bims-covirf Biomed News
on COVID19 risk factors
Issue of 2020‒07‒26
nine papers selected by
Catherine Rycroft
BresMed


  1. Acta Med Port. 2020 Jul 24.
    Laires PA, Nunes C.
      INTRODUCTION: COVID-19 is a viral respiratory disease, which became a global threat to public health. Specific subsets of the population are more vulnerable, namely those with chronic diseases. We aimed to estimate the share of the Portuguese population at the highest risk for complications following COVID-19 infection due to both old age and specific comorbidities.MATERIAL AND METHODS: Our sample included all people aged 65 years and above (2215 men and 3486 women) who participated in the fifth Portuguese National Health Interview Survey, conducted in 2014. In order to project the potential population at highest risk for COVID-19, we used the latest available official demographic estimates from the National Institute of Statistics - INE 2018. We used a more restrictive definition of risk combining old age criteria and the following chronic conditions as potential risk factors for COVID-19 according to the available literature: hypertension, diabetes, chronic obstructive pulmonary disease, cardio- and cerebrovascular disease.
    RESULTS: We estimated that 15.5% (n = 1 560 667) of the Portuguese population might be at increased risk for complications from COVID-19 because of old age and existing chronic conditions. Such estimates vary across the country (from 1.7% in Azores to 33.7% in Northern Portugal). Northern Portugal not only has the highest prevalence of selected morbidity (72.8%) within mainland Portugal, but also has the largest population at risk for COVID-19 (n = 526 607). This was followed by the Lisbon and Tagus Valley region (n = 408 564) and Central Portugal (n = 388 867).
    DISCUSSION: Our results should encourage authorities to continue protecting those more vulnerable to the pandemic threat, particularly on those areas of the country which are more likely to be further affected.
    CONCLUSION: We projected a considerable number of Portuguese people at the highest risk for severe COVID-19 disease due to both old age and pre-existing chronic conditions. Such estimates vary across the country.
    Keywords:  Age Factors; COVID-19; Chronic Disease/epidemiology; Coronavirus Infections/ epidemiology; Portugal; Risk Assessment; Risk Factors; Severity of Illness Index
    DOI:  https://doi.org/10.20344/amp.14222
  2. Public Health. 2020 Jul 07. pii: S0033-3506(20)30294-8. [Epub ahead of print]185 261-263
    Bray I, Gibson A, White J.
      BACKGROUND: There is emerging evidence about characteristics that may increase the risk of coronavirus disease 2019 (COVID-19) mortality, but they are highly correlated.METHODS: An ecological analysis was used to estimate associations between these variables and age-standardised COVID-19 mortality rates at the local authority level.
    RESULTS: Ethnicity, population density and overweight/obesity were all found to have strong independent associations with COVID-19 mortality, at the local authority level.
    DISCUSSION: This analysis provides some preliminary evidence about which variables are independently associated with COVID-19 mortality and suggests that others (deprivation and pollution) are not directly linked. It highlights the importance of multivariate analyses to understand the factors that increase vulnerability to COVID-19.
    Keywords:  COVID-19; Deprivation; Ethnicity; Obesity; Overweight; Pollution; Population density
    DOI:  https://doi.org/10.1016/j.puhe.2020.06.056
  3. Front Immunol. 2020 ;11 1606
    Carter-Timofte ME, Jørgensen SE, Freytag MR, Thomsen MM, Brinck Andersen NS, Al-Mousawi A, Hait AS, Mogensen TH.
      Coronavirus disease-19 (COVID-19) describes a set of symptoms that develop following infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Whilst COVID-19 disease is most serious in patients with significant co-morbidities, the reason for healthy individuals succumbing to fulminant infection is largely unexplained. In this review, we discuss the most recent findings in terms of clinical features and the host immune response, and suggest candidate immune pathways that may be compromised in otherwise healthy individuals with fulminating COVID-19. On the basis of this early knowledge we reason a potential genetic effect on host immune response pathways leading to increased susceptibility to SARS-CoV-2 infection. Understanding these pathways may help not only in unraveling disease pathogenesis, but also in suggesting targets for therapy and prophylaxis. Importantly such insight should instruct efforts to identify those at increased risk in order to institute preventative measures, such as prophylactic medication and/or vaccination, when such opportunities arise in the later phases of the current pandemic or during future similar pandemics.
    Keywords:  SARS-coronavirus 2; host immune defenses; immunopathology; innate immunity; primary immunodeficiency; whole exome sequencing
    DOI:  https://doi.org/10.3389/fimmu.2020.01606
  4. medRxiv. 2020 Jul 14. pii: 2020.07.11.20151563. [Epub ahead of print]
    Correa-Agudelo E, Mersha T, Hernandez A, Branscum AJ, MacKinnon NJ, Cuadros DF.
