S1 Dataset -

Background
COVID-19 experiences on noncommunicable diseases (NCDs) from district-level hospital settings during waves I and II are scarcely documented. The aim of this study is to investigate the NCDs associated with COVID-19 severity and mortality in a district-level hospital with a high HIV/TB burden.
Methods
This was a retrospective observational study that compared COVID-19 waves I and II at Khayelitsha District Hospital in Cape Town, South Africa. COVID-19 adult patients with a confirmed SARS-CoV-2 polymerase chain reaction (PCR) or positive antigen test were included. In order to compare the inter wave period, clinical and laboratory parameters on hospital admission of noncommunicable diseases, the Student t-test or Mann-Whitney U for continuous data and the X2 test or Fishers’ Exact test for categorical data were used. The role of the NCD subpopulation on COVID-19 mortality was determined using latent class analysis (LCA).
Findings
Among 560 patients admitted with COVID-19, patients admitted during wave II were significantly older than those admitted during wave I. The most prevalent comorbidity patterns were hypertension (87%), diabetes mellitus (65%), HIV/AIDS (30%), obesity (19%), Chronic Kidney Disease (CKD) (13%), Congestive Cardiac Failure (CCF) (8.8%), Chronic Obstructive Pulmonary Disease (COPD) (3%), cerebrovascular accidents (CVA)/stroke (3%), with similar prevalence in both waves except HIV status [(23% vs 34% waves II and I, respectively), p = 0.022], obesity [(52% vs 2.5%, waves II and I, respectively), p <0.001], previous stroke [(1% vs 4.1%, waves II and I, respectively), p = 0.046]. In terms of clinical and laboratory findings, our study found that wave I patients had higher haemoglobin and HIV viral loads. Wave II, on the other hand, had statistically significant higher chest radiography abnormalities, fraction of inspired oxygen (FiO2), and uraemia. The adjusted odds ratio for death vs discharge between waves I and II was similar (0.94, 95%CI: 0.84–1.05). Wave I had a longer average survival time (8.0 vs 6.1 days) and a shorter average length of stay among patients discharged alive (9.2 vs 10.7 days). LCA revealed that the cardiovascular phenotype had the highest mortality, followed by diabetes and CKD phenotypes. Only Diabetes and hypertension phenotypes had the lowest mortality.
Conclusion
Even though clinical and laboratory characteristics differed significantly between the two waves, mortality remained constant. According to LCA, the cardiovascular, diabetes, and CKD phenotypes had the highest death probability.

研究背景
新冠疫情第一、二波期间，地区级医院中与COVID-19相关的非传染性疾病（noncommunicable diseases, NCDs）相关诊疗经验鲜有记载。本研究旨在针对HIV/结核（TB）负担较高的地区级医院，探究与COVID-19重症程度及死亡风险相关的非传染性疾病。

研究方法
本研究为回顾性观察研究，对比了南非开普敦卡耶利特沙地区医院（Khayelitsha District Hospital）接收的新冠疫情第一、二波患者数据。纳入经SARS-CoV-2聚合酶链反应（polymerase chain reaction, PCR）检测阳性或抗原检测阳性的成年COVID-19患者。为对比两波疫情期间患者入院时的非传染性疾病相关临床与实验室参数，本研究针对连续性数据采用t检验（Student t-test）或曼-惠特尼U检验（Mann-Whitney U test），针对分类数据采用卡方检验（X² test）或费希尔精确检验（Fisher's Exact Test）。本研究采用潜在类别分析（latent class analysis, LCA）明确非传染性疾病亚群对COVID-19患者死亡风险的影响。

研究结果
本研究共纳入560例COVID-19住院患者，第二波疫情期间收治的患者年龄显著高于第一波患者。本研究纳入患者中最常见的合并症模式依次为高血压（87%）、糖尿病（65%）、HIV/AIDS（30%）、肥胖（19%）、慢性肾脏病（CKD, Chronic Kidney Disease）（13%）、充血性心力衰竭（CCF, Congestive Cardiac Failure）（8.8%）、慢性阻塞性肺疾病（COPD, Chronic Obstructive Pulmonary Disease）（3%）、脑血管意外（CVA, cerebrovascular accidents）/脑卒中（3%）。除HIV感染状态（第二波23% vs 第一波34%，p=0.022）、肥胖（第二波52% vs 第一波2.5%，p<0.001）及既往脑卒中史（第二波1% vs 第一波4.1%，p=0.046）外，其余合并症在两波疫情中的患病率均无显著差异。
临床与实验室检测结果方面，第一波患者的血红蛋白水平及HIV病毒载量更高；而第二波患者的胸部影像学异常比例、吸入氧分数（fraction of inspired oxygen, FiO2）及尿毒症相关指标水平均显著升高，差异具有统计学意义。校正后，第一波与第二波患者的死亡与出院校正比值比相似（0.94，95%置信区间：0.84~1.05）。第一波疫情中，存活患者的平均生存时间更长（8.0天 vs 6.1天），而存活出院患者的平均住院时长更短（9.2天 vs 10.7天）。潜在类别分析结果显示，心血管表型患者的死亡率最高，其次为糖尿病表型与CKD表型；仅糖尿病表型与高血压表型患者的死亡率最低。

研究结论
尽管两波疫情期间患者的临床与实验室特征存在显著差异，但患者的总体死亡率并未发生明显变化。潜在类别分析结果显示，心血管表型、糖尿病表型及CKD表型患者的死亡风险最高。