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Cosmos Study

Effect of Comorbidities on Hospitalization and Death in COVID-19 Patients

Abstract: Diabetes, heart failure, immunocompromise, COPD, and class 3 obesity all contribute to risk of COVID-19-related hospitalization and death.
June 2, 2020
Kieran Gallagher, MPH | Alejandro Munoz del Rio, PhD | Doug Winesett, MD | Jackie Gerhart, MD

Using data from 190,194 COVID-19 patients, the following conditions were found to be most strongly associated with a higher risk of hospitalization and death:

  • Heart failure
  • Diabetes
  • A weakened immune system
  • COPD
  • A BMI of 40 or higher
Figure 1
Effect of COVID-19 on hospitalization and death by comorbidity
Effect of COVID-19 on hospitalization and death by comorbidity
Figure 1: The light blue bars show higher or lower risk of hospitalization and death (using hazard ratios) for each comorbidity, controlling for age group, sex, and other comorbidities. For example, diabetics have a hazard ratio of 1.6 for hospitalization, which means that patients with diabetes are 60 percent more likely to be hospitalized compared to patients with the same age group, sex, and combination of comorbidities who don’t have diabetes. The dark blue lines indicate 95% confidence intervals, or the range that contains the true value with 95% certainty.

Asthma and hypertension were associated with a higher risk of hospitalization, but not death.

The estimates for risk of death align with an NHS study1 that used similar methods in a smaller sample.

Not all comorbidities were present at the time of admission, and some may have been caused by COVID-19. Full methodology and further discussion are included in the linked report.

The data in this analysis were pooled from 45 health systems representing 470 hospitals that span 20 different states and cover 50 million active patients as of May 13, 2020.

References:

References

  1. Williamson, E et al. OpenSAFELY: factors associated with COVID-19-related hospital deaths in the linked electronic health records of 17 million adult NHS patients. medRxiv. May 6, 2020. DOI: 10.1101/2020.05.06.20092999