Abstract
BackgroundHospitalized COVID-19 patients tend to be older and frequently have hypertension, diabetes, or coronary heart disease, but whether these comorbidities are true risk factors (ie, more common than in the general older population) is unclear. We estimated associations between preexisting diagnoses and hospitalized COVID-19 alone or with mortality, in a large community cohort.MethodsUK Biobank (England) participants with baseline assessment 2006–2010, followed in hospital discharge records to 2017 and death records to 2020. Demographic and preexisting common diagnoses association tested with hospitalized laboratory-confirmed COVID-19 (March 16 to April 26, 2020), alone or with mortality, in logistic models.ResultsOf 269 070 participants aged older than 65, 507 (0.2%) became COVID-19 hospital inpatients, of which 141 (27.8%) died. Common comorbidities in hospitalized inpatients were hypertension (59.6%), history of fall or fragility fractures (29.4%), coronary heart disease (21.5%), type 2 diabetes (type 2, 19. 9%), and asthma (17.6%). However, in models adjusted for comorbidities, age group, sex, ethnicity, and education, preexisting diagnoses of dementia, type 2 diabetes, chronic obstructive pulmonary disease, pneumonia, depression, atrial fibrillation, and hypertension emerged as independent risk factors for COVID-19 hospitalization, the first 5 remaining statistically significant for related mortality. Chronic kidney disease and asthma were risk factors for COVID-19 hospitalization in women but not men.ConclusionsThere are specific high-risk preexisting comorbidities for COVID-19 hospitalization and related deaths in community-based older men and women. These results do not support simple age-based targeting of the older population to prevent severe COVID-19 infections.
Highlights
The 2019 novel coronavirus (SARS-COV-19) has caused a global pandemic [1], with a wide spectrum of clinical disease presentations, from asymptomatic infection to respiratory failure with high mortality [2]
COVID-19 patients had a mean of 2.4 diagnoses compared to other participants with 1.4 diagnoses
We found that some chronic conditions reported as common co-morbidities in COVID-19 patients, were modestly or not (CHD) significantly more common with COVID-19 than in other older UK Biobank participants
Summary
The 2019 novel coronavirus (SARS-COV-19) has caused a global pandemic [1], with a wide spectrum of clinical disease presentations, from asymptomatic infection to respiratory failure with high mortality [2]. Co-morbidities vary with patient age-group, and in those aged over 70, obesity is less common and dementia is more common [3] Such data on common co-morbidities in hospitalized patients is important for understanding the acute treatment challenge, but it is unclear whether these conditions are common in COVID-19 patients merely because they are common in the older population. To identify those at most risk of severe COVID-19, data are needed on which pre-existing conditions are disproportionately common in severely affected patients compared to the background population. We aimed to estimate associations between pre-existing diagnoses and COVID-19 status, in a large community cohort
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