Infectious Disease

Age, gender, and comorbidities all have an effect on outcomes after hospitalization with COVID-19

January 06, 2021

3 min read

Source / information

Source:

Navar AM et al. LBS.08: AHA goes viral: COVID-19, influenza vaccines, and cardiovascular disease. Presented at: American Heart Association Scientific Sessions; 13-17 November 2020 (virtual meeting).

Disclosure:
The data set was provided by Cerner Corp. and Amazon Web Services. Navar reports that she was a strategic advisor to Cerner Corp. but was not compensated for working on the study.

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In a national private health database, age, male sex and comorbidities increased the risk of death in patients hospitalized with COVID-19. This is based on data presented at the American Heart Association’s virtual scientific sessions.

The results were largely consistent with data from the AHA’s COVID-19 CVD registry, which was also presented at the meeting.

About half of the patients hospitalized with COVID-19 had high blood pressure.

The record of patients with COVID-19 was obtained from Cerner Corp. and Amazon Web Services, Cardiology Today Next Gen Innovator Ann Marie Navar, MD, PhD, Associate Professor of Internal Medicine and of Population and Data Science at the University of Texas Southwestern Medical Center said during a presentation.

Ann Marie Navar

“We need to understand who is most at risk, especially when we use vaccination strategies,” she said. “We also need to understand risk factors so that people can understand their own risk of disease and make informed decisions accordingly. For people hospitalized with COVID-19, it is important that we understand the risk factors for worse outcomes as we need to have important informed conversations with patients and their families about their prognosis. “

The dataset, which included visits through July 1, was created from electronic health records from 52 health systems, she said. To be included, a patient had to have a positive COVID-19 test within 2 weeks or while hospitalized, or a diagnostic code for COVID-19 while hospitalized.

The analysis included 19,584 patients with COVID-19 (mean age 52 years; 47% women; 29.4% Hispanic American) who died or were discharged home during the study period.

In the cohort, 31.1% had diabetes, 50.4% hypertension, 14.3% HF, 18% CAD, and 5.6% had end-stage kidney disease, Navar said.

The hospital death rate was 20.7%. 32.6% required mechanical ventilation, 5% had MI, 2% had pulmonary embolism, and 1.5% had stroke.

“The mortality within these complications was quite high,” she said, noting that 74.6% of patients on mechanical ventilation, 55.5% of patients with MI, 26.5% of patients with PE, and 56% of patients died with stroke.

Regarding age, “it is noticeable that from the age of 55, the risk of death in hospitalized patients increases almost linearly,” said Navar.

Hispanic patients had lower death rates than non-Hispanic patients (12.7% versus 25%), she said. Among those whose ethnicity was unknown, the death rate was 19.7%.

The death rates by race were as follows: white, 20.8%; Black 22.7%; Asian / Pacific Islander, 19.7%; Indians / Alaskan Natives, 24.1%; other 15.5%; and unknown 26.6%.

The post-comorbidity mortality rates were as follows: CAD 28.8%; End-stage kidney disease, 28.7%; HF 32.4%; Hypertension 20.4%; and diabetes 21.5%.

In an inverse cubic spline analysis, “although we saw an increase in BMI mortality from around 30 kg / m2, it was actually the most dramatic increase among the underweight,” said Navar. “This is after the patients were hospitalized and we have seen a disproportionate number of patients who were obese and were initially hospitalized. This suggests that being underweight after hospitalization may be just as large or worse a risk factor than being overweight. “

After multivariable adjustment, the following predictors of mortality after COVID-19 hospitalization were: male sex (OR = 1.46; 95% CI, 1.31-1.62), Medicare insurance (OR = 1.77; 95 % CI, 1.51-2.08), Medicaid Insurance (OR = 1.62; 95% CI, 1.31-2), Diabetes (OR = 1.27; 95% CI, 1.13-1 , 42), HF (OR = 1.29; 95% CI, 1.13-1.47) chronic kidney disease (OR = 1.5); 95% CI, 1.32-1.69), said Navar, noting that Hispanic ethnicity protects against mortality (OR = 0.71; 95% CI, 0.59-0.86), there were differences after Age and BMI along the inverted cubic spline and there were differences No significant differences by race.

“Because of the correlation between these different risk factors, it’s a little difficult to understand which factors are actually driving risk and which are only more statistically significant in the model,” said Navar.

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