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Prevalence of Comorbidities in COVID-19 Related Hospitalizations and Deaths

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COVID-19 hospitalization and mortality information were assessed in a sample of 36 million active patients.1 Nearly 10 million of those patients have documented hypertension, diabetes, chronic obstructive pulmonary disease (COPD), or moderate/severe asthma as of April 30, 2020. The summarized data were contributed by 31 health systems (300 hospitals) across 18 states. Table 1 shows the prevalence of these conditions in the sample data set as compared to national baselines for adults.

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Table 1. Prevalence of examined conditions in adults in the active patient population as compared to national baselines.

In this sample, 124,783 patients were COVID-19 positive. There are 52,163 (42%) patients who do not yet have a known outcome as of April 30, 2020. These patients may or may not escalate further to hospitalization or death.

The charts below show how the four included comorbidities are distributed across the whole sample, across COVID-19 positive hospitalized patients, and then across COVID-19 related deaths. These subpopulations are not mutually exclusive. For example, a COVID-19 positive patient who was hospitalized then died would appear in all three patient populations. Figure 1 shows these metrics grouped by sex, while Figure 2 shows these metrics grouped by age group.

Generally, the prevalence of COPD, diabetes, hypertension, and various combinations of these comorbidities appears higher in COVID-19 hospitalized patients and COVID-19 deaths than in the overall active patient population. Specifically, the combination of diabetes and hypertension appears to show a proportionally higher representation among hospitalizations and deaths. There does not appear to be much variation in prevalence of comorbidities across sexes. This information may help clinicians understand which of their COVID-19 patients may be at heightened risk for severe illness.  

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Figure 1. Distribution of comorbidities by sex for all active patients, COVID-19 positive hospitalized patients, and COVID-19 related deaths.
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Figure 2. Distribution of comorbidities by age group for all active patients, COVID-19 positive hospitalized patients, and COVID-19 related deaths. COVID-19 related deaths are not shown for patients age 18 years and under due to small sample size (n = 7).

1 Definitions can be found at the end of the brief.

2 While there are national baselines for asthma generally, there is not a known national baseline for moderate/severe asthma, which is what is used in this analysis.

3 Akinbami, Omolara Jean, and Xiang Liu. Chronic Obstructive Pulmonary Disease Among Adults Aged 18 and Over in the United States, 1998-2009. Hyattsville, MD: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2011.

4 Chronic obstructive pulmonary disease is a child code under the SNOMED code used in our search for chronic obstructive lung disease. There is not a known national baseline for COPD, which was used in this analysis.

5 Centers for Disease Control and Prevention. “National diabetes statistics report, 2020.” Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services (2020).

6 “Hypertension Prevalence and Control Among Adults: United States, 2015–2016.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 18 Oct. 2017, www.cdc.gov/nchs/products/databriefs/db289.htm.

6 Comments

  1. Obesity has been identified as a critical comorbid condition in other reports. Does it now show up here because obesity is not reliably captured in ehr data, or because it does not appear as a major comorbidity factor in your analysis?

    1. Thank you for your suggestion. We are studying BMI and plan to do a report.

  2. Are the medication regimens for the patients in this cohort available? Our analytics have shown strong correlation with ER visits, hospitalizations and death in polpharmacy patients. It would be interesting to see if there is a correlation with worse outcomes in COVID patients.

    1. Thank you for the suggestion. We’ll add this to the list of studies to consider.

  3. Thank you for this report. I noticed that the distribution of co-morbid conditions was not shown for all COVID patients. Is this due to challenges of identifying a non-hospitalized COVID cohort?

    1. Hi Elsie, thank you for reading. That’s correct. The availability of tests and criteria for being tested have varied depending on where patients receive care, introducing selection bias. The population of patients who have tested positive does not accurately represent everyone who has had COVID-19.

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