Impact of comorbidity burden on mortality in patients with COVID-19 using the Korean health insurance database

Area of Science:

• Epidemiology
• Public Health
• Gerontology

Background:

• The coronavirus disease (COVID-19) pandemic has highlighted the critical role of pre-existing health conditions in patient outcomes.
• Understanding the impact of comorbidity burden on COVID-19 mortality is essential for risk stratification and resource allocation.

Purpose of the Study:

• To investigate the association between comorbidity burden and mortality in patients diagnosed with COVID-19.
• To evaluate the predictive performance of the Charlson Comorbidity Index (CCI) and its age-adjusted version (ACCI) for COVID-19 related mortality.

Main Methods:

• Analysis of nationwide health insurance claims data from South Korea, including demographic characteristics, comorbidities, and mortality records of 7590 COVID-19 patients.
• Calculation of odds ratios for mortality associated with various comorbidities, adjusted for age and sex.
• Receiver operating characteristic (ROC) curve analysis to assess the predictive value of CCI and ACCI for mortality.

Main Results:

• A total of 227 (3.0%) deaths were recorded among the study cohort.
• After adjusting for age and sex, hypertension, diabetes mellitus, congestive heart failure, dementia, chronic pulmonary disease, liver disease, renal disease, and cancer were identified as significant risk factors for mortality.
• The age-adjusted Charlson Comorbidity Index (ACCI) demonstrated strong predictive power, with a threshold >3.5 yielding the best cut-off point for mortality prediction (Area Under ROC: 0.92).

Conclusions:

• Multiple comorbidities are significant risk factors contributing to mortality in COVID-19 patients.
• The age-adjusted Charlson Comorbidity Index is a valuable tool for predicting mortality risk in COVID-19 patients, underscoring the importance of age and comorbidities in disease severity.