Risk Factors of Infection, Hospitalization and Death from SARS-CoV-2: A Population-Based Cohort Study

Abstract

We conducted a prospective population-based cohort study to assess risk factors for infection, hospitalization, and death from SARS-CoV-2. The study comprised the people covered by the Health Service of Navarre, Spain. Sociodemographic variables and chronic conditions were obtained from electronic healthcare databases. Confirmed infections, hospitalizations, and deaths from SARS-CoV-2 were obtained from the enhanced epidemiological surveillance during the second SARS-CoV-2 epidemic surge (July–December 2020), in which diagnostic tests were widely available. Among 643,757 people, 5497 confirmed infections, 323 hospitalizations, 38 intensive care unit admissions, and 72 deaths from SARS-CoV-2 per 100,000 inhabitants were observed. A higher incidence of confirmed infection was associated with people aged 15–29 years, nursing home residents, healthcare workers, people born in Latin America or Africa, as well as in those diagnosed with diabetes, cardiovascular disease, chronic obstructive pulmonary disease (COPD), chronic kidney disease, dementia, severe obesity, hypertension and functional dependence. The risk of hospitalization in the population was associated with males, higher age, nursing home residents, Latin American or African origin, and those diagnosed with immunodeficiency, diabetes, cardiovascular disease, COPD, asthma, kidney disease, cerebrovascular disease, cirrhosis, dementia, severe obesity, hypertension and functional dependence. The risk of death was associated with males, higher age, nursing home residents, Latin American origin, low income level, immunodeficiency, diabetes, cardiovascular disease, COPD, kidney disease, dementia, and functional dependence. This study supports the prioritization of the older population, nursing home residents, and people with chronic conditions and functional dependence for SARS-CoV-2 prevention and vaccination, and highlights the need for additional preventive support for immigrants.

A prospective cohort study on the intersectionality of obesity, chronic disease, social factors, and incident risk of COVID-19 in US low-income minority middle-age mothers

“…Although we did not have specific information about their occupations, we speculate that mothers with higher education may be less likely to be employed in service-related jobs and more likely to engage in remote work, which may have reduced their potential for virus exposure. Consistent with previous research that reported a higher risk of COVID-19 infection among immigrants [ 13 , 14 ], our data demonstrated a significantly increased risk of COVID-19 test positivity among foreign-born mothers independent of the effects of age, education, obesity, and chronic medical conditions. Although the exact mechanism underlying this association is unknown, we hypothesize that this is likely due to a combination of social risk factors of COVID-19 exposure and infection shown to be prevalent in foreign-born populations, such as exposure to overcrowded living environments, higher incidence of poverty, and employment in high exposure/contact jobs (i.e., to provide essential services such as health care, or at essential businesses like grocery stores, etc.)…”

“…Notably, our study showed a lower risk of COVID-19 test positivity in smokers. Although similar findings have been found in previous studies [ 3 , 8 , 13 ], this result should be considered carefully due to the smoking status in our study reflecting the status during index pregnancy, not current.…”

“…Previous observational studies have shown conflicting results about the association between chronic medical conditions and COVID-19 infection, perhaps in part due to selectivity of COVID-19 testing [ 3 , 13 , 14 ]. For example, a study conducted by Gu et al [ 3 ].…”

“…Although some studies have examined race and ethnicity disparities in testing, incidence, and outcomes of COVID-19 [ 3 , 4 , 11 ], data are limited about what factors are associated with excess COVID-19 infection rate in communities of color, especially, among those understudied and underrepresented, including urban, low-income, minority, mothers. Further limiting our understanding of associated factors, most studies have performed analyses on individuals who received COVID-19 testing [ 4 , 5 , 7 , 8 , 12 ] or in general cohort population [ 13 , 14 ], but did not take into account selection in COVID-19 testing. Given COVID-19 testing was not performed at random due to limited testing availability and prioritization, particularly in the early phases of the pandemic, such analyses may have led to selection bias [ 3 ].…”

Effects of 105 biological, socioeconomic, behavioural, and environmental factors on the risk of SARS-CoV-2 infection and a severe course of Covid-19: A prospective longitudinal study

“…Moreover, the range of factors examined by these retrospective or cross-sectional studies was rather limited. Factors significantly or non-significantly associated with Covid-19 were sex 1 , age 1 , ethnicity 2 , urbanisation 3 , residence in a multifamily unit 4 , BMI and obesity 2,5,6 , smoking 2,7 , physical fitness and forced expiratory volume 2 , the number of daily contacts 3 , wearing masks and washing hands 3 , socioeconomic deprivation 2 , particular AB0 blood groups [8-10], Rh factor [10], vitamin D deficiency [11], high-density lipoprotein level 2 , use of immunosuppressants 8 , and a growing set of comorbidities – cardiovascular disease, chronic obstructive pulmonary disease (COPD), chronic kidney disease, dementia, hypertension and functional dependence 6 , and toxoplasmosis 9 . Other factors, such as contact with animals, have been suggested only on a theoretical basis 10 or are merely discussed in non-scientific sources, such as popular literature or the internet.…”