Which burden of COVID-19 was greater: main diagnosis or comorbidity?

Abstract

Abstract Background Severe cases of COVID-19 require hospital treatment due to the risk of developing a life-threatening condition. Monitoring and reporting indicators of severe forms of COVID-19 in the population can warn health authorities of its increasing presence and the growing demand for hospital treatment and measures to protect persons at risk. By estimating the total and age-sex disaggregated Years Lived with Disability (YLD), we differentiated the magnitude of the burden of COVID-19 among inpatients with COVID-19 as the main diagnosis and as comorbidity. Methods Within the EU-COST Action 18218 and as partners of the BoCO-19 study, we calculated the total age and sex-disaggregated YLD and YLD/100,000 population due to COVID-19 for hospitalized cases in Serbia from 2020 March 6 - December 31. The number of cases of ICD-X: U07.1 and U07.2 as the main diagnosis, separately and with U07.1 as comorbidity, were taken from the hospitalization database of the Institute of Public Health of Serbia, and disability weights and length of the disease from the German national BoD study. Results In 2020, 25,496 covid-19 cases were hospitalized (55.9% were men). 65.7% of all cases were covid-19 as a comorbidity diagnosis. 195.0 YLD was estimated for all hospitalized cases (man: 109.0 YLD or 3.2 YLD /100,000, women: 95.9 YLD or 2.4 YLD/100,000). YLD and YLD/100,000 due to covid-19 as a comorbidity diagnosis were the highest among males aged 40-84 and females aged 55-84. Conclusions In Serbia, more men than women were hospitalized due to COVID-19. Hospitalized adult men had the most YLD and the highest YLD rates. Inpatients in which covid-19 was diagnosed as a comorbidity had higher YLD and YLD rates, especially male patients. On average, the YLD burden of COVID-19 as a comorbidity for hospitalized cases was almost triple that of COVID-19 as the main diagnosis, suggesting the need for improving health protection and safety measures. Key messages • In Serbia, among hospitalized cases, the YLD due to COVID-19 is three times higher in patients diagnosed with COVID-19 as a comorbidity than in the main diagnosis. • To decrease the YLD due to severe COVID-19, enhancing the safety and health protection of inpatients from contracting COVID-19 as comorbidity is of utmost importance.