Underlying Medical Conditions and Severe Illness Among 540,667 Adults Hospitalized With COVID-19, March 2020–March 2021
ORIGINAL RESEARCH — Volume 18 — July 1, 2021
PEER REVIEWED
Figure 1. Prevalence of the most frequent underlying medical conditions in a sample of adults hospitalized with COVID-19 in Premier Healthcare Database Special COVID-19 Release. Underlying medical conditions were defined by 1) using Chronic Condition Indicator to identify chronic International Classification of Diseases, Tenth Revision, Clinical Modification codes; 2) aggregating the codes into a smaller number of categories by using the Clinical Classifications Software Refined (CCSR); 3) a clinical review of CCSR categories that classified CCSR codes as “likely underlying,” “indeterminate,” or “likely acute”; and 4) including only “likely underlying” CCSR categories and excluding “indeterminate” and “likely acute” CCSR categories. Patients coded with both CCSR categories of “diabetes with complication” and “diabetes without complication” (n = 55,141) were classified as having diabetes with complication. The following frequent (present in ≥10.0% of patients) “indeterminate” CCSR categories were excluded: cardiac dysrhythmias (n = 124,367 [23.0%]), heart failure (n = 104,858 [19.4%]), other specified nervous system disorders (n = 89,929 [16.6%]), other specified and unspecified nutritional and metabolic disorders (n = 89,337 [16.5%]), coagulation and hemorrhagic disorders (n = 75,766 [14.0%]), and diseases of white blood cells (n = 57,765 [10.7%]). Abbreviation: COPD, chronic obstructive pulmonary disease.
| Underlying Medical Condition | No. (%) |
|---|---|
| Essential hypertension | 272,591 (50.4) |
| Disorders of lipid metabolism | 267,057 (49.4) |
| Obesity | 178,153 (33.0) |
| Diabetes with complication | 171,727 (31.8) |
| Coronary atherosclerosis and other heart disease | 134,839 (24.9) |
| Esophageal disorders | 133,954 (24.8) |
| Chronic kidney disease | 132,544 (24.5) |
| Anxiety and fear-related disorders | 98,846 (18.3) |
| COPD and bronchiectasis | 92,193 (17.1) |
| Thyroid disorders | 91,244 (16.9) |
| Depressive disorders | 85,150 (15.7) |
| Implant device or graft-related encounter | 80,947 (15.0) |
| Sleep–wake disorders | 78,241 (14.5) |
| Neurocognitive disorders | 77,817 (14.4) |
| Osteoarthritis | 77,196 (14.3) |
| Aplastic anemia | 63,442 (11.7) |
| Diabetes without complication | 59,813 (11.1) |
| Asthma | 56,566 (10.5) |
Figure 2. Risk ratio (95% CI) of death, invasive mechanical ventilation (IMV), and admission to intensive care unit (ICU), by the number of underlying medical conditions among adults hospitalized with COVID-19 in the Premier Healthcare Database Special COVID-19 Release. Each panel contains the results of a single generalized linear model with Poisson distribution and log link function, adjusted for age group, sex, race/ethnicity, payer type, hospital urbanicity, US Census region of hospital, admission month, and admission month squared as controls. Patients who died without ICU care or IMV were excluded from the sample when estimating the model with the outcome of ICU care or IMV, respectively.
| Outcome | Risk Ratio (95% CI) |
|---|---|
| Death | |
| No conditions | Reference |
| 1 condition | 1.53 (1.41–1.67) |
| 2–5 conditions | 2.55 (2.32–2.80) |
| 6–10 conditions | 3.29 (2.98–3.63) |
| >10 conditions | 3.82 (3.45–4.23) |
| IMV | |
| No conditions | Reference |
| 1 condition | 1.57 (1.45–1.70) |
| 2-5 conditions | 2.91 (2.68–3.15) |
| 6-10 conditions | 4.10 (3.75–4.49) |
| >10 conditions | 4.47 (4.07–4.90) |
| ICU admission | |
| No conditions | Reference |
| 1 condition | 1.32 (1.27–1.36) |
| 2-5 conditions | 1.60 (1.52–1.69) |
| 6-10 conditions | 1.84 (1.73–1.97) |
| >10 conditions | 1.96 (1.82–2.11) |
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