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. 2020 Jun 29;35(25):e237.
doi: 10.3346/jkms.2020.35.e237.

Effect of Underlying Comorbidities on the Infection and Severity of COVID-19 in Korea: a Nationwide Case-Control Study

Wonjun Ji #  1 , Kyungmin Huh #  2 , Minsun Kang  3 , Jinwook Hong, Gi Hwan Bae  3 , Rugyeom Lee  3 , Yewon Na  3 , Hyoseon Choi  4 , Seon Yeong Gong  4 , Yoon Hyeong Choi  4 , Kwang Pil Ko  4 , Jeong Soo Im  4 , Jaehun Jung  3   5
Affiliations

Effect of Underlying Comorbidities on the Infection and Severity of COVID-19 in Korea: a Nationwide Case-Control Study

Wonjun Ji et al. J Korean Med Sci. .

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic is an emerging threat worldwide. It remains unclear how comorbidities affect the risk of infection and severity of COVID-19.

Methods: This is a nationwide retrospective case-control study of 219,961 individuals, aged 18 years or older, whose medical costs for COVID-19 testing were claimed until May 15, 2020. COVID-19 diagnosis and infection severity were identified from reimbursement data using diagnosis codes and on the basis of respiratory support use, respectively. Odds ratios (ORs) were estimated using multiple logistic regression, after adjusting for age, sex, region, healthcare utilization, and insurance status.

Results: The COVID-19 group (7,341 of 219,961) was young and had a high proportion of female. Overall, 13.0% (954 of 7,341) of the cases were severe. The severe COVID-19 group had older patients and a proportion of male ratio than did the non-severe group. Diabetes (odds ratio range [ORR], 1.206-1.254), osteoporosis (ORR, 1.128-1.157), rheumatoid arthritis (ORR, 1.207-1.244), substance use (ORR, 1.321-1.381), and schizophrenia (ORR, 1.614-1.721) showed significant association with COVID-19. In terms of severity, diabetes (OR, 1.247; 95% confidential interval, 1.009-1.543), hypertension (ORR, 1.245-1.317), chronic lower respiratory disease (ORR, 1.216-1.233), chronic renal failure, and end-stage renal disease (ORR, 2.052-2.178) were associated with severe COVID-19.

Conclusion: We identified several comorbidities associated with COVID-19. Health care workers should be more careful while diagnosing and treating COVID-19 when patients have the abovementioned comorbidities.

Keywords: COVID-19; Comorbidity; Risk Factor; SARS-CoV-2; Severity.

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Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1. Overview of national health insurance claims data from Health Insurance Review & Assessment Service of Korea (Redrawn from Jung et al. Sci Rep 2019;19(1):8750).
Fig. 2
Fig. 2. Flow chart of selecting process for study participants.
COVID-19 = coronavirus disease 2019, HIRA = Health Insurance Review & Assessment Service.
Fig. 3
Fig. 3. Analysis of relationship between comorbidities and infection of COVID-19.
COVID-19 = coronavirus disease 2019, N/A = not applicable, IDDN = insulin-dependent diabetes mellitus, NIDDM = non-insulin dependent diabetes mellitus, ESRD = end-stage renal disease, OR = odds ratio.
Fig. 4
Fig. 4. Analysis of relationship between comorbidities on severity of COVID-19.
COVID-19 = coronavirus disease 2019, N/A = not applicable, IDDN = insulin-dependent diabetes mellitus, NIDDM = non-insulin dependent diabetes mellitus, ESRD = end-stage renal disease, OR = odds ratio.
See this image and copyright information in PMC

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