Age is the main determinant of COVID-19 related in-hospital mortality with minimal impact of pre-existing comorbidities, a retrospective cohort study
on behalf of the CAPACITY-COVID collaborative consortium
(2022) BMC Geriatrics, volume 22, issue 1
(Article)
Abstract
BACKGROUND: Age and comorbidities increase COVID-19 related in-hospital mortality risk, but the extent by which comorbidities mediate the impact of age remains unknown. METHODS: In this multicenter retrospective cohort study with data from 45 Dutch hospitals, 4806 proven COVID-19 patients hospitalized in Dutch hospitals (between February and July 2020) from
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the CAPACITY-COVID registry were included (age 69[58-77]years, 64% men). The primary outcome was defined as a combination of in-hospital mortality or discharge with palliative care. Logistic regression analysis was performed to analyze the associations between sex, age, and comorbidities with the primary outcome. The effect of comorbidities on the relation of age with the primary outcome was evaluated using mediation analysis. RESULTS: In-hospital COVID-19 related mortality occurred in 1108 (23%) patients, 836 (76%) were aged ≥70 years (70+). Both age 70+ and female sex were univariably associated with outcome (odds ratio [OR]4.68, 95%confidence interval [4.02-5.45], OR0.68[0.59-0.79], respectively;both p< 0.001). All comorbidities were univariably associated with outcome (p<0.001), and all but dyslipidemia remained significant after adjustment for age70+ and sex. The impact of comorbidities was attenuated after age-spline adjustment, only leaving female sex, diabetes mellitus (DM), chronic kidney disease (CKD), and chronic pulmonary obstructive disease (COPD) significantly associated (female OR0.65[0.55-0.75], DM OR1.47[1.26-1.72], CKD OR1.61[1.32-1.97], COPD OR1.30[1.07-1.59]). Pre-existing comorbidities in older patients negligibly (<6% in all comorbidities) mediated the association between higher age and outcome. CONCLUSIONS: Age is the main determinant of COVID-19 related in-hospital mortality, with negligible mediation effect of pre-existing comorbidities. TRIAL REGISTRATION: CAPACITY-COVID ( NCT04325412 ).
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Keywords: Aged, COVID-19, Comorbidity, Female, Hospital Mortality, Hospitalization, Humans, Male, Retrospective Studies, Risk Factors, SARS-CoV-2, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't
ISSN: 1471-2318
Publisher: BioMed Central
Note: Funding Information: The CAPACITY-COVID registry is supported by the Dutch Heart Foundation (2020B006 CAPACITY), the EuroQol Research Foundation, Novartis Global, Sanofi Genzyme Europe, Novo Nordisk Nederland, Servier Nederland, and Daiichi Sankyo Nederland. The Dutch Network for Cardiovascular Research (WCN), a partner within the CAPACITY-COVID consortium, received funding from the Dutch Heart Foundation (2020B006 CAPACITY) for site management and logistic support in the Netherlands. Marijke Linschoten is supported by the Alexandre Suerman Stipend of the University Medical Center Utrecht. Folkert W. Asselbergs is supported by CardioVasculair Onderzoek Nederland 2015–12 eDETECT and by the National Institute of Health Research (NIHR) University College London Hospitals Biomedical Research Centre. Funding Information: We want to express our gratitude and appreciation to all participating sites and researchers part of the CAPACITY-COVID collaborative consortium. CAPACITY-COVID gratefully acknowledges the following organizations for their assistance in the development of the registry and/or coordination regarding the data registration in the collaborating centres: partners of the Dutch CardioVascular Alliance (DCVA), the Dutch Association of Medical Specialists (FMS), and the British Heart Foundation Centers of Research Excellence. In addition, the consortium is grateful for the endorsement of the CAPACITY-COVID initiative by the European Society of Cardiology (ESC), the European Heart Network (EHN), and the Society for Cardiovascular Magnetic Resonance (SCMR). Furthermore, the consortium appreciates the endorsement of CAPACITY-COVID as a flagship research project within the National Institute for Health Research (NIHR)/British Heart Foundation (BHF) Partnership framework for COVID-19 research. Part of this work is supported by the BigData@Heart Consortium, funded by the Innovative Medicines Initiative-2 joint undertaking under grant agreement no. 116074. This joint undertaking receives support from the EU’s Horizon 2020 research and innovation programme and EFP IA. Publisher Copyright: © 2022, The Author(s).
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