Volume 7 Issue 2
Population Risk Factors for Severe Disease and Mortality in COVID-19 in the United States during the Pre-Vaccine Era: A Retrospective Cohort Study of National Inpatient Sample
Kavin Raj,Karthik Yeruva,Keerthana Jyotheeswara Pillai,Preetham Kumar,Ankit Agrawal,Sanya Chandna,Akhilesh Khuttan,Shalini Tripathi,Ramya Akella,Thulasi Ram Gudi,Abi Watts,Christian C Toquica Gahona,Umesh Bhagat,Surya Kiran Aedma,Ayesha Tamkinat Jalal,Shyam Ganti,Padmini Varadarajan andRamdas G Pai
1Division of Cardiology, Department of Medicine, University of California Riverside School of Medicine, Riverside, CA 92521, USA
2Department of Internal Medicine, Merit Health River Region Hospital, Vicksburg, MS 39183, USA
3Department of Medicine, Kilpauk Medical College, Tamil Nadu 600010, India
4Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
5Department of Cardiac Hospital Medicine, University of Iowa, Iowa City, IA 52242, USA
6Department of Hospital Medicine, Carolina East Medical Center, New Bern, NC 28560, USA
7Department of Hospital Medicine, Pikeville Medical Center, Pikeville, KY 41501, USA
8Division of Cardiology, Department of Medicine, University of Texas Health Sciences Center at Houston, Houston, TX 77030, USA
9Division of Cardiology, Department of Medicine, Kansas University Medical Center, Kansas City, KS 66160, USA
10Department of Internal Medicine, Memorial Healthcare System, Hollywood, FL 33021, USA
Author to whom correspondence should be addressed.
Abstract
Background-Previous studies on coronavirus disease 2019 (COVID-19) were limited to specific geographical locations and small sample sizes. Therefore, we used the National Inpatient Sample (NIS) 2020 database to determine the risk factors for severe outcomes and mortality in COVID-19. Methods-We included adult patients with COVID-19. Univariate and multivariate logistic regression was performed to determine the predictors of severe outcomes and mortality in COVID-19. Results-1,608,980 (95% CI 1,570,803–1,647,156) hospitalizations with COVID-19 were included. Severe complications occurred in 78.3% of COVID-19 acute respiratory distress syndrome (ARDS) and 25% of COVID-19 pneumonia patients. The mortality rate for COVID-19 ARDS was 54% and for COVID-19 pneumonia was 16.6%. On multivariate analysis, age > 65 years, male sex, government insurance or no insurance, residence in low-income areas, non-white races, stroke, chronic kidney disease, heart failure, malnutrition, primary immunodeficiency, long-term steroid/immunomodulatory use, complicated diabetes mellitus, and liver disease were associated with COVID-19 related complications and mortality. Cardiac arrest, septic shock, and intubation had the highest odds of mortality. Conclusions-Socioeconomic disparities and medical comorbidities were significant determinants of mortality in the US in the pre-vaccine era. Therefore, aggressive vaccination of high-risk patients and healthcare policies to address socioeconomic disparities are necessary to reduce death rates in future pandemics.
Keywords: COVID-19 complications; COVID-19 mortality; socioeconomic disparities; COVID-19 risk factors; national inpatient sample (NIS); cardiovascular diseases
