Clinical Characterization of Patients With COVID-19 in Primary Care in Catalonia: Retrospective Observational Study

Abstract

Background The country of Spain has one of the highest incidences of COVID-19, with more than 1,000,000 cases as of the end of October 2020. Patients with a history of chronic conditions, obesity, and cancer are at greater risk from COVID-19; moreover, concerns surrounding the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin type II receptor blockers (ARBs) and its relationship to COVID-19 susceptibility have increased since the beginning of the pandemic. Objective The objectives of this study were to compare the characteristics of patients diagnosed with COVID-19 to those of patients without COVID-19 in primary care; to determine the risk factors associated with the outcome of mortality; and to determine the potential influence of certain medications, such as ACEIs and ARBs, on the mortality of patients with COVID-19. Methods An observational retrospective study of patients diagnosed with COVID-19 in the Catalan Central Region of Spain between March 1 and August 17, 2020, was conducted. The data were obtained from the Primary Care Services Information Technologies System of the Catalan Institute of Health in Barcelona, Spain. Results The study population included 348,596 patients (aged >15 years) registered in the Primary Care Services Information Technologies System of the Catalan Central Region. The mean age of the patients was 49.53 years (SD 19.42), and 31.17% of the patients were aged ≥60 years. 175,484/348,596 patients (50.34%) were women. A total of 23,844/348,596 patients (6.84%) in the population studied were diagnosed with COVID-19 during the study period, and the most common clinical conditions of these patients were hypertension (5267 patients, 22.1%) and obesity (5181 patients, 21.7%). Overall, 2680/348,596 patients in the study population (0.77%) died during the study period. The number of deaths among patients without COVID-19 was 1825/324,752 (0.56%; mean age 80.6 years, SD 13.3), while among patients diagnosed with COVID-19, the number of deaths was 855/23,844 (3.58%; mean age 83.0 years, SD 10.80) with an OR of 6.58 (95% CI 6.06-7.15). Conclusions We observed that women were more likely to contract COVID-19 than men. In addition, our study did not show that hypertension, obesity, or being treated with ACEIs or ARBs was linked to an increase in mortality in patients with COVID-19. Age is the main factor associated with mortality in patients infected with SARS-CoV-2.

Individuals With SARS-CoV-2 Infection During the First and Second Waves in Catalonia, Spain: Retrospective Observational Study Using Daily Updated Data

“…Further analyses that compare the first and second waves in other countries would be very useful to determine expected common characteristics and differences. A couple of previous reports characterized the first wave in Spain, as in April and August 2020 [37,38]. The authors of a report from the Working Group for the Surveillance and Control of COVID-19 observed a much higher percentage of hospitalized patients among individuals who tested positive in a diagnostic test when compared with our study (45% versus 11%), which could be explained by the definition of a case.…”

Risk Factors for COVID-19 Morbidity and Mortality in Institutionalised Elderly People

“…In this sense, of note is the importance of the information provided by studies of prognostic factors of morbidity and mortality by COVID-19, by populational and community bases, in contrast to studies in the hospital setting [ 49 ]. The former can estimate the risk with a lower risk of selection bias, and this has been produced in some studies showing discordance between the factors associated and not associated with morbidity and mortality by COVID-19 [ 24 , 54 ].…”

Sars-Cov-2 Infection in Patients on Long-Term Treatment with Macrolides in Spain: A National Cross-Sectional Study

“…Until mid-April, SARS-CoV-2 PCR or serology diagnostics were not available in Primary Care Health Centers. Even so, 48% of patients were confirmed cases with molecular diagnostic techniques, a higher value compared to other studies conducted in Primary Care [ 31 ]. Fifth, there may be additional confounders influencing outcomes.…”

“…These facts make them more susceptible to a poor prognosis and a higher probability of hospitalization and death regardless of COVID-19 [ 25 , 29 ]. The convergence of the threat of COVID-19 and antimicrobial resistance is a cocktail for devastating effects for this population [ 28 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ]. Being a very high-risk population, it is supposed that they have probably not left their homes, and have taken strict protective measures against infections: social distancing, the use of face mask and hydroalcoholic disinfectant gel, and strict control of symptoms with medication.…”

“…According to the available literature [ 28 , 31 , 34 , 35 , 36 , 37 , 38 , 43 ], patients with severe outcomes of COVID-19 were older, male and presented more comorbidities including cardiovascular and cerebrovascular diseases, COPD, bronchiectasis, malignancies, diabetes mellitus, chronic kidney failure and liver failure, and less frequently asthma. However, statistically significant differences were only observed for age, the number of comorbidities and the presence of cardiovascular and cerebrovascular diseases.…”