bims-covirf Biomed News
on COVID19 risk factors
Issue of 2020–08–23
eight papers selected by
Catherine Rycroft, BresMed
  1. The Age-Related Risk of Severe Outcomes Due to COVID-19 Infection: A Rapid Review, Meta-Analysis, and Meta-Regression.
  2. Mortality Attributed to COVID-19 in High-Altitude Populations.
  3. Risk factors for severe cases of COVID-19: a retrospective cohort study.
  4. Quantification of Death Risk in Relation to Sex, Pre-Existing Cardiovascular Diseases and Risk Factors in COVID-19 Patients: Let's Take Stock and See Where We Are.
  5. Clinical characteristics and risk factors for mortality of patients with COVID-19 in a large dataset from Mexico.
  6. Does gender influence clinical expression and disease outcomes in COVID-19? A systematic review and meta-analysis.
  7. COVID-19, smoking and inequalities: a study of 53 002 adults in the UK.
  8. Diabetes Mellitus is Associated with Severe Infection and Mortality in Patients with COVID-19: A Systematic Review and Meta-analysis.
  1. Int J Environ Res Public Health. 2020 Aug 17. pii: E5974. [Epub ahead of print]17(16):
    The Age-Related Risk of Severe Outcomes Due to COVID-19 Infection: A Rapid Review, Meta-Analysis, and Meta-Regression.
    Karla Romero Starke, Gabriela Petereit-Haack, Melanie Schubert, Daniel Kämpf, Alexandra Schliebner, Janice Hegewald, Andreas Seidler.
      Increased age appears to be a strong risk factor for COVID-19 severe outcomes. However, studies do not sufficiently consider the age-dependency of other important factors influencing the course of disease. The aim of this review was to quantify the isolated effect of age on severe COVID-19 outcomes. We searched Pubmed to find relevant studies published in 2020. Two independent reviewers evaluated them using predefined inclusion and exclusion criteria. We extracted the results and assessed seven domains of bias for each study. After adjusting for important age-related risk factors, the isolated effect of age was estimated using meta-regression. Twelve studies met our inclusion criteria: four studies for COVID-19 disease severity, seven for mortality, and one for admission to ICU. The crude effect of age (5.2% and 13.4% higher risk of disease severity and death per age year, respectively) substantially decreased when adjusting for important age-dependent risk factors (diabetes, hypertension, coronary heart disease/cerebrovascular disease, compromised immunity, previous respiratory disease, renal disease). Adjusting for all six comorbidities indicates a 2.7% risk increase for disease severity (two studies), and no additional risk of death per year of age (five studies). The indication of a rather weak influence of age on COVID-19 disease severity after adjustment for important age-dependent risk factors should be taken in consideration when implementing age-related preventative measures (e.g., age-dependent work restrictions).
    Keywords:  COVID-19; age; disease severity; mortality
    DOI:  https://doi.org/10.3390/ijerph17165974
  2. High Alt Med Biol. 2020 Aug 17.
    Mortality Attributed to COVID-19 in High-Altitude Populations.
    Orison O Woolcott, Richard N Bergman.
      Woolcott, Orison O., and Richard N. Bergman. Mortality attributed to COVID-19 in high-altitude populations. High Alt Med Biol. 00:000-000, 2020. Background: Since partial oxygen pressure decreases as altitude increases, environmental hypoxia could worsen Coronavirus Disease 2019 (COVID-19) patient's hypoxemia. We compared COVID-19 mortality at different altitudes. Methods: Retrospective analysis of population-level data on COVID-19 deaths was conducted in the United States (1,016 counties) and Mexico (567 municipalities). Mixed-model Poisson regression analysis of the association between altitude and COVID-19 mortality was conducted using individual-level data from 40,168 Mexican subjects with COVID-19, adjusting for multiple covariates. Results: Between January 20 and April 13, 2020, mortality rates were higher in U.S. counties located at ≥2,000 m elevation versus those located <1,500 m (12.3 vs. 3.2 per 100,000; p < 0.001). In Mexico, between March 13 and May 13, 2020, mortality rates were higher in municipalities located at ≥2,000 m versus those located <1,500 m (5.3 vs. 3.9 per 100,000; p < 0.001). Among Mexican subjects younger than 65 years, the risk of death was 36% higher in those living at ≥2,000 m versus those living at <1,500 m (adjusted incidence rate ratio [IRR]: 1.36; confidence interval [95% CI], 1.05-1.78; p = 0.022). Among Mexican men, the risk of death was 31% higher at ≥2,000 m versus that at <1,500 m (adjusted IRR: 1.31; 95% CI, 1.03-1.66; p = 0.025). No association between altitude and COVID-19 mortality was found among Mexican women or among Mexican subjects 65 years of age and older. Conclusions: Altitude is associated with COVID-19 mortality in men younger than 65 years.
