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. 2025 Jul 30:12:1608667.
doi: 10.3389/fmed.2025.1608667. eCollection 2025.

Exploring the differences in mortality and its associated factors among young-old and old-old COVID-19 patients

Linyi Zhong  1   2 , Linlin Huang  2 , Mengchen Zhang  2 , Congcong Tian  2 , Lijuan Zhang  2 , Guobin Song  2
Affiliations

Exploring the differences in mortality and its associated factors among young-old and old-old COVID-19 patients

Linyi Zhong et al. Front Med (Lausanne). .

Abstract

Background: This study aims to compare the differences in mortality and related factors between old-old and young-old COVID-19 patients and find unique factors related to survival in old-old patients.

Study design: Single-center retrospective cohort study following STROBE guidelines.

Methods: We included 302 elderly (≥65 years old) COVID-19 patients admitted to Shijiazhuang People's Hospital from December 1, 2022 to March 31, 2023. Among them, 142 were assigned to the young-old group (65-74 years old) and 160 in the old-old group (≥75 years old). Demographic, clinical and laboratory data were extracted, and descriptive statistical analysis, comparison of differences between groups, Cox proportional hazards regression analysis, and subgroup analysis were adopted.

Results: Compared with the young-old group, the mortality of old-old patients was higher (31.3% vs. 12.7%, p < 0.001). Risk factors associated with mortality specifically in old-old patients include dyspnea (HR: 2.829, 95%CI: 1.571-5.093), acute cardiac injury (HR: 2.403, 95%CI: 1.369-4.219), and diabetes (HR: 2.401, 95%CI: 1.311-4.397), glucocorticoid therapy (HR: 2.397, 95%CI: 1.198-4.798). Moreover, there was a significant difference in the survival curves between the young-old and the old-old group (p = 0.0001). However, no significant sex differences in mortality and survival curves were found in either group.

Conclusion: This study found for the first time that dyspnea symptoms, acute heart injury, diabetes, and glucocorticoid therapy are unique risk factors related to survival in old-old patients with COVID-19. These factors need more attention when treating old-old patients to prevent poor prognosis.

Keywords: COVID-19; mortality; older adults; retrospective study; risk factors.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier survival curves displaying the survival probability in young-old and old-old COVID patients.
Figure 2
Figure 2
(a) Sex differences of mortality in young-old and old-old COVID patients. There was no significant sex difference in mortality in young-old group (p = 0.658), which was also seen in old-old group (p = 0.246). (b) Sex differences of Kaplan–Meier survival analysis in young-old COVID patients. (c) Sex differences of Kaplan–Meier survival analysis in old-old COVID patients.
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