Age-Adjusted Associations Between Comorbidity and Outcomes of COVID-19: A Review of the Evidence From the Early Stages of the Pandemic

Abstract

Objectives: Early in the COVID-19 pandemic, people with underlying comorbidities were overrepresented in hospitalised cases of COVID-19, but the relationship between comorbidity and COVID-19 outcomes was complicated by potential confounding by age. This review therefore sought to characterise the international evidence base available in the early stages of the pandemic on the association between comorbidities and progression to severe disease, critical care, or death, after accounting for age, among hospitalised patients with COVID-19.Methods: We conducted a rapid, comprehensive review of the literature (to 14 May 2020), to assess the international evidence on the age-adjusted association between comorbidities and severe COVID-19 progression or death, among hospitalised COVID-19 patients – the only population for whom studies were available at that time.Results: After screening 1,100 studies, we identified 14 eligible for inclusion. Overall, evidence for obesity and cancer increasing risk of severe disease or death was most consistent. Most studies found that having at least one of obesity, diabetes mellitus, hypertension, heart disease, cancer, or chronic lung disease was significantly associated with worse outcomes following hospitalisation. Associations were more consistent for mortality than other outcomes. Increasing numbers of comorbidities and obesity both showed a dose-response relationship. Quality and reporting were suboptimal in these rapidly conducted studies, and there was a clear need for additional studies using population-based samples.Conclusions: This review summarises the most robust evidence on this topic that was available in the first few months of the pandemic. It was clear at this early stage that COVID-19 would go on to exacerbate existing health inequalities unless actions were taken to reduce pre-existing vulnerabilities and target control measures to protect groups with chronic health conditions.

Asymptomatic COVID‐19 and ST‐elevation myocardial infarction in young adults: lessons learned from two similar cases

“… 11 The risk of complications in STEMI and COVID‐19 increases with age and co‐morbidities. 14 , 15 However, in both clinical cases presented by us, patients were young and only one of them had history of previous stroke. Successful outcomes of these two critical patients to our opinion were conditioned by urgent primary percutaneous coronary intervention with further multidisciplinary treatment approach.…”

COVID-19 Outcomes and Genomic Characterization of SARS-CoV-2 Isolated From Veterans in New England States: Retrospective Analysis

“…We used STATA v16 (StataCorp) for logistic regressions to predict our hospitalization and mortality, and ordinal logistic regression to predict peak disease severity. We first conducted a univariate analysis, then used significant variables from the univariate analysis ( P <.05) to use in a multivariate model for each of our outcomes to assess the impact of several variables at once, which has been frequently used in COVID-19 literature [ 9 , 10 , 32 - 34 ]. Assumptions for logistic regressions (binary outcome, linearity, no outliers, and multicollinearity) were tested and met, with maximum variance inflation factors of 2.…”

Authors' Response to Peer Reviews of “COVID-19 Outcomes and Genomic Characterization of SARS-CoV-2 Isolated From Veterans in New England States: Retrospective Analysis”

“…1. Authors added reference [30] but did not indicate or cite it in the paper. I guess it should be listed here: "which has been frequently used in COVID-19 literature [9,[31][32][33].…”