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Age-Related Risk Factors and Complications of Patients With COVID-19: A Population-Based Retrospective Study

Han Zhang¹, Yingying Wu², Yuqing He¹

¹Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.

Frontiers in Medicine

|January 28, 2022

Insights

Age significantly impacts coronavirus disease 2019 (COVID-19) outcomes. Younger patients face higher risks from cancer and intracerebral hemorrhage, while older patients are primarily affected by age and male gender. Complications vary by age group.

Area of Science:

Epidemiology
Infectious Diseases
Gerontology

Background:

The first wave of the COVID-19 pandemic presented unique challenges in understanding disease progression and risk factors across diverse patient demographics.
Age is a critical determinant in the severity and outcomes of infectious diseases, necessitating a granular analysis of its impact on COVID-19.

Purpose of the Study:

To investigate age-specific differences in clinical characteristics, risk factors, and complications among hospitalized patients with COVID-19.
To identify independent risk factors for mortality in COVID-19 patients across different age strata.

Main Methods:

A population-based retrospective study analyzing 36,358 hospitalized COVID-19 patients during the initial pandemic wave in Wuhan City.
Multivariate logistic regression was employed to determine risk factors for COVID-19 mortality.
Canonical correlation analysis (CCA) explored associations between comorbidities and complications.

Main Results:

Overall mortality was 6.85%, with age, male gender, alcohol consumption, smoking, hypertension, diabetes, cancer, chronic kidney disease, and intracerebral hemorrhage identified as independent risk factors for death.
Patients under 40 years old showed significantly higher mortality odds associated with cancer and intracerebral hemorrhage.
Patients over 80 years old had increased mortality risk primarily linked to advanced age and male gender. Arrhythmias, gastrointestinal bleeding, and sepsis were more frequent in younger deceased patients.

Conclusions:

Coronavirus disease 2019 (COVID-19) exhibits distinct clinical manifestations, risk factors, and complications that are disproportionately influenced by patient age.
The impact of pre-existing conditions on the incidence of extrapulmonary complications in COVID-19 patients appears limited.

Read full analysis

Abstract:

Objective: To study the differences in clinical characteristics, risk factors, and complications across age-groups among the inpatients with the coronavirus disease 2019 (COVID-19). Methods: In this population-based retrospective study, we included all the positive hospitalized patients with COVID-19 at Wuhan City from December 29, 2019 to April 15, 2020, during the first pandemic wave. Multivariate logistic regression analyses were used to explore the risk factors for death from COVID-19. Canonical correlation analysis (CCA) was performed to study the associations between comorbidities and complications. Results: There are 36,358 patients in the final cohort, of whom 2,492 (6.85%) died. Greater age (odds ration [OR] = 1.061 [95% CI 1.057-1.065], p < 0.001), male gender (OR = 1.726 [95% CI 1.582-1.885], p < 0.001), alcohol consumption (OR = 1.558 [95% CI 1.355-1.786], p < 0.001), smoking (OR = 1.326 [95% CI 1.055-1.652], p = 0.014), hypertension (OR = 1.175 [95% CI 1.067-1.293], p = 0.001), diabetes (OR = 1.258 [95% CI 1.118-1.413], p < 0.001), cancer (OR = 1.86 [95% CI 1.507-2.279], p < 0.001), chronic kidney disease (CKD) (OR = 1.745 [95% CI 1.427-2.12], p < 0.001), and intracerebral hemorrhage (ICH) (OR = 1.96 [95% CI 1.323-2.846], p = 0.001) were independent risk factors for death from COVID-19. Patients aged 40-80 years make up the majority of the whole patients, and them had similar risk factors with the whole patients. For patients aged <40 years, only cancer (OR = 17.112 [95% CI 6.264-39.73], p < 0.001) and ICH (OR = 31.538 [95% CI 5.213-158.787], p < 0.001) were significantly associated with higher odds of death. For patients aged >80 years, only age (OR = 1.033 [95% CI 1.008-1.059], p = 0.01) and male gender (OR = 1.585 [95% CI 1.301-1.933], p < 0.001) were associated with higher odds of death. The incidence of most complications increases with age, but arrhythmias, gastrointestinal bleeding, and sepsis were more common in younger deceased patients with COVID-19, with only arrhythmia reaching statistical difference (p = 0.039). We found a relatively poor correlation between preexisting risk factors and complications. Conclusions: Coronavirus disease 2019 are disproportionally affected by age for its clinical manifestations, risk factors, complications, and outcomes. Prior complications have little effect on the incidence of extrapulmonary complications.

Keywords:

COVID-19 age complications death risk factors

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