The Age-Related Risk of Severe Outcomes Due to COVID-19 Infection: A Rapid Review, Meta-Analysis, and Meta-Regression

Abstract

Increased age appears to be a strong risk factor for COVID-19 severe outcomes. However, studies do not sufficiently consider the age-dependency of other important factors influencing the course of disease. The aim of this review was to quantify the isolated effect of age on severe COVID-19 outcomes. We searched Pubmed to find relevant studies published in 2020. Two independent reviewers evaluated them using predefined inclusion and exclusion criteria. We extracted the results and assessed seven domains of bias for each study. After adjusting for important age-related risk factors, the isolated effect of age was estimated using meta-regression. Twelve studies met our inclusion criteria: four studies for COVID-19 disease severity, seven for mortality, and one for admission to ICU. The crude effect of age (5.2% and 13.4% higher risk of disease severity and death per age year, respectively) substantially decreased when adjusting for important age-dependent risk factors (diabetes, hypertension, coronary heart disease/cerebrovascular disease, compromised immunity, previous respiratory disease, renal disease). Adjusting for all six comorbidities indicates a 2.7% risk increase for disease severity (two studies), and no additional risk of death per year of age (five studies). The indication of a rather weak influence of age on COVID-19 disease severity after adjustment for important age-dependent risk factors should be taken in consideration when implementing age-related preventative measures (e.g., age-dependent work restrictions).

Health Inequalities During COVID-19 and Their Effects on Morbidity and Mortality

“…These populations are known to have an aging population, 16 higher burden of preventable diseases such as hypertension and diabetes, and poorer access to healthcare. 17 There is extensive evidence suggesting that the risk of mortality from COVID-19 is higher in the ageing population, 16 , 18 potentially causing the non-ASMR to be higher in rural populations than urban ones. 19 Moreover, studies suggest that rural communities tend to have a higher burden of pre-existing conditions than urban communities.…”

Under COVID of the night

“…Particularly vulnerable populations to COVID-19 proved to be the aged and infirm, who are more likely to have complicated comorbidities and might have an exaggerated inflammatory immune response to the virus 3 ; those already at risk for adverse health outcomes based simply, and tragically, on their race 4 ; and people with immune systems that were functionally compromised. Patients with hematologic malignancies are potentially ideal viral breeding grounds, with immune systems already corrupted and rendered at least somewhat incompetent by cancer, and by both cytotoxic and immunologic therapies which, by design, further suppress immune function.…”

The Efficacy and Safety of Hydroxychloroquine in Patients with COVID-19: A Multicenter National Retrospective Cohort

“…However, a recent study quantifying the isolated effect of age on severity of COVID-19 outcomes concluded a minimal influence of age after adjusting for important age-dependent risk factors (e.g., diabetes, hypertension, cardiovascular disease (CVD) etc.) [ 29 ]. Indeed, this was observed in our HCQ-receiving cohort, which showed a higher number of associated comorbidities, namely diabetes mellitus, hypertension, and COPD, compared to the control cohort.…”