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Review
. 2020 Aug 17;17(16):5974.
doi: 10.3390/ijerph17165974.

The Age-Related Risk of Severe Outcomes Due to COVID-19 Infection: A Rapid Review, Meta-Analysis, and Meta-Regression

Karla Romero Starke  1 , Gabriela Petereit-Haack  2 , Melanie Schubert  1 , Daniel Kämpf  1 , Alexandra Schliebner  1 , Janice Hegewald  1 , Andreas Seidler  1
Affiliations
Review

The Age-Related Risk of Severe Outcomes Due to COVID-19 Infection: A Rapid Review, Meta-Analysis, and Meta-Regression

Karla Romero Starke et al. Int J Environ Res Public Health. .

Abstract

Increased age appears to be a strong risk factor for COVID-19 severe outcomes. However, studies do not sufficiently consider the age-dependency of other important factors influencing the course of disease. The aim of this review was to quantify the isolated effect of age on severe COVID-19 outcomes. We searched Pubmed to find relevant studies published in 2020. Two independent reviewers evaluated them using predefined inclusion and exclusion criteria. We extracted the results and assessed seven domains of bias for each study. After adjusting for important age-related risk factors, the isolated effect of age was estimated using meta-regression. Twelve studies met our inclusion criteria: four studies for COVID-19 disease severity, seven for mortality, and one for admission to ICU. The crude effect of age (5.2% and 13.4% higher risk of disease severity and death per age year, respectively) substantially decreased when adjusting for important age-dependent risk factors (diabetes, hypertension, coronary heart disease/cerebrovascular disease, compromised immunity, previous respiratory disease, renal disease). Adjusting for all six comorbidities indicates a 2.7% risk increase for disease severity (two studies), and no additional risk of death per year of age (five studies). The indication of a rather weak influence of age on COVID-19 disease severity after adjustment for important age-dependent risk factors should be taken in consideration when implementing age-related preventative measures (e.g., age-dependent work restrictions).

Keywords: COVID-19; age; disease severity; mortality.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study selection process.
Figure 2
Figure 2
Risk of bias of studies by outcome.
Figure 3
Figure 3
Pooled effect of the risk of age on disease severity, random-effects meta-analysis.
Figure 4
Figure 4
Pooled effect of the risk of age on mortality, random-effects meta-analysis.
Figure 5
Figure 5
Funnel plot of mortality per age year.
Figure 6
Figure 6
Effect of the adjustment scenarios on the relative risk (RR) of the association between age and COVID-19 disease severity and death.
See this image and copyright information in PMC

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