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. 2022 Sep;27(35):2100883.
doi: 10.2807/1560-7917.ES.2022.27.35.2100883.

Age-specific associations between underlying health conditions and hospitalisation, death and in-hospital death among confirmed COVID-19 cases: a multi-country study based on surveillance data, June to December 2020

Tjede Funk  1 , Francesco Innocenti  1   2 , Joana Gomes Dias  1 , Lina Nerlander  1 , Tanya Melillo  3 , Charmaine Gauci  4 , Jackie M Melillo  3 , Patrik Lenz  5 , Helena Sebestova  5 , Pavel Slezak  6 , Iva Vlckova  5 , Jacob Dag Berild  7 , Camilla Mauroy  7 , Elina Seppälä  7   8 , Ragnhild Tønnessen  7   9 , Anne Vergison  10 , Joël Mossong  10 , Silvana Masi  10 , Laetitia Huiart  10 , Gillian Cullen  11 , Niamh Murphy  11 , Lois O'Connor  11 , Joan O'Donnell  11 , Piers Mook  12 , Richard G Pebody  12 , Nick Bundle  1
Affiliations

Age-specific associations between underlying health conditions and hospitalisation, death and in-hospital death among confirmed COVID-19 cases: a multi-country study based on surveillance data, June to December 2020

Tjede Funk et al. Euro Surveill. 2022 Sep.

Abstract

BackgroundUnderlying conditions are risk factors for severe COVID-19 outcomes but evidence is limited about how risks differ with age.AimWe sought to estimate age-specific associations between underlying conditions and hospitalisation, death and in-hospital death among COVID-19 cases.MethodsWe analysed case-based COVID-19 data submitted to The European Surveillance System between 2 June and 13 December 2020 by nine European countries. Eleven underlying conditions among cases with only one condition and the number of underlying conditions among multimorbid cases were used as exposures. Adjusted odds ratios (aOR) were estimated using 39 different age-adjusted and age-interaction multivariable logistic regression models, with marginal means from the latter used to estimate probabilities of severe outcome for each condition-age group combination.ResultsCancer, cardiac disorder, diabetes, immunodeficiency, kidney, liver and lung disease, neurological disorders and obesity were associated with elevated risk (aOR: 1.5-5.6) of hospitalisation and death, after controlling for age, sex, reporting period and country. As age increased, age-specific aOR were lower and predicted probabilities higher. However, for some conditions, predicted probabilities were at least as high in younger individuals with the condition as in older cases without it. In multimorbid patients, the aOR for severe disease increased with number of conditions for all outcomes and in all age groups.ConclusionWhile supporting age-based vaccine roll-out, our findings could inform a more nuanced, age- and condition-specific approach to vaccine prioritisation. This is relevant as countries consider vaccination of younger people, boosters and dosing intervals in response to vaccine escape variants.

Keywords: COVID-19; SARS-CoV-2; death; hospitalisation; in-hospital death; underlying health conditions.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Adjusted odds ratios and predicted probabilities of hospitalisation, death and in-hospital death for the first set of underlying condition compared with COVID-19 cases without an underlying condition, EU/EEAa, 2 June–13 December 2020b
Figure 2
Figure 2
Adjusted odds ratios and predicted probabilities of hospitalisation, death and in-hospital death for the second set of underlying condition compared with COVID-19 cases without an underlying condition, EU/EEAa, 2 June–13 December 2020b
Figure 3
Figure 3
Adjusted odds ratios and predicted probabilities of hospitalisation, death and in-hospital death for the third set of underlying condition compared with COVID-19 cases without an underlying condition, EU/EEAa, 2 June–13 December 2020b
See this image and copyright information in PMC

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