Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2022 Mar 5;22(1):184.
doi: 10.1186/s12877-021-02673-1.

Age is the main determinant of COVID-19 related in-hospital mortality with minimal impact of pre-existing comorbidities, a retrospective cohort study

M T H M Henkens #  1   2 , A G Raafs #  3 , J A J Verdonschot  4 , M Linschoten  5 , M van Smeden  6 , P Wang  4 , B H M van der Hooft  7 , R Tieleman  8 , M L F Janssen  9 , R M A Ter Bekke  3 , M R Hazebroek  3 , I C C van der Horst  3   10 , F W Asselbergs #  5   11   12 , F J H Magdelijns #  7 , S R B Heymans  3   13   14 ; CAPACITY-COVID collaborative consortium
Collaborators, Affiliations
Multicenter Study

Age is the main determinant of COVID-19 related in-hospital mortality with minimal impact of pre-existing comorbidities, a retrospective cohort study

M T H M Henkens et al. BMC Geriatr. .

Abstract

Background: Age and comorbidities increase COVID-19 related in-hospital mortality risk, but the extent by which comorbidities mediate the impact of age remains unknown.

Methods: In this multicenter retrospective cohort study with data from 45 Dutch hospitals, 4806 proven COVID-19 patients hospitalized in Dutch hospitals (between February and July 2020) from the CAPACITY-COVID registry were included (age 69[58-77]years, 64% men). The primary outcome was defined as a combination of in-hospital mortality or discharge with palliative care. Logistic regression analysis was performed to analyze the associations between sex, age, and comorbidities with the primary outcome. The effect of comorbidities on the relation of age with the primary outcome was evaluated using mediation analysis.

Results: In-hospital COVID-19 related mortality occurred in 1108 (23%) patients, 836 (76%) were aged ≥70 years (70+). Both age 70+ and female sex were univariably associated with outcome (odds ratio [OR]4.68, 95%confidence interval [4.02-5.45], OR0.68[0.59-0.79], respectively;both p< 0.001). All comorbidities were univariably associated with outcome (p<0.001), and all but dyslipidemia remained significant after adjustment for age70+ and sex. The impact of comorbidities was attenuated after age-spline adjustment, only leaving female sex, diabetes mellitus (DM), chronic kidney disease (CKD), and chronic pulmonary obstructive disease (COPD) significantly associated (female OR0.65[0.55-0.75], DM OR1.47[1.26-1.72], CKD OR1.61[1.32-1.97], COPD OR1.30[1.07-1.59]). Pre-existing comorbidities in older patients negligibly (<6% in all comorbidities) mediated the association between higher age and outcome.

Conclusions: Age is the main determinant of COVID-19 related in-hospital mortality, with negligible mediation effect of pre-existing comorbidities.

Trial registration: CAPACITY-COVID ( NCT04325412 ).

Keywords: COVID-19; Hospitalization; Mediation analysis; Mortality; Netherlands.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Predicted and observed in-hospital mortality (univariable age-restricted cubic spline adjusted). % Mortality predicted: The white line represents the predicted mortality rates at different ages, accompanied by 95% confidence intervals in blue. # Observed patients: The grey bars represent the number of patients observed within the different age categories. The light grey bars are the patients that were discharged without palliative care. The dark grey bars are the patients in which in-hospital mortality (or palliative discharge) occurred
Fig. 2
Fig. 2
Associations of age and comorbidities with in-hospital mortality. A) Univariable association of age 70+, sex, and comorbidities with in-hospital mortality; B) Association of all comorbidities after adjustment for age 70+ and sex; C) Association of sex and all comorbidities after age spline adjustment. COPD = chronic obstructive pulmonary disease
Fig. 3
Fig. 3
Mediation analysis with age ≥ 70 years as independent predictor, the individual comorbidities as mediator and in-hospital mortality as outcome. All comorbidities partly mediated the effect of age on in-hospital mortality (all p-values < 0.001). The mediation effect was 5% (95% CI 2–9%) for hypertension, 3% (95% CI 2–4%) for diabetes mellitus, 3% (95% CI 0.4–6%) for dyslipidemia, 5% (95% CI 3–7%) for chronic kidney disease, 2% (95% CI 1–3%) for COPD, and 5% (95% CI 2–9%) for history of cardiac disease. COPD = chronic obstructive pulmonary disease
See this image and copyright information in PMC

References

    1. WHO COVID-19 Dashboard. Geneva: World Health Organization, 2020. Available online: https://covid19.who.int/ (last cited: 16-07-2021).
    1. Sun P, Lu X, Xu C, Sun W, Pan B. Understanding of COVID-19 based on current evidence. J Med Virol. 2020;92(6):548–551. doi: 10.1002/jmv.25722. - DOI - PMC - PubMed
    1. Wu C, Chen X, Cai Y, Ja X, Zhou X, Xu S, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA. Intern Med. 2020;180(7):934–943. - PMC - PubMed
    1. Grasselli G, Greco M, Zanella A, Albano G, Antonelli M, Bellani G, et al. Risk factors associated with mortality among patients with COVID-19 in intensive care units in Lombardy, Italy. JAMA Intern Med. 2020;180(10):1345–1355. doi: 10.1001/jamainternmed.2020.3539. - DOI - PMC - PubMed
    1. NHS Digital . Coronavirus (COVID-19): shielded patients list. 2020.

Publication types

Associated data