    Keywords:  COVID-19; altitude; deaths; intubation; mortality; pneumonia
    DOI:  https://doi.org/10.1089/ham.2020.0098
  3. Aging (Albany NY). 2020 Aug 15. 12
    Risk factors for severe cases of COVID-19: a retrospective cohort study.
    Feng He, Qingqing Luo, Ming Lei, Lixin Fan, Xinning Shao, Guanglie Huang, Jun Zeng, Ziwen Zhao, Shuguang Qin, Zhi Yang, Na Yu, Liuping Yang, Jie Cao.
       BACKGROUND: SARS-CoV-2 has raged around the world since March, 2020. We aim to describe the clinical characteristics and risk factors of severe patients with COVID-19 in Guangzhou.
    RESULTS: The severity and mortality of COVID-19 was 10.4% and 0.3% respectively. And each 1-year increase in age (OR, 1.057; 95% CI, 1.018-1.098; P=0.004), Wuhan exposure history greater than 2 weeks (OR, 2.765; 95% CI, 1.040-7.355; P=0.042), diarrhea (OR, 24.349; 95% CI, 3.580-165.609; P=0.001), chronic kidney disease (OR, 6.966; 95% CI, 1.310-37.058; P = 0.023), myoglobin higher than 106 μg/L (OR, 8.910; 95% CI, 1.225-64.816; P=0.031), white blood cell higher than 10×109/L (OR, 5.776; 95% CI, 1.052-31.722; P=0.044), and C-reactive protein higher than 10 mg/L (OR, 5.362; 95% CI, 1.631-17.626; P=0.006) were risk factors for severe cases.
    CONCLUSION: Older age, Wuhan exposure history, diarrhea, chronic kidney disease, elevated myoglobin, elevated white blood cell and C-reactive protein were independent risk factors for severe patients with COVID-19 in Guangzhou.
    METHODS: We included 288 adult patients with COVID-19 and compared the data between severe and non-severe group. We used univariate and multivariate logistic regression methods to explore risk factors of severe cases.
    Keywords:  COVID-19; clinical characteristics; risk factors; severe cases
    DOI:  https://doi.org/10.18632/aging.103803
  4. J Clin Med. 2020 Aug 19. pii: E2685. [Epub ahead of print]9(9):
    Quantification of Death Risk in Relation to Sex, Pre-Existing Cardiovascular Diseases and Risk Factors in COVID-19 Patients: Let's Take Stock and See Where We Are.
    Amalia Ioanna Moula, Linda Renata Micali, Francesco Matteucci, Fabiana Lucà, Carmelo Massimiliano Rao, Orlando Parise, Gianmarco Parise, Michele Massimo Gulizia, Sandro Gelsomino.
      Patients with pre-existing cardiovascular disease (CVD) might be more susceptible to infection from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and have higher mortality rates. Nevertheless, the risk of mortality has not been previously quantified. The aim of this meta-analysis is to quantify the risk of mortality in coronavirus disease 2019 (COVID-19) patients. A meta-analysis was conducted analyzing the impact of (1) sex, (2) age, (3) CVD with coronary artery disease (CAD), (4) CAD alone, (5) CVD without CAD, (6) hypertension, (7) cerebrovascular diseases, and (8) diabetes on mortality. Relative risk was assessed for dichotomous variables, mean difference for continuous variables. Twenty-six studies were included, encompassing 8497 patients. Males had 16% higher risk of mortality than females (p < 0.05) and elderly patients had higher chance of dying than younger patients (p < 0.0001). Patients with overall CVD have a 1.96-fold higher mortality risk (p < 0.0001). CAD increases risk of mortality by 1.90-fold (p < 0.05). CVD-CAD were found to increase risk up to 2.03-fold (p < 0.05). Hypertension, cerebrovascular disease and diabetes increase the risk of death up to 1.73-fold, 1.76-fold and 1.59-fold, respectively (p < 0.0001, p < 0.0001, p < 0.05, respectively). Sex, age, presence of CAD and/or other types of CVD, hypertension, cerebrovascular diseases and diabetes mellitus increase mortality in patients with COVID-19.
