Comorbidities associated with mortality in 31,461 adults with COVID-19 in the United States: A federated electronic medical record analysis

Abstract

Background

At the beginning of June 2020, there were nearly 7 million reported cases of coronavirus disease 2019 (COVID-19) worldwide and over 400,000 deaths in people with COVID-19. The objective of this study was to determine associations between comorbidities listed in the Charlson comorbidity index and mortality among patients in the United States with COVID-19.

Methods and findings

A retrospective cohort study of adults with COVID-19 from 24 healthcare organizations in the US was conducted. The study included adults aged 18–90 years with COVID-19 coded in their electronic medical records between January 20, 2020, and May 26, 2020. Results were also stratified by age groups (<50 years, 50–69 years, or 70–90 years). A total of 31,461 patients were included. Median age was 50 years (interquartile range [IQR], 35–63) and 54.5% ( n = 17,155) were female. The most common comorbidities listed in the Charlson comorbidity index were chronic pulmonary disease (17.5%, n = 5,513) and diabetes mellitus (15.0%, n = 4,710). Multivariate logistic regression analyses showed older age (odds ratio [OR] per year 1.06; 95% confidence interval [CI] 1.06–1.07; p < 0.001), male sex (OR 1.75; 95% CI 1.55–1.98; p < 0.001), being black or African American compared to white (OR 1.50; 95% CI 1.31–1.71; p < 0.001), myocardial infarction (OR 1.97; 95% CI 1.64–2.35; p < 0.001), congestive heart failure (OR 1.42; 95% CI 1.21–1.67; p < 0.001), dementia (OR 1.29; 95% CI 1.07–1.56; p = 0.008), chronic pulmonary disease (OR 1.24; 95% CI 1.08–1.43; p = 0.003), mild liver disease (OR 1.26; 95% CI 1.00–1.59; p = 0.046), moderate/severe liver disease (OR 2.62; 95% CI 1.53–4.47; p < 0.001), renal disease (OR 2.13; 95% CI 1.84–2.46; p < 0.001), and metastatic solid tumor (OR 1.70; 95% CI 1.19–2.43; p = 0.004) were associated with higher odds of mortality with COVID-19. Older age, male sex, and being black or African American (compared to being white) remained significantly associated with higher odds of death in age-stratified analyses. There were differences in which comorbidities were significantly associated with mortality between age groups. Limitations include that the data were collected from the healthcare organization electronic medical record databases and some comorbidities may be underreported and ethnicity was unknown for 24% of participants. Deaths during an inpatient or outpatient visit at the participating healthcare organizations were recorded; however, deaths occurring outside of the hospital setting are not well captured.

Conclusions

Identifying patient characteristics and conditions associated with mortality with COVID-19 is important for hypothesis generating for clinical trials and to develop targeted intervention strategies.

Abstract

In this analysis of electronic health records, Stephanie Harrison and colleagues investigate comorbidities and mortality in COVID-19 patients.

Author summary

Why was this study done?

• Coronavirus disease 2019 (COVID-19) has led to a public health emergency internationally.

• As of June 2020, there were over 400,000 deaths reported with COVID-19 globally and over 110,000 deaths were in the US, but many people have also recovered.

• Because of the unprecedented outbreak of COVID-19 worldwide, little is known about which underlying health conditions may impact a person’s likelihood of dying with COVID-19.

• Some previous studies have suggested being older; being from a black, Asian, or minority ethnic (BAME) background; and having certain health conditions may increase risk of death with COVID-19, but further evidence is needed to understand factors which influence this.

What did the researchers do and find?

• The research utilized a network of 24 healthcare organizations in the US, which provided deidentified data from electronic medical records of patients.

• A total of 31,461 adults with COVID-19 coded in their electronic medical records were included in the study after a search of the network between January 20, 2020, and May 26, 2020.

• We determined associations between age, sex, ethnicity, comorbidities, and death with COVID-19 during the study period.

• After accounting for the other included factors in the study, being older, being male, being black or African American, and having a history of myocardial infarction, congestive heart failure, dementia, chronic pulmonary disease, mild liver disease, moderate/severe liver disease, renal disease, or metastatic solid tumor were all associated with higher odds of death with COVID-19.

• There were differences in which comorbidities were associated with death when we stratified the results by age group.

What do these findings mean?

• Identifying factors associated with death with COVID-19 could help with hypothesis generating for clinical trials and identify patients who may need to be targeted for early intervention or monitoring.

• The study has limitations; for example, some health conditions may be underreported or incorrectly coded in electronic medical records at the time of data entry, and all deaths of participants may not have been captured.