Characteristics, comorbidities and survival analysis of young adults hospitalized with COVID-19 in New York City

Abstract

This study reviewed 395 young adults, 18–35 year-old, admitted for COVID-19 to one of the eleven hospitals in New York City public health system. Demographics, comorbidities, clinical course, outcomes and characteristics linked to hospitalization were analyzed including temporal survival analysis. Fifty-seven percent of patients had a least one major comorbidity. Mortality without comorbidity was in 3.8% patients. Further investigation of admission features and medical history was conducted. Comorbidities associated with mortality were diabetes (n = 54 deceased/73 diagnosed,74% tested POS;98.2% with diabetic history deceased; Wilcoxon p (Wp) = .044), hypertension (14/44,32% POS, 25.5%; Wp = 0.030), renal (6/16, 37.5% POS,11%; Wp = 0.000), and cardiac (6/21, 28.6% POS,11%; Wp = 0.015). Kaplan survival plots were statistically significant for these four indicators. Data suggested glucose >215 or hemoglobin A1c >9.5 for young adults on admission was associated with increased mortality. Clinically documented respiratory distress on admission was statistically significant outcome related to mortality (X2 = 236.6842, df = 1, p < .0001). Overall, 28.9% required supportive oxygen beyond nasal cannula. Nasal cannula oxygen alone was required for 71.1%, who all lived. Non-invasive ventilation was required for 7.8%, and invasive mechanical ventilation 21.0% (in which 7.3% lived, 13.7% died). Temporal survival analysis demonstrated statistically significant response for Time to Death <10 days (X2 = 18.508, df = 1, p = .000); risk lessened considerably for 21 day cut off (X2 = 3.464, df = 1, p = .063), followed by 31 or more days of hospitalization (X2 = 2.212, df = 1, p = .137).

Risk factors for severity of COVID-19 in hospital patients age 18–29 years

“…Additionally, we were able to assess thirty-day patient statuses, including subsequent hospital encounters, and to capture a range of disease outcomes. The previously published research articles describing risk factors for severe COVID-19 in young adults included a combined total of fewer than 1,500 patients, and primarily included information from the diagnostic encounter [6][7][8]. Our findings constitute a substantial addition to the existing knowledge base because we not only included data for young adults diagnosed at both inpatient and emergency department encounters, but also collected longitudinal outcome data, thus allowing us to characterize patients at all stages of disease progression.…”

“…Specifically, the proportion of young-adult COVID-19 patients in the Houston area has markedly increased over time [5]. Among studies in young adults, only a few have incorporated longitudinal clinical data [6][7][8]. However, these studies were either conducted with small sample size [6,8] or only reported preliminary data on the proportion of patients who experienced the composite event of death and mechanical ventilation [7].…”

“…Although young adults are at increased risk for COVID-19 exposure, the risk of immediate and long term COVID-19 outcomes and sequalae in young adults infected with SARS-CoV-2 is still largely unknown. While increased age and comorbidities have been identified as independent risk factors for hospitalization and death in the general population, the association between specific disease outcomes and other demographic and clinical risk factors among young adults diagnosed with COVID-19 have been described in only a few studies [6,7]. The current study aimed to investigate 30-day COVID-19 disease outcomes among young adults 18-29 years old diagnosed within a large, metropolitan hospital system from March 1 to December 7, 2020.…”

COVID-19 in young and middle-aged adults: predictors of poor outcome and clinical differences

“…These findings are consistent with the rates Cunningham et al found using a national all-payer hospital database in adults aged 18–34 years admitted to US hospitals, namely, 21% required intensive care and 2.7% died [ 14 ]. Notably, Altonen et al reported an even higher mortality rate of 13% in this population in New York City public hospitals [ 15 ]. Recent data from the from the Spanish Ministry of Health show that more than 2 million patients between 20 and 60 years of age have been infected with SARS-CoV-2 and 3.9% of them have required hospitalization; 0.39% (10% of hospitalized patients) have been admitted to the ICU with an overall mortality rate of 0.1% [ 16 ].…”

“…The only baseline comorbidity that carried a significant risk in our study was heart disease. Numerous studies have shown that patients with underlying heart diseases have higher odds of death from COVID-19 [23][24][25][26] and it has also been described as a risk factor in a younger population [15]. The worse prognosis of COVID-19 in patients with a history of heart disease could be related to elevated expression of ACE2 and a higher baseline production and release of renin.…”