Factors Associated With COVID-19 Death in the United States: Cohort Study (Preprint)

Abstract

BACKGROUND Since the initial COVID-19 cases were identified in the United States in February 2020, the United States has experienced a high incidence of the disease. Understanding the risk factors for severe outcomes identifies the most vulnerable populations and helps in decision-making. OBJECTIVE This study aims to assess the factors associated with COVID-19–related deaths from a large, national, individual-level data set. METHODS A cohort study was conducted using data from the Optum de-identified COVID-19 electronic health record (EHR) data set; 1,271,033 adult participants were observed from February 1, 2020, to August 31, 2020, until their deaths due to COVID-19, deaths due to other reasons, or the end of the study. Cox proportional hazards models were constructed to evaluate the risks for each patient characteristic. RESULTS A total of 1,271,033 participants (age: mean 52.6, SD 17.9 years; male: 507,574/1,271,033, 39.93%) were included in the study, and 3315 (0.26%) deaths were attributed to COVID-19. Factors associated with COVID-19–related death included older age (80 vs 50-59 years old: hazard ratio [HR] 13.28, 95% CI 11.46-15.39), male sex (HR 1.68, 95% CI 1.57-1.80), obesity (BMI 40 vs <30 kg/m<sub>2</sub>: HR 1.71, 95% CI 1.50-1.96), race (Hispanic White, African American, Asian vs non-Hispanic White: HR 2.46, 95% CI 2.01-3.02; HR 2.27, 95% CI 2.06-2.50; HR 2.06, 95% CI 1.65-2.57), region (South, Northeast, Midwest vs West: HR 1.62, 95% CI 1.33-1.98; HR 2.50, 95% CI 2.06-3.03; HR 1.35, 95% CI 1.11-1.64), chronic respiratory disease (HR 1.21, 95% CI 1.12-1.32), cardiac disease (HR 1.10, 95% CI 1.01-1.19), diabetes (HR 1.92, 95% CI 1.75-2.10), recent diagnosis of lung cancer (HR 1.70, 95% CI 1.14-2.55), severely reduced kidney function (HR 1.92, 95% CI 1.69-2.19), stroke or dementia (HR 1.25, 95% CI 1.15-1.36), other neurological diseases (HR 1.77, 95% CI 1.59-1.98), organ transplant (HR 1.35, 95% CI 1.09-1.67), and other immunosuppressive conditions (HR 1.21, 95% CI 1.01-1.46). CONCLUSIONS This is one of the largest national cohort studies in the United States; we identified several patient characteristics associated with COVID-19–related deaths, and the results can serve as the basis for policy making. The study also offered directions for future studies, including the effect of other socioeconomic factors on the increased risk for minority groups.

Shedding of Infectious SARS-CoV-2 Despite Vaccination

“…Age and male sex have been considered risk factors for COVID-19 disease [22][23][24][25][26]. While one might hypothesize that older individuals and/or males might have higher SARS-CoV-2 burdens and therefore lower Ct values at the time of testing, evidence for this is mixed, with some studies reporting lower Ct values in older individuals [24,27], others in younger individuals [28], and still others finding no difference by age [20,[29][30][31][32][33][34].…”

Efficacy and safety of olokizumab, interleukin-6 inhibitor, in hospitalized patients with COVID-19

“…Например, среди более 3480 пациентов с COVID-19, госпитализированных в перепрофилированные клиники Сеченовского Университета в апреле-мае 2020 г., факторами риска смерти были возраст, мужской пол, хроническая болезнь почек, сахарный диабет, хронические заболевания сердца и деменция [16]. В американском когортном исследовании более чем у 1270000 взрослых пациентов с COVID-19 факторы риска смерти включали в себя старческий возраст, мужской пол, ожирение (индекс массы тела ≥40 кг/м 2 ), хронические заболевания легких и сердца, сахарный диабет, рак легкого, выраженное нарушение функции легких, инсульт/ деменцию, другие неврологические заболевания, трансплантацию органа и другие состояния, сопровождающиеся подавлением иммунитета [17]. Наибольшее неблагоприятное значение имел старческий возраст: у пациентов в возрасте ≥80 лет риск смерти увеличился примерно в 13 раз по сравнению с таковым у лиц в возрасте 50-59 лет.…”