    Keywords:  COVID-19; SARS-CoV-2; cardiovascular diseases; diabetes mellitus; hypertension; mortality
    DOI:  https://doi.org/10.3390/jcm9092685
  5. Ann Epidemiol. 2020 Aug 13. pii: S1047-2797(20)30286-6. [Epub ahead of print]
    Clinical characteristics and risk factors for mortality of patients with COVID-19 in a large dataset from Mexico.
    G M Parra-Bracamonte, N Lopez-Villalobos, F E Parra-Bracamonte.
       PURPOSE: Purpose of this study was to assess clinical characteristics and risk factors for mortality of patients with COVID-19 from Mexico, given that currently is in active community transmission.
    METHODS: Multivariate logistic regression model and Kaplan-Meier survival curves were fitted to study odds of death of characteristics and comorbidities in COVID-19 patients in Mexico.
    RESULTS: Age, sex and the most frequent comorbidities diabetes, obesity and hypertension were significantly associated to risk of death by COVID-19 (P<0.0001). Smoking habits was not identified as risk factor for death. Less frequent comorbidities such as chronic obstructive pulmonary disease, chronic kidney disease and immunosuppressed patients also showed a significant risk for death (P<0.0001). Hospitalized and pneumonia patients had serious risks for mortality (P<0.0001) and more attention to specific conditions might be considered during clinical admission.
    CONCLUSIONS: More vulnerable positive patient is depicted by a male patient, older that 41 years, that increase their hazard risk with more prevalent comorbidities diabetes, obesity and hypertension.
    Keywords:  Comorbidity; Mexico; Odds ratio; SARS-CoV-2; Survival probability
    DOI:  https://doi.org/10.1016/j.annepidem.2020.08.005
  6. Int J Infect Dis. 2020 Aug 12. pii: S1201-9712(20)30607-X. [Epub ahead of print]
    Does gender influence clinical expression and disease outcomes in COVID-19? A systematic review and meta-analysis.
    Augusta Ortolan, Mariagrazia Lorenzin, Mara Felicetti, Andrea Doria, Roberta Ramonda.
       BACKGROUND: Severe Acute Respiratory Syndrome coronavirus-2 (SARS-CoV) has been recently characterized, and soon spread around the world generating a pandemic. It has been suggested that men are more severely affected by the viral disease (COVID-19) than women.
    OBJECTIVE: the aim of the present Systematic Literature Review (SRL) and meta-analysis was to analyse the influence of gender on COVID-19 mortality, severity and disease outcomes. A SRL was performed in PubMed and Embase searching terms corresponding to the "PEO" format (Population = adult patients affected with COVID-19, Exposure = gender; Outcome = any available clinical outcomes by gender, including mortality and disease severity), search dates 01/01/2020-31/04/2020. Exclusion criteria were: case reports/series, reviews, commentaries, language other than English. We included full-text original articles. Data about study type, country, patients characteristics were extracted. Study quality was evaluated by Newcastle-Ottawa Scale (NOS). From a total of 950 hits generated by databases search, 85 articles fulfilling inclusion/exclusion criteria were selected.
    RESULTS: A random-effect meta-analysis was performed to compare mortality, recovery rates and disease severity in men versus women. Male to female ratio was 1: 0.8. A significant association between male sex and mortality (OR = 1.81; 95%CI: 1.25-2.62), as well as a lower chance of recovery in men (OR = 0.72; 95% CI: 0.55- 0.95). Male patients had a higher odd to present with a severe form of COVID-19 (OR = 1.46; 95%CI: 1.10-1.94).
    CONCLUSIONS: male are more susceptible to COVID-19 infection, present with a more severe disease and have a worse prognosis. Further studies are warranted to unravel biological mechanisms underlying these observations.
    Keywords:  COVID-19; gender; systematic review and meta-analysis
    DOI:  https://doi.org/10.1016/j.ijid.2020.07.076
  7. Tob Control. 2020 Aug 21. pii: tobaccocontrol-2020-055933. [Epub ahead of print]
    COVID-19, smoking and inequalities: a study of 53 002 adults in the UK.
    Sarah E Jackson, Jamie Brown, Lion Shahab, Andrew Steptoe, Daisy Fancourt.
