Evidence used to update the list of underlying medical conditions that increase a person’s risk of severe illness from COVID-19

Evidence used to update the list of underlying medical conditions that increase a person’s risk of severe illness from COVID-19

Updates to the list of underlying medical conditions that put adults of any age at increased risk for severe illness from the virus that causes COVID-19 were based on published reports, articles in press, unreviewed pre-prints, and internal data available between December 1, 2019 and September 1, 2020*. This list is a living document that will be periodically updated by CDC, and it could rapidly change as the science evolves. Severe illness from COVID-19 is defined as hospitalization, admission to the ICU, intubation or mechanical ventilation, or death.

The level of evidence for each condition was determined by CDC reviewers based on available information about COVID-19. Conditions were added to the list (if not already on the previous underlying medical conditions list [originally released in March 2020]) if evidence for an association with severe illness from COVID-19 met any of the following criteria:

  • Strongest and most consistent evidence: Defined as consistent evidence from multiple small studies or a strong association from a large study,
  • Mixed evidence: Defined as multiple studies that reached different conclusions about risk associated with a condition, or
  • Limited evidence: Defined as consistent evidence from a small number of studies.

Qualifiers to previously listed conditions were added or removed if there was strong evidence to support that the condition be expanded. Conditions previously listed were to be removed if there was strong and consistent evidence demonstrating no association with severe outcomes. Based on this criterion, no conditions were removed from the previous underlying medical conditions list dated March 2020; however, in this most recent update in October 2020, smoking was moved from “mixed evidence” to “strong evidence.”

*Updates to smoking were based on evidence available between December 1, 2019 and July 20, 2020.

Evidence used to update the list of underlying medical conditions that increase a person’s risk of severe illness from COVID-19
Level of Evidence Condition Evidence of Impact on COVID-19 Severity Notes
Strongest and Most Consistent Evidence Cancer Systematic Review [6]
Cohort Study [7,8]
Case Series [9]
New to updated list as of July 17, 2020
Chronic kidney disease Case Series [10, 11, 12]
Cohort Studies [13, 14, 15]
On previous version of list as “Chronic Kidney Disease Requiring Dialysis”
COPD Meta Analyses [4, 16]
Case Series [17]
Cohort Study [14]
On previous version of list
Heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies Cohort Study [1, 2]
Meta Analyses [3, 4]
Case Series [5]
On previous version of list as “Serious Heart Conditions”
Obesity (BMI> 30 kg/m2) Cohort Studies [18, 19, 20, 21, 22]
Cross-sectional [23]
Previously listed
Severe Obesity (BMI ≥ 40 kg/m2) Cohort Study [98, 99]
Cross-Sectional Study [95]
Meta Analysis [107]
Previously listed
Sickle cell disease Case Series [24, 25, 26, 27, 28] On previous version of list
Smoking Meta Analyses [3, 16*, 63, 64, 65, 66, 101, 102, 104, 105] On previous version of list
Solid organ transplantation Case Series [12, 29, 30, 31, 32, 33, 34]
Meta Analysis [100]
New to updated list as of June 25, 2020
Type 2 diabetes mellitus Case Series [11]
Longitudinal Study [35]
Cohort Study [36, 37]
Meta Analysis [38]
Cross-Sectional Study [114]
On previous version of list
Mixed Evidence Asthma Cohort Study [14, 39, 40, 41]
Case Series [17]
On previous version of list
Cerebrovascular disease Meta Analysis [42, 43, 44, 45]
Synthesis of Evidence [46]
Cohort Study [1, 2, 47, 48, 49]
New to updated list as of June 25, 2020
Hypertension Cohort Study [1, 2, 49, 50, 51, 91, 93]
Case Series [92]
Systematic Review [52]
Meta Analyses [3, 4, 53, 94]
New to updated list as of June 25, 2020
Pregnancy Systematic Review [54]
Case Control Study [55]
Case Series [56, 57, 58, 59]
Cohort Study [60, 61, 62]
On previous version of list
Use of corticosteroids or other immunosuppressive medications Case Series [67, 68, 69]
Cohort Study [70, 71]
On previous version of list
Limited Evidence Bone marrow transplantation Review [72] On previous version of list
HIV Case Series [73, 74]
Cohort Study [109, 110, 111, 112]
On previous version of list
Immune deficiencies Case Series [75]
Systematic Review [76]
On previous version of list
Inherited metabolic disorders Cohort Study [47, 77] New to updated list as of June 25, 2020; specific to pediatric populations at this time
Liver disease Meta-Analysis [78]
Cohort  Study [79, 80]
Literature Review [81]
On previous version of list
Neurologic conditions Cross-Sectional Study [82]
Cohort Study [41, 49, 77]
New to updated list as of June 25, 2020; specific to pediatric populations at this time
Other chronic lung diseases Meta-Analysis [4]
Case Series [17]
Cohort Study [14, 83]
On previous version of list
Overweight (BMI > 25 kg/m2, but < 30 kg/m2) Cohort Study [96, 106]
Case Series [97]
Meta Analysis [115]
Previously unlisted
Pediatrics Systematic Review [84, 85]
Cross-Sectional Study [82, 86, 107]
Cohort Study [77, 87, 88, 103, 108, 113]
New to updated list as of July 17, 2020
Thalassemia Case Series [89]
Cross-Sectional Study [90]
On previous version of list
Type 1 diabetes mellitus Case Series [11]
Cohort Study [36, 37]
Meta-Analysis [38]
Cross-Sectional Study [114]
On previous version of list

*Methodological issues found by other authors; re-analyzed by Guo [64] and an association finding risk factor for greater severity was found.

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