Age, sex, comorbidities associated with SARS-CoV-2 deaths among veterans
Older age, male sex and comorbidities are associated with increased risk for death among U.S. veterans with SARS-CoV-2 infection, according to study results published in JAMA Network Open.
“Infection with SARS-CoV-2 has a very broad spectrum of clinical severity, ranging from asymptomatic infection to life-threatening illness,” George N. Ioannou, BMBCh, MS, associate professor of medicine at the University of Washington Seattle and director of hepatology at VA Puget Sound Health Care System, Seattle, and colleagues wrote. “It remains unclear why some patients infected with SARS-CoV-2 develop the severe complications of COVID-19, which include acute respiratory distress syndrome and death.”
Researchers conducted a longitudinal cohort study on patients tested for SARS-CoV-2 from February to May at the Department of Veterans Affairs national health care system. Of 88,747 patients, 10,131 (11.4%) U.S. veterans tested positive (mean age, 63.6 years; 91% men).
The primary outcomes included risk of hospitalization, mechanical ventilation and death estimated in time-to-event analyses with Cox proportional hazards models.
Patients testing positive for COVID-19 had higher rates of 30-day hospitalization (adjusted HR = 1.13; 95% CI, 1.08-1.13), mechanical ventilation (aHR = 4.15; 95% CI, 3.74-4.61) and death (aHR = 4.44; 95% CI, 4.07-4.83) compared with those who tested negative. Characteristics significantly associated with mortality in patients with COVID-19 included older age (aHR = 60.8; 95% CI, 29.67-124.61), high COVID-19 burden (aHR = 1.21; 95% CI, 1.02-1.45), fever (aHR = 1.51; 95% CI, 1.32-1.72) and dyspnea (aHR = 1.78; 95% CI, 1.53-2.07).
Abnormalities in blood tests exhibiting dose-response associations with mortality, including aminotransferase (aHR = 1.86; 95% CI, 1.35-2.57), creatinine (aHR = 3.79; 95% CI, 2.62-5.48) and neutrophil-to-lymphocyte ratio (aHR = 2.88; 95% CI, 2.12-3.91), were also found to be associated with mortality in these patients.
These covariates were independently associated with mechanical ventilation along with Black race (aHR = 1.52; 95% CI, 1.25-1.85), male sex (aHR = 2.07; 95% CI, 1.3-3.32), diabetes (aHR = 1.4; 95% CI, 1.18-1.67) and hypertension (aHR = 1.3; 95% CI, 1.03-1.64).
Researchers observed most deaths in this cohort occurring in patients aged at least 50 years (63.4%), of male sex (12.3%) and with a Charlson Comorbidity Index score of at least 1 (11.1%).
Obesity, Black race, Hispanic ethnicity, COPD, hypertension and smoking were not significantly associated with mortality in the adjusted analysis.
“Recognizing risk factors for adverse outcomes is a preliminary step toward developing prognostic models that will allow for real-time identification of patients most and least likely to benefit from available interventions,” the researchers wrote. “Some risk factors may be reversible or modifiable, such that eliminating them might be a strategy for reducing the mortality rate of SARS-CoV-2 or may provide clues as to the pathogenesis of severe, life-threatening SARS-CoV-2.”