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Factors associated with COVID-19 related hospitalisation, critical care admission and mortality using linked primary
Lisa Cummins1, Irene Ebyarimpa1, Nathan Cheetham1
1Financial Strategy Team, NHS North East London Commissioning Alliance, London, UK.
Insights
Identifying individuals at higher risk for severe COVID-19 outcomes is crucial. This study highlights age, ethnicity, obesity, diabetes, chronic kidney disease, and learning disabilities as key risk factors for hospitalization and death.
Area of Science:
- Public Health
- Epidemiology
- Infectious Disease Research
Background:
- Identifying high-risk populations for COVID-19 hospitalization and mortality is essential for targeted interventions.
- The first UK COVID-19 wave necessitated rapid identification of risk factors.
Purpose of the Study:
- To identify demographic, deprivation, and clinical factors associated with increased risk of COVID-19 hospitalization, ICU admission, and mortality.
- To pinpoint specific patient cohorts requiring enhanced protection during COVID-19 outbreaks.
Main Methods:
- Multivariate logistic regression analysis was performed on linked primary and secondary care data.
- The study included confirmed COVID-19 cases aged 16+ between February 1, 2020, and June 30, 2020.
- Odds ratios (OR), 95% confidence intervals (CI), and P-values were calculated for various risk factors.
Main Results:
- Confirmed risk factors include male sex, Black or Asian ethnicity, age over 50, obesity, type 2 diabetes, and chronic kidney disease (CKD).
- Obesity increased the risk of ICU admission.
- Learning disabilities were strongly associated with increased mortality (OR = 4.75).
- Three or more comorbidities significantly increased the risk of hospitalization and death.
Conclusions:
- Age, sex, ethnicity, obesity, CKD, and diabetes are confirmed determinants of severe COVID-19 outcomes.
- People with learning disabilities and multi-morbidity represent novel, high-risk patient cohorts requiring active protection during COVID-19 waves.
Background:
It is important that population cohorts at increased risk of hospitalisation and death following a COVID-19 infection are identified and protected.
Objectives:
We identified risk factors associated with increased risk of hospitalisation, intensive care unit (ICU) admission and mortality in inner North East London (NEL) during the first UK COVID-19 wave.
Methods:
Multivariate logistic regression analysis on linked primary and secondary care data from people aged 16 or older with confirmed COVID-19 infection between 01/02/2020 and 30/06/2020 determined odds ratios (OR), 95% confidence intervals (CI) and P-values for the association between demographic, deprivation and clinical factors with COVID-19 hospitalisation, ICU admission and mortality.
Results:
Over the study period, 1781 people were diagnosed with COVID-19, of whom 1195 (67%) were hospitalised, 152 (9%) admitted to ICU and 400 (23%) died. Results confirm previously identified risk factors: being male, or of Black or Asian ethnicity, or aged over 50. Obesity, type 2 diabetes and chronic kidney disease (CKD) increased the risk of hospitalisation. Obesity increased the risk of being admitted to ICU. Underlying CKD, stroke and dementia increased the risk of death. Having learning disabilities was strongly associated with increased risk of death (OR = 4.75, 95% CI = [1.91, 11.84], P = .001). Having three or four co-morbidities increased the risk of hospitalisation (OR = 2.34, 95% CI = [1.55, 3.54], P < .001; OR = 2.40, 95% CI = [1.55, 3.73], P < .001 respectively) and death (OR = 2.61, 95% CI = [1.59, 4.28], P < .001; OR = 4.07, 95% CI = [2.48, 6.69], P < .001 respectively).
Conclusions:
We confirm that age, sex, ethnicity, obesity, CKD and diabetes are important determinants of risk of COVID-19 hospitalisation or death. For the first time, we also identify people with learning disabilities and multi-morbidity as additional patient cohorts that need to be actively protected during COVID-19 waves.
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