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Meta-Analysis
. 2021 Jan 11;11(1):e044640.
doi: 10.1136/bmjopen-2020-044640.

Demographic risk factors for COVID-19 infection, severity, ICU admission and death: a meta-analysis of 59 studies

Bart G Pijls  1 , Shahab Jolani  2 , Anique Atherley  3 , Raissa T Derckx  4 , Janna I R Dijkstra  5 , Gregor H L Franssen  6 , Stevie Hendriks  7 , Anke Richters  8 , Annemarie Venemans-Jellema  9 , Saurabh Zalpuri  10 , Maurice P Zeegers  11
Affiliations
Meta-Analysis

Demographic risk factors for COVID-19 infection, severity, ICU admission and death: a meta-analysis of 59 studies

Bart G Pijls et al. BMJ Open. .

Abstract

Objective: We aimed to describe the associations of age and sex with the risk of COVID-19 in different severity stages ranging from infection to death.

Design: Systematic review and meta-analysis.

Data sources: PubMed and Embase through 4 May 2020.

Study selection: We considered cohort and case-control studies that evaluated differences in age and sex on the risk of COVID-19 infection, disease severity, intensive care unit (ICU) admission and death.

Data extraction and synthesis: We screened and included studies using standardised electronic data extraction forms and we pooled data from published studies and data acquired by contacting authors using random effects meta-analysis. We assessed the risk of bias using the Newcastle-Ottawa Scale.

Results: We screened 11.550 titles and included 59 studies comprising 36.470 patients in the analyses. The methodological quality of the included papers was high (8.2 out of 9). Men had a higher risk for infection with COVID-19 than women (relative risk (RR) 1.08, 95% CI 1.03 to 1.12). When infected, they also had a higher risk for severe COVID-19 disease (RR 1.18, 95% CI 1.10 to 1.27), a higher need for intensive care (RR 1.38, 95% CI 1.09 to 1.74) and a higher risk of death (RR 1.50, 95% CI 1.18 to 1.91). The analyses also showed that patients aged 70 years and above have a higher infection risk (RR 1.65, 95% CI 1.50 to 1.81), a higher risk for severe COVID-19 disease (RR 2.05, 95% CI 1.27 to 3.32), a higher need for intensive care (RR 2.70, 95% CI 1.59 to 4.60) and a higher risk of death once infected (RR 3.61, 95% CI 2.70 to 4.84) compared with patients younger than 70 years.

Conclusions: Meta-analyses on 59 studies comprising 36.470 patients showed that men and patients aged 70 and above have a higher risk for COVID-19 infection, severe disease, ICU admission and death.

Prospero registration number: CRD42020180085.

Keywords: COVID-19; epidemiology; infectious diseases.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart showing study selection.
Figure 2
Figure 2
Forest plot showing the association between sex and risk of COVID-19 infection. Overall, men have a 1.08 times higher risk of COVID-19 infection than women. Liu et al. RR, relative risk.
Figure 3
Figure 3
Forest plot showing the association between sex and risk of severe COVID-19. Overall, men have a 1.18 times higher risk of severe COVID-19 than women. Zhang et al; Zhang et al; Zhang et al; Zhang et al; Liu et al. RR, relative risk.
Figure 4
Figure 4
Forest plot showing the association between sex and risk of ICU admission due to COVID-19. Overall, men have a 1.38 times higher risk of ICU admission due to COVID-19 than women. Zhang et al. ICU, intensive care unit; RR, relative risk.
Figure 5
Figure 5
Forest plot showing the association between sex and risk of death due to COVID-19. Overall, men have a 1.50 times higher risk of death due to COVID-19 than women. RR, relative risk.
Figure 6
Figure 6
Forest plot showing the association between age and risk of COVID-19 infection. Overall, patients aged 70 years or older have a 1.65 times higher risk of COVID-19 infection than patients younger than 70 years. Liu et al. RR, relative risk.
Figure 7
Figure 7
Forest plot showing the association between age and risk of severe COVID-19. Overall, patients aged 70 years or older have a 2.05 times higher risk of severe COVID-19 than patients younger than 70 years. Zhang et al; Zhang et al. RR, relative risk.
Figure 8
Figure 8
Forest plot showing the association between age and risk of ICU admission due to COVID-19. Overall, patients aged 70 years or older have a 2.70 times higher risk of ICU admission due to COVID-19 than patients younger than 70 years. Zhang et al. ICU, intensive care unit; RR, relative risk.
Figure 9
Figure 9
Forest plot showing the association between age and risk of death due to COVID-19. Overall, patients aged 70 years or older have a 3.61 times higher risk of death due to COVID-19 than patients younger than 70 years. RR, relative risk.
See this image and copyright information in PMC

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