16.7%) | 621 |
Rural areas | Zhejiang | 4(1.9%) | 45(20.9%) | 130(60.5%) | 36(16.7%) | 215 | 13.433 | 0.004 |
Henan | 26(4.1%) | 201(32.1%) | 315(50.2%) | 85(13.6%) | 627 |
| | Imported case n (%) | | | |
| No | Yes | |
Urban areas | Zhejiang | 430(53.4%) | 375(46.6%) | 805 | 0.132 | 0.716 |
Henan | 322(52.4%) | 292(47.6%) | 614 |
Rural areas | Zhejiang | 126(59.4%) | 86(40.6%) | 212 | 26.071 | < 0.001 |
Henan | 240(39.2%) | 372(60.8%) | 612 |
| | From Hubei province n (%) | | | |
| No | Yes | |
Urban areas | Zhejiang | 403(56.8%) | 307(43.2%) | 710 | 1.949 | 0.163 |
Henan | 270(52.7%) | 242(47.3%) | 512 |
Rural areas | Zhejiang | 130(65.0%) | 70(35.0%) | 200 | 59.560 | < 0.001 |
Henan | 172(33.3%) | 345(66.7%) | 517 |
| | From Wuhan city n (%) | | | |
| No | Yes | |
Urban areas | Zhejiang | 382(54.7%) | 316(45.3%) | 698 | 0.532 | 0.466 |
Henan | 291(56.8%) | 221(43.2%) | 512 |
Rural areas | Zhejiang | 122(61.3%) | 77(38.7%) | 199 | 41.345 | < 0.001 |
Henan | 180(34.8%) | 337(65.2%) | 517 |
| | Contact the case n (%) | | | |
| No | Yes | |
Urban areas | Zhejiang | 67(14.5%) | 395(85.5%) | 462 | 7.418 | 0.006 |
Henan | 26(8.1%) | 295(91.9%) | 321 |
Rural areas | Zhejiang | 15(12.2%) | 108(87.8%) | 123 | 1.000 | 0.317 |
Henan | 21(8.9%) | 216(91.1%) | 237 |
| | Time interval (day) | | t | P |
Urban areas | Zhejiang | 6.84 ± 4.00 | | 0.1313 | 0.896 |
Henan | 6.81 ± 3.97 | |
Rural areas | Zhejiang | 7.17 ± 4.02 | | -1.858 | 0.064 |
Henan | 7.94 ± 4.36 | |
Comparison of designated hospitals for COVID-19 treatment in Henan and Zhejiang
Generally, a higher-grade hospital will be beneficial for COVID-19 treatment. 147 and 100 designated treatment hospitals were announced by Henan and Zhejiang Heath Commissions, respectively (Figure.5A). Most of designated treatment hospitals in Henan were grade 2A (103), while designated treatment hospitals in Zhejiang were mainly from 3A (25), 3B (32) and 2A (37). In order to further explore whether there is really a difference in the level of treatment for those confirmed cases, we analyzed the medical level of the specific hospitals where the patients were treated. Together, we found that the patients in Zhejiang were indeed treated in higher-grade hospitals, and this difference was statistically significant (P < 0.001) (Figure.5B and Figure.5C).