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. 2021 Jan 9;21(1):40.
doi: 10.1186/s12879-021-05764-x.

Relationship of socio-demographics, comorbidities, symptoms and healthcare access with early COVID-19 presentation and disease severity

Laura Vaughan  1   2 , Darlene Veruttipong  1   3 , Jonathan G Shaw  1   3 , Noemie Levy  4 , Lauren Edwards  1   2 , Marcy Winget  5   6
Affiliations

Relationship of socio-demographics, comorbidities, symptoms and healthcare access with early COVID-19 presentation and disease severity

Laura Vaughan et al. BMC Infect Dis. .

Abstract

Background: COVID-19 studies are primarily from the inpatient setting, skewing towards severe disease. Race and comorbidities predict hospitalization, however, ambulatory presentation of milder COVID-19 disease and characteristics associated with progression to severe disease is not well-understood.

Methods: We conducted a retrospective chart review including all COVID-19 positive cases from Stanford Health Care (SHC) in March 2020 to assess demographics, comorbidities and symptoms in relationship to: 1) their access point of testing (outpatient, inpatient, and emergency room (ER)) and 2) development of severe disease.

Results: Two hundred fifty-seven patients tested positive: 127 (49%), 96 (37%), and 34 (13%) at outpatient, ER and inpatient, respectively. Overall, 61% were age < 55; age > 75 was rarer in outpatient setting (11%) than ER (14%) or inpatient (24%). Most patients presented with cough (86%), fever/chills (76%), or fatigue (63%). 65% of inpatients reported shortness of breath compared to 30-32% of outpatients and ER patients. Ethnic/minority patients had a significantly higher risk of developing severe disease (Asian OR = 4.8 [1.6-14.2], Hispanic OR = 3.6 [1.1-11.9]). Medicare-insured patients were marginally more likely (OR = 4.0 [0.9-17.8]). Other factors associated with developing severe disease included kidney disease (OR = 6.1 [1.0-38.1]), cardiovascular disease (OR = 4.7 [1.0-22.1], shortness of breath (OR = 5.4 [2.3-12.6]) and GI symptoms (OR = 3.3 [1.4-7.7]; hypertension without concomitant CVD or kidney disease was marginally significant (OR = 2.3 [0.8-6.5]).

Conclusions: Early widespread symptomatic testing for COVID-19 in Silicon Valley included many less severely ill patients. Thorough manual review of symptomatology reconfirms the heterogeneity of COVID-19 symptoms, and challenges in using clinical characteristics to predict decline. We re-demonstrate that socio-demographics are consistently associated with severity.

Keywords: COVID-19; Comorbidities; Race; Socio-demographics; Symptoms.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart depicting total study cohort of COVID-19 positive patients and how the total chart review cohort was achieved. ER, Emergency Room
See this image and copyright information in PMC

References

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