      Background The role of health-related disparities including sociodemographic, environmental, and critical care capacity in the COVID-19 pandemic are poorly understood. In the present study, we characterized vulnerable populations located in areas at higher risk of COVID-19 related mortality and low critical healthcare capacity in the U.S. Methods Using Bayesian multilevel analysis and small area disease risk mapping, we assessed the spatial variation of COVID-19 related mortality risk for the U.S. in relation with healthcare disparities including race, ethnicity, poverty, air quality, and critical healthcare capacity. Results Overall, highly populated, regional air hub areas, and minorities had an increased risk of COVID-19 related mortality. We found that with an increase of only 1 ug/m3 in long term PM2.5 exposure, the COVID-19 mortality rate increased by 13%. Counties with major air hubs had 18% increase in COVID-19 related death compared to counties with no airport connectivity. Sixty-eight percent of the counties with high COVID-19 related mortality risk were also counties with lower critical care capacity than national average. These counties were primary located at the North- and South-Eastern regions of the country. Conclusion The existing disparity in health and environmental risk factors that exacerbate the COVID-19 related mortality, along with the regional healthcare capacity, determine the vulnerability of populations to COVID-19 related mortality. The results from this study can be used to guide the development of strategies for the identification and targeting preventive strategies in vulnerable populations with a higher proportion of minority groups living in areas with poor air quality and low healthcare capacity.
    DOI:  https://doi.org/10.1101/2020.07.11.20151563
  5. MMWR Morb Mortal Wkly Rep. 2020 Jul 24. 69(29): 945-950
    Razzaghi H, Wang Y, Lu H, Marshall KE, Dowling NF, Paz-Bailey G, Twentyman ER, Peacock G, Greenlund KJ.
      Risk for severe coronavirus disease 2019 (COVID-19)-associated illness (illness requiring hospitalization, intensive care unit [ICU] admission, mechanical ventilation, or resulting in death) increases with increasing age as well as presence of underlying medical conditions that have shown strong and consistent evidence, including chronic obstructive pulmonary disease, cardiovascular disease, diabetes, chronic kidney disease, and obesity (1-4). Identifying and describing the prevalence of these conditions at the local level can help guide decision-making and efforts to prevent or control severe COVID-19-associated illness. Below state-level estimates, there is a lack of standardized publicly available data on underlying medical conditions that increase the risk for severe COVID-19-associated illness. A small area estimation approach was used to estimate county-level prevalence of selected conditions associated with severe COVID-19 disease among U.S. adults aged ≥18 years (5,6) using self-reported data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) and U.S. Census population data. The median prevalence of any underlying medical condition in residents among 3,142 counties in all 50 states and the District of Columbia (DC) was 47.2% (range = 22.0%-66.2%); counties with the highest prevalence were concentrated in the Southeast and Appalachian region. Whereas the estimated number of persons with any underlying medical condition was higher in population-dense metropolitan areas, overall prevalence was higher in rural nonmetropolitan areas. These data can provide important local-level information about the estimated number and proportion of persons with certain underlying medical conditions to help guide decisions regarding additional resource investment, and mitigation and prevention measures to slow the spread of COVID-19.
    DOI:  https://doi.org/10.15585/mmwr.mm6929a1
  6. J Gerontol A Biol Sci Med Sci. 2020 Jul 20. pii: glaa183. [Epub ahead of print]
    Atkins JL, Masoli JAH, Delgado J, Pilling LC, Kuo CL, Kuchel GA, Melzer D.
      BACKGROUND: Hospitalized COVID-19 patients tend to be older and frequently have hypertension, diabetes or coronary heart disease (CHD), but whether these co-morbidities are true risk factors (i.e. more common than in the general older population) is unclear. We estimated associations between pre-existing diagnoses and hospitalized COVID-19 alone or with mortality, in a large community cohort.METHODS: UK Biobank (England) participants with baseline assessment 2006 to 2010, followed in hospital discharge records to 2017 and death records to 2020. Demographic and pre-existing common diagnoses association tested with hospitalized laboratory confirmed COVID-19 (16th March to 26th April 2020), alone or with mortality, in logistic models.
    RESULTS: Of 269,070 participants aged 65+, 507 (0.2%) became COVID-19 hospital inpatients, of which 141 (27.8%) died. Common co-morbidities in hospitalized inpatients were hypertension (59.6%), history of fall or fragility fractures (29.4%), coronary heart disease (CHD, 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, pre-existing diagnoses of dementia, type 2 diabetes, COPD, pneumonia, depression, atrial fibrillation and hypertension emerged as independent risk factors for COVID-19 hospitalization, the first five remaining statistically significant for related mortality. Chronic Kidney Disease and asthma were risk factors for COVID-19 hospitalization in women but not men.
    CONCLUSION: There are specific high risk pre-existing co-morbidities 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.
    Keywords:  COVID-19; Epidemiology; Morbidity; Mortality
    DOI:  https://doi.org/10.1093/gerona/glaa183
  7. Am J Trop Med Hyg. 2020 Jul 16.
    Soares RCM, Mattos LR, Raposo LM.
