Patients younger than 60 years of age with COVID-19 who have certain demographic characteristics and comorbidities at an increased risk of mortality compared with those aged 60 years and older with the same comorbidities, according to results of a study published in Journal of Infectious Diseases and Epidemiology.
Between March and May 2020, investigators conducted a retrospective analysis of patients with confirmed COVID-19 at a single center in New York City. They assessed the moderating effects of demographics on the relationship between comorbidities and the risk of mortality from COVID-19.
A total of 8324 patients were included in the analysis, and 918 (11%) died. The investigators reviewed electronic health records (EHR) and ICD-9/ICD-10 diagnosis codes to obtain patients’ comorbidity and demographic data. Of the 34 comorbidities investigated, 30 were associated with a significantly increased risk of mortality. The comorbidities with the greatest mortality risk included cardiac arrhythmia (odds ratio [OR], 15.9; 95% CI, 13-19.3; P <.001), coagulopathy (OR, 7.5; 95% CI, 6.4-8.8; P <.001), fluid and electrolyte disorders (OR, 22; 95% CI, 17.7-27.2; P <.001), hypertension (OR, 7.4; 95% CI, 6.2-8.8; P <.001), myocardial infarction (OR, 7.2; 95% CI, 5.9-8.6; P <.001), and neurologic disorders (OR, 7.9; 95% CI, 6.7-9.2; P <.001).
After stratification of patients’ comorbidities by sex, age, and ethnicity, the investigators noted that women with major depressive disorder (MDD) had an increased risk of mortality (OR, 1.2; 95% CI, 0.8-1.6; P =.44) compared with men with MDD. Mortality risk was also increased among younger patients (age, <60 years) with cardiac arrhythmia (OR, 15.3; 95% CI, 9.0-25.9; P <.001), neurologic disorders (OR, 4.6; 95% CI, 2.9-7.3; P < .001), paralysis (OR, 2.5; 95% CI, 1.0-6.1; P =.04), and pulmonary disorders (OR, 4.5; 95% CI, 2.7-7.4; P <.001) compared with older patients (age, ≥60 years) with the same comorbidities. Compared with patients in other demographic groups with anemia and solid tumors without metastasis, mortality risk was increased among White patients with anemia (OR, 1.2; 95% CI, 0.8-1.7; P =.32) and Black patients with solid tumors without metastasis (OR, 2.0; 95% CI, 1.0-3.9; P =.03).
The study limitations included the lack of or incomplete electronic health record data, comorbidities were extracted from lists of patients’ problems associate and did not include dates to indicate their onset, limited availability and sensitivity in regard to SARS-CoV-2 infection testing, and the generalizability of the results to other patient populations. In addition, differences in admission, discharge, and triage decisions may have affected the mortality results.
The investigators concluded, “identifying groups with Covid-19 at greater risk for mortality can lead to increased awareness and targeted health interventions at the individual and community level to improve Covid-19 outcomes.”
Solomon S, Hochman S, Sheikh R, Lighter J, Phillips M, Stachel A. The impact of age, sex, and race on the association of risk factors and mortality in COVID-19 patients. J Infect Dis Epidemiol. 2021;7:215. doi.org/10.23937/2474-3658/1510215