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. 2020 Nov 5;15(11):e0241824.
doi: 10.1371/journal.pone.0241824. eCollection 2020.

Is older age associated with COVID-19 mortality in the absence of other risk factors? General population cohort study of 470,034 participants

Frederick K Ho  1 , Fanny Petermann-Rocha  1   2 , Stuart R Gray  2 , Bhautesh D Jani  1 , S Vittal Katikireddi  1 , Claire L Niedzwiedz  1 , Hamish Foster  1 , Claire E Hastie  1 , Daniel F Mackay  1 , Jason M R Gill  2 , Catherine O'Donnell  1 , Paul Welsh  2 , Frances Mair  1 , Naveed Sattar  2 , Carlos A Celis-Morales  1   2 , Jill P Pell  1
Affiliations

Is older age associated with COVID-19 mortality in the absence of other risk factors? General population cohort study of 470,034 participants

Frederick K Ho et al. PLoS One. .

Abstract

Introduction: Older people have been reported to be at higher risk of COVID-19 mortality. This study explored the factors mediating this association and whether older age was associated with increased mortality risk in the absence of other risk factors.

Methods: In UK Biobank, a population cohort study, baseline data were linked to COVID-19 deaths. Poisson regression was used to study the association between current age and COVID-19 mortality.

Results: Among eligible participants, 438 (0.09%) died of COVID-19. Current age was associated exponentially with COVID-19 mortality. Overall, participants aged ≥75 years were at 13-fold (95% CI 9.13-17.85) mortality risk compared with those <65 years. Low forced expiratory volume in 1 second, high systolic blood pressure, low handgrip strength, and multiple long-term conditions were significant mediators, and collectively explained 39.3% of their excess risk. The associations between these risk factors and COVID-19 mortality were stronger among older participants. Participants aged ≥75 without additional risk factors were at 4-fold risk (95% CI 1.57-9.96, P = 0.004) compared with all participants aged <65 years.

Conclusions: Higher COVID-19 mortality among older adults was partially explained by other risk factors. 'Healthy' older adults were at much lower risk. Nonetheless, older age was an independent risk factor for COVID-19 mortality.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Association of age with COVID-19 mortality by adjustment schemes.
Model 1 (Baseline): Sex, ethnicity, deprivation, duration of follow-up, smoking; Model 2 (Physical): Baseline + BMI, SBP; Model 3 (Respiratory): Baseline + FEV1, FEV1/FVC; Model 4 (Frailty): Baseline + frailty stages; Model 5 (LTC): Baseline + number of LTCs; BMI body mass index; SBP systolic blood pressure; FEV forced expiratory volume; FVC forced vital capacity; LTC long-term conditions.
Fig 2
Fig 2. Associations between combinations of age group and risk factors and COVID-19 mortality.
Adjusted for sex, ethnicity, deprivation, duration of follow-up; N number; RR relative risk; CI confidence interval; FEV forces expiratory volume; LTC long-term condition.
Fig 3
Fig 3. Association between age group combined with number of risk factors and COVID-19 mortality.
Adjusted for sex, ethnicity, deprivation, duration of follow-up Risk factors included smoking, obesity, hypertension, FEV1, frailty, and number of LTCs ≥3.
See this image and copyright information in PMC

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