      Brazil is, at the time of writing, the global epicenter of COVID-19, but information on risk factors for hospitalization and mortality in the country is still limited. Demographic and clinical data of COVID-19 patients until June 11th, 2020 were retrieved from the State Health Secretariat of Espírito Santo, Brazil. Potential risk factors for COVID-19 hospitalization and death were analyzed by univariate and multivariable logistic regression models. A total of 10,713 COVID-19 patients were included in this study; 81.0% were younger than 60 years, 55.2% were female, 89.2% were not hospitalized, 32.9% had at least one comorbidity, and 7.7% died. The most common symptoms on admission were cough (67.7%) and fever (62.6%); 7.1% of the patients were asymptomatic. Cardiovascular diseases (23.7%) and diabetes (10.3%) were the two most common chronic diseases. Multivariate logistic regression analysis identified an association of all explanatory variables, except for cough and diarrhea, with hospitalization. Older age (odds ratio [OR] = 3.95, P < 0.001) and shortness of breath (OR = 3.55, P < 0.001) were associated with increase of odds to COVID-19 death in hospitalized patients. Our study provided evidence that older age, male gender, Asian, indigenous or unknown race, comorbidities (smoking, kidney disease, obesity, pulmonary disease, diabetes, and cardiovascular disease), as well as fever and shortness of breath increased the risk of hospitalization. For death outcome in hospitalized patients, only older age and shortness of breath increased the risk.
    DOI:  https://doi.org/10.4269/ajtmh.20-0483
  8. Obes Rev. 2020 Jul 19.
    Földi M, Farkas N, Kiss S, Zádori N, Váncsa S, Szakó L, Dembrovszky F, Solymár M, Bartalis E, Szakács Z, Hartmann P, Pár G, Erőss B, Molnár Z, Hegyi P, Szentesi A, .
      The disease course of COVID-19 varies from asymptomatic infection to critical condition leading to mortality. Identification of prognostic factors is important for prevention and early treatment. We aimed to examine whether obesity is a risk factor for the critical condition in COVID-19 patients by performing a meta-analysis. The review protocol was registered onto PROSPERO (CRD42020185980). A systematic search was performed in five scientific databases between 1 January and 11 May 2020. After selection, 24 retrospective cohort studies were included in the qualitative and quantitative analyses. We calculated pooled odds ratios (OR) with 95% confidence intervals (CIs) in meta-analysis. Obesity was a significant risk factor for intensive care unit (ICU) admission in a homogenous dataset (OR = 1.21, CI: 1.002-1.46; I2 = 0.0%) as well as for invasive mechanical ventilation (IMV) (OR = 2.05, CI: 1.16-3.64; I2 = 34.86%) in COVID-19. Comparing body mass index (BMI) classes with each other, we found that a higher BMI always carries a higher risk. Obesity may serve as a clinical predictor for adverse outcomes; therefore, the inclusion of BMI in prognostic scores and improvement of guidelines for the intensive care of patients with elevated BMI are highly recommended.
    Keywords:  COVID-19; intensive care; mechanical ventilation; obesity
    DOI:  https://doi.org/10.1111/obr.13095
  9. Am J Med Sci. 2020 Jun 20. pii: S0002-9629(20)30257-3. [Epub ahead of print]
    Li AY, Hannah TC, Durbin JR, Dreher N, McAuley FM, Marayati NF, Spiera Z, Ali M, Gometz A, Kostman JT, Choudhri TF.
      BACKGROUND: There has been much interest in environmental temperature and race as modulators of Coronavirus disease-19 (COVID-19) infection and mortality. However, in the United States race and temperature correlate with various other social determinants of health, comorbidities, and environmental influences that could be responsible for noted effects. This study investigates the independent effects of race and environmental temperature on COVID-19 incidence and mortality in United States counties.METHODS: Data on COVID-19 and risk factors in all United States counties was collected. 661 counties with at least 50 COVID-19 cases and 217 with at least 10 deaths were included in analyses. Upper and lower quartiles for cases/100,000 people and halves for deaths/100,000 people were compared with t-tests. Adjusted linear and logistic regression analyses were performed to evaluate the independent effects of race and environmental temperature.
    RESULTS: Multivariate regression analyses demonstrated Black race is a risk factor for increased COVID-19 cases (OR=1.22, 95% CI: 1.09-1.40, P=0.001) and deaths independent of comorbidities, poverty, access to health care, and other risk factors. Higher environmental temperature independently reduced caseload (OR=0.81, 95% CI: 0.71-0.91, P=0.0009), but not deaths.
    CONCLUSIONS: Higher environmental temperatures correlated with reduced COVID-19 cases, but this benefit does not yet appear in mortality models. Black race was an independent risk factor for increased COVID-19 cases and deaths. Thus, many proposed mechanisms through which Black race might increase risk for COVID-19, such as socioeconomic and healthcare-related predispositions, are inadequate in explaining the full magnitude of this health disparity.
    Keywords:  Black Race; COVID-19; Coronavirus; Environmental temperature; SARS-CoV-2
    DOI:  https://doi.org/10.1016/j.amjms.2020.06.015