       BACKGROUND: This study aimed to examine associations between smoking and COVID-19 relevant outcomes, taking into account the influence of inequalities and adjusting for potential confounding variables.
    METHODS: Cross-sectional data were used from an online study of adults in the UK (n=53 002). Main outcome measures were confirmed and suspected COVID-19, worry about catching or becoming seriously ill from COVID-19 and adherence to protective behaviours. Covariates included age, sex, ethnicity, education (post-16 qualifications: yes/no), key worker status and comorbid health conditions.
    RESULTS: Compared with never smokers (0.26% (95% CI 0.21% to 0.33%)), prevalence of confirmed COVID-19 was higher among current (0.56% (0.41% to 0.75%)) but not ex-smokers (0.19% (0.13% to 0.28%)). Associations were similar before (current: OR=2.14 (1.49-3.08); ex-smokers: OR=0.73 (0.47-1.14)) and after (current: OR=1.79 (1.22-2.62); ex-smokers: OR=0.85 (0.54-1.33)) adjustment. For current smokers, this was moderated by socio-economic position, with higher rates only seen in those without post-16 qualifications (OR=3.53 (2.04-6.10)). After including suspected cases, prevalence was higher among current smokers (11.2% (10.6% to 11.9%), OR=1.11 (1.03-1.20)) and ex-smokers (10.9% (10.4% to 11.5%), OR=1.07 (1.01-1.15)) than never smokers (10.2% (9.9% to 10.6%)), but remained higher only among ex-smokers after adjustment (OR=1.21 (1.13-1.29)). Current and ex-smokers had higher odds than never smokers of reporting significant stress about becoming seriously ill from COVID-19 (current: OR=1.34 (1.27-1.43); ex-smokers: OR=1.22 (1.16-1.28)). Adherence to recommendations to prevent spread of COVID-19 was high (96.3% (96.1% to 96.4%)), but lower among current than never smokers (OR=0.70 (0.62-0.78)).
    CONCLUSIONS: In a population sample, current smoking was independently associated with self-reported confirmed COVID-19 infection. There were socio-economic disparities, with the association only apparent among those without post-16 qualifications. Smokers reported lower adherence to guidelines despite being more worried than non-smokers about catching or becoming seriously ill from COVID-19.
    Keywords:  disparities; global health; nicotine; socio-economic status
    DOI:  https://doi.org/10.1136/tobaccocontrol-2020-055933
  8. Arch Med Res. 2020 Aug 07. pii: S0188-4409(20)30681-0. [Epub ahead of print]
    Diabetes Mellitus is Associated with Severe Infection and Mortality in Patients with COVID-19: A Systematic Review and Meta-analysis.
    Luxiang Shang, Mengjiao Shao, Qilong Guo, Jia Shi, Yang Zhao, Jiasuoer Xiaokereti, Baopeng Tang.
       BACKGROUND AND AIM: Currently, the number of patients with coronavirus disease 2019 (COVID-19) infection is increasing rapidly worldwide. In this study, we aimed to assess whether diabetes mellitus (DM) would increase the risk of severe infection and death in patients with COVID-19.
    METHODS: We systematically searched the PubMed, Web of Science, MedRxiv and COVID-19 academic research communication platform for studies reporting clinical severity and/or overall mortality data on DM in patients with COVID-19 published up to July 10, 2020. The primary outcome was to compare the severe infection rate and mortality rate in COVID-19 patients with and without DM, and to calculate the odds ratio (OR) and 95% confidence interval (CI).
    RESULTS: A total of 76 studies involving 31,067 patients with COVID-19 were included in our meta-analysis. COVID-19 patients with DM had higher severe infection and case-mortality rates compared with those without DM (21.4 vs. 10.6% and 28.5 vs. 13.3%, respectively, all p <0.01). COVID-19 patients with DM were at significantly elevated risk of severe infection (OR = 2.38, 95% CI: 2.05-2.78, p <0.001) and mortality (OR = 2.21, 95% CI: 1.83-2.66, p <0.001).
    CONCLUSION: DM is associated with increased risk of severe infection and higher mortality in patients with COVID-19. Our study suggests that clinicians should pay more attention to the monitoring and treatment of COVID-19 patients with DM.
    Keywords:  COVID-19; Diabetes mellitus; Disease severity; Meta-analysis; Mortality
    DOI:  https://doi.org/10.1016/j.arcmed.2020.07.005
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