Epidemiological Risk Factors Associated with Death and Severe Disease in Patients Suffering From COVID-19: A Comprehensive Systematic Review and Meta-analysis
Abstract
Introduction
Progression of COVID-19 to severe disease and death is insufficiently understood.
Objective
Summarize the prevalence adverse outcomes, risk factors, and association of risk factors with adverse outcomes in COVID-19 patients.
Methods
We searched Medline, Embase and Web of Science for case-series and observational studies of hospitalized COVID-19 patients through May 22, 2020. Data were analyzed by fixed-effects meta-analysis, using Shore’s adjusted confidence intervals to address heterogeneity.
Results
Forty-four studies comprising 20594 hospitalized patients met inclusion criteria; 12591 from the US-Europe and 7885 from China. Pooled prevalence of death [%(95% CI)] was 18% (15-22%). Of those that died, 76% were aged≥ 60 years, 68% were males, and 63%, 38%, and 29% had hypertension, diabetes and heart disease, respectively. The case fatality risk [%(95% CI)] were 62% (48-78) for heart disease, 51% (36-71) for COPD, and 42% (34-50) for age≥ 60 years and 49% (33-71) for chronic kidney disease (CKD). Summary relative risk (sRR) of death were higher for age≥ 60 years [sRR=3.8; 95% CI: 2.9-4.8; n=12 studies], males [1.3; 1.2-1.5; 17], smoking history [1.9; 1.1-3.3; n=6], COPD [2.0; 1.6-2.4; n=9], hypertension [1.8; 1.7-2.0; n=14], diabetes [1.5; 1.4-1.7; n=16], heart disease [2.0; 1.7-2.4; 16] and CKD [2.0; 1.3-3.1; 8]. The overall prevalence of hypertension (55%), diabetes (31%) and heart disease (16%) among COVODI-19 patients in the US were substantially higher than the general US population.
Conclusions
Public health screening for COVID-19 can be prioritized based on risk-groups. A higher prevalence of cardiovascular risk factors in COVID-19 patients can suggest increased risk of SARS-CoV-2 acquisition in the population.
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