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. 2020 Dec 28;8(2):ofaa638.
doi: 10.1093/ofid/ofaa638. eCollection 2021 Feb.

Risk of Clinical Severity by Age and Race/Ethnicity Among Adults Hospitalized for COVID-19-United States, March-September 2020

Audrey F Pennington  1 , Lyudmyla Kompaniyets  1 , April D Summers  1 , Melissa L Danielson  1 , Alyson B Goodman  1   2 , Jennifer R Chevinsky  1 , Leigh Ellyn Preston  1 , Lyna Z Schieber  1 , Gonza Namulanda  1 , Joseph Courtney  1 , Heather M Strosnider  1 , Tegan K Boehmer  1   2 , William R Mac Kenzie  1   2 , James Baggs  1 , Adi V Gundlapalli  1
Affiliations

Risk of Clinical Severity by Age and Race/Ethnicity Among Adults Hospitalized for COVID-19-United States, March-September 2020

Audrey F Pennington et al. Open Forum Infect Dis. .

Abstract

Background: Older adults and people from certain racial and ethnic groups are disproportionately represented in coronavirus disease 2019 (COVID-19) hospitalizations and deaths.

Methods: Using data from the Premier Healthcare Database on 181 813 hospitalized adults diagnosed with COVID-19 during March-September 2020, we applied multivariable log-binomial regression to assess the associations between age and race/ethnicity and COVID-19 clinical severity (intensive care unit [ICU] admission, invasive mechanical ventilation [IMV], and death) and to determine whether the impact of age on clinical severity differs by race/ethnicity.

Results: Overall, 84 497 (47%) patients were admitted to the ICU, 29 078 (16%) received IMV, and 27 864 (15%) died in the hospital. Increased age was strongly associated with clinical severity when controlling for underlying medical conditions and other covariates; the strength of this association differed by race/ethnicity. Compared with non-Hispanic White patients, risk of death was lower among non-Hispanic Black patients (adjusted risk ratio, 0.96; 95% CI, 0.92-0.99) and higher among Hispanic/Latino patients (risk ratio [RR], 1.15; 95% CI, 1.09-1.20), non-Hispanic Asian patients (RR, 1.16; 95% CI, 1.09-1.23), and patients of other racial and ethnic groups (RR, 1.13; 95% CI, 1.06-1.21). Risk of ICU admission and risk of IMV were elevated among some racial and ethnic groups.

Conclusions: These results indicate that age is a driver of poor outcomes among hospitalized persons with COVID-19. Additionally, clinical severity may be elevated among patients of some racial and ethnic minority groups. Public health strategies to reduce severe acute respiratory syndrome coronavirus 2 infection rates among older adults and racial and ethnic minorities are essential to reduce poor outcomes.

Keywords: 2019 novel coronavirus disease; adult; health care disparities; mortality; race/ethnicity.

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Figures

Figure 1.
Figure 1.
Risk ratios for the associations between age and COVID-19 clinical severity, stratified by race/ethnicity, when adjusted for covariates (risk compared with a reference group of 18–39 years). Numeric results corresponding to this figure are listed in Table 3 and Supplementary Table 1. Each plot uses a different y-axis. Abbreviations: COVID-19, coronavirus disease 2019; ICU, intensive care unit.
See this image and copyright information in PMC

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