Risk Factors
This meta-analysis aims to provide an overview of the major predictors of SARS-CoV-2 related mortality rates (MR). All prospective and retrospective observational studies reporting crude overall COVID-19-related MR in hospitalized patients were included in the study. There were 87 articles included in the study. The primary outcome was the analysis of MR in hospitalized patients. Secondary outcomes involved the comparison of MR with age and countries. Further, the association between diabetes, hypertension, cardiovascular disease, chronic kidney disease and chronic obstructive pulmonary disease with MR was analyzed. Average age of the population included was 60.9 ± 8.2 years, with males more prevalent than females (57.7 ± 13.5%). MR for U.S. was higher compared to other countries (Q = 6.25, p < 0.02 for US vs. others). Among morbidities reported, arterial hypertension was most prevalent (mean 40.8%) followed by diabetes (22.3%), cardiovascular disease (18.5%), chronic kidney disease (12.0%), active malignancies (8.2%) and chronic obstructive pulmonary disease (6.8%). After adjusting for confounders, all morbidities tested remained significantly associated with a higher MR; diabetes and chronic obstructive pulmonary disease had the strongest predictors of mortality.
This study uses data from NHANES to better understand the proportion of the population that is at risk of severe COVID-19 infection. Risk factors analyzed in the study were gender, age, race/ethnicity, educational attainment, income, and history of heart disease.
After data weighting, there were an estimated 176.1 million individuals representing 75.4% of U.S. adults that had at least one high-risk health condition, 40.3% had 2 or more conditions and 18.5% had 3 or more conditions. Excluding age as a risk factor, 72.6% of U.S. adults were estimated to be at increased risk of severe COVID-19 infection. Interestingly, a considerable amount of the population at-risk of severe infection were those < 65 with 69.2% at increased-risk overall, including 58.8% in the 18-29 age group. Obesity was the most prevalent risk condition (41.3%), followed by age ≥65 (20.2%) and chronic kidney disease (15.8%). Excluding obesity, 61.1% of the overall population and 51.2% of those < 65 had an increased risk of moderate-severe infection.
Similar at-risk proportions were seen among black and white individuals (75.6 vs 78.0%, p>0.05), and in younger adults (71.5 vs. 70.8%, p>0.05). Additionally, younger Hispanics and whites were estimated to be at increased risk (68.4 vs 70.8%, p>0.05), with proportionally fewer Hispanics in the overall population at increased risk compared to whites (71.6 vs 78.0%, p<0.05). Socioeconomic differences were also prevalent. Those with lower education levels (<high school vs. >high school, 83.0 vs 71.0%, p<0.05) and lower income levels (<150% vs. ≥150% federal poverty level, 54.7% vs 49.1%, p<0.05) had a greater proportion at increased-risk. When observing risk factors, approximately 6.2 million (14.5% of the population) had heart disease. Among these, almost all had at least one additional CDC risk factor (97.9%) and majority had 2 or more risk factors (83.8%).
