Obesity, CVD, other factors mean 75% of US adults may be at risk for severe COVID-19
As many as three-quarters of the U.S. adult population has at least one risk factor for severe COVID-19 infection according to CDC guidelines, which could make vaccine prioritization difficult, researchers reported.
The risk was especially elevated in patients with CVD, those with low incomes and those with a low education level, according to the study published in the American Journal of Preventive Cardiology.
When the researchers extrapolated data from the 2015-2018 National Health and Nutrition Examination Survey, they found 176.1 million individuals, representing 75.4% of U.S. adults, had at least one increased risk condition as defined by the CDC, 40.3% had at least two conditions and 18.5% had at least three conditions. Among adults younger than 65 years, 69.2% were estimated to be at increased risk.
The population at risk
“As preventive cardiologists, we wanted to know more about the population at risk for developing severe COVID-19 infection. We wanted to understand what proportion of the U.S. population was at risk and were particularly interested in the proportion of younger individuals. These data would help inform prevention practices,” Amit Khera, MD, MSc, FACC, FAHA, Dallas Heart Ball Chair in Hypertension and Heart Disease, director of the preventive cardiology program and associate professor of medicine at University of Texas Southwestern Medical Center, told Healio.
The most prevalent risk conditions as defined by the CDC were obesity (41.3%), age 65 years or older (20.2%) and chronic kidney disease (15.8%), Khera and colleagues found. An estimated 6.2 million individuals (14.5%) had heart disease. Among these, virtually all had at least one additional CDC risk factor (97.9%) and most had at least two or at least three risk factors (83.8% and 58.5%, respectively), the researchers wrote.
In the overall population, 75.6% of Black adults and 78% of white adults were at high risk (P > .05), but there was a lower percentage of Hispanic adults at high risk (71.6%) compared with white adults (P < .05), Khera and colleagues wrote, noting that among people younger than 65 years, there was no difference between Hispanic and white adults in percentage at high risk.
Mortality risk not explained
“It is well known that Blacks and Hispanics have had disproportionately high mortality rates from COVID-19, and thus these CDC criteria do not explain the increased mortality rates in these groups,” Khera told Healio. “Our study just looked at the presence of these risk factors, but not their severity or treatment, or other factors that could contribute to the higher mortality rates.”
People with lower education levels had elevated rates of being at high risk (less than high school, 83%; more than high school, 71%; P < .05), as did people with lower income levels (less than 150% of federal poverty level, 54.7%; 150% or more of federal poverty level, 49.1%; P < .05), Khera and colleagues found.
“Clearly, with three-quarters of the population having at least one of these risk factors, these CDC criteria may not be optimal to prioritize vaccination. The results also remind us about the health of our population, and why we are failing the stress test of COVID-19, as well as the work we have to do to improve population health for a more resilient population,” Khera told Healio.
For more information:
Amit Khera, MD, MSc, FACC, FAHA, can be reached at firstname.lastname@example.org.