JMIR Public Health Surveill. 2020 Aug 3. doi: 10.2196/20872. Online ahead of print.
BACKGROUND: Reliably identifying patients at increased risk for coronavirus disease 2019 (COVID-19) complications could guide clinical decisions, public health policies, and preparedness efforts. Multiple studies have attempted to characterize at-risk patients, using various data sources and methodologies. Most of these studies, however, explored condition-specific patient cohorts (e.g., hospitalized patients) or had limited access to patients' medical history; thus, investigating related questions and, potentially, obtaining biased results.
OBJECTIVE: To identify factors associated with COVID-19 complications from the complete medical records of a nationally representative SARS-CoV-2 infected cohort.
METHODS: We studied a cohort of all SARS-CoV-2 positive individuals, confirmed by polymerase chain reaction testing of either nasopharyngeal or saliva samples, in a nationwide health organization (covering 2.3 million individuals) and identified those who suffered from serious complications (that is, experienced moderate or severe symptoms of COVID-19, admitted to intensive care unit or died). We then compared the prevalence of pre-existing conditions, extracted from electronic health records, between complicated and non-complicated COVID-19 patient cohorts to identify the conditions that significantly increase the risk of disease complications, in various age and sex strata.
RESULTS: Of the 4,353 SARS-CoV-2 positive individuals, 173 (4%) patients suffered from COVID-19 complications (all above the age of 18 years). Our analysis suggests that cardiovascular and kidney diseases, obesity, and hypertension are significant risk factors for COVID-19 complications. It also indicates that depression (e.g., odds ratio, OR, for males 65 years or older: 2.94, 95% confidence intervals [1.55, 5.58]; P = .014) as well as cognitive and neurological disorder (e.g., OR for individuals ≥ 65 years old: 2.65 [1.69, 4.17]; P < .001) are significant risk factors; and that smoking and background of respiratory diseases do not significantly increase the risk of complications.
CONCLUSIONS: Our analysis agrees with previous studies on multiple risk factors, including hypertension and obesity. It also finds depression, cognitive and neurological disorders, but not smoking and respiratory diseases, to be significantly associated with COVID-19 complications. Adjusting existing risk definitions following these observations may improve their accuracy and impact the global pandemic containment and recovery efforts.