Risk Factors for COVID-19-associated hospitalization: COVID-19-Associated Hospitalization Surveillance Network and Behavioral Risk Factor Surveillance System

  1. Jean Y. Ko
  2. Melissa L. Danielson
  3. Machell Town
  4. Gordana Derado
  5. Kurt J. Greenlund
  6. Pam Daily Kirley
  7. Nisha B. Alden
  8. Kimberly Yousey