Nationwide analysis of the impact of COVID-19 in patients with a cardiovascular, oncological or chronic pulmonary disease in the context of an Eastern European country with a low vaccination rate, Bulgaria: March 2020–April 2022

Abstract

ObjectiveThis study focused on Bulgarian patient cohorts harbouring a single documented chronic comorbidity–cardiovascular pathology, an oncological disease or a chronic pulmonary diseases (CPD) comparing the outcomes in fully vaccinated and non-vaccinated populations classified by sex and age groups in ambulatory, hospital and intensive care unit (ICU) settings at the national level.DesignRetrospective analysisSettings, participants and outcome measuresIn total, 1 126 946 patients with confirmed COVID-19, on a national level, were retrospectively analysed between March 2020 and April 2022, using data from the Ministry of Health’s United Information Portal, launched in March 2020.ResultsOf all the confirmed 247 441 hospitalised cases of COVID-19, 67 723 (27.3%) had documented cardiovascular disease (CVD), 2140 (0.9%) had confirmed solid malignancy (regardless of stage) and 3243 (1.3%) had established CPD as their only chronic pathology. The number of cumulative deaths in each subgroup was 10 165 (in-hospital=5812 and ICU=4353); 4.0% vaccinated (410/10 165, p<0.001), 344 (in-hospital=196 and ICU=148), 4.9% vaccinated (17/344, p<0.001), 494 (in-hospital=287 and ICU=207) and 5.2% vaccinated (26/494, p<0.001), respectively. Statistical significance (p<0.001) was obtained in favour of reduced ambulatory, hospitalisation and both in-hospital and ICU-related mortality in the vaccinated cohorts, and BNT162b2 was the most effective at preventing mortality in all age groups.ConclusionsThis retrospective analysis shows that patients vaccinated against COVID-19 demonstrated trends of reduced hospitalisations and premature mortality in patients with CVD, solid malignancy or CPD as a single comorbidity.

Covid-19: Course and prognosis in patients with severe clinical form

“…Bulgaria is among the countries with the highest mortality rate and the lowest COVID-19 vaccine coverage in Europe [14]. Negative attitude in terms of vaccines are confirmed by our data, which show that 64% of patients with severe COVID-19 have been unvaccinated.…”

Relative Risk of Death in Bulgarian Cancer Patients during the Initial Waves of the COVID-19 Pandemic

“…Bulgaria was unique case for the management of the COVID-19 pandemic with suppression of the initial spread and waves with very restrictive measures including complete lockdown in March–May 2020 [ 23 ]. However, subsequent poor management and control of general preventive measures and vaccination hesitancy led to high mortality rates with subsequent waves [ 24 , 25 ]. This increase in in mortality affected both the general population and cancer patients in Bulgaria as evidenced by our descriptive analyses of monthly mortality during the period 2020–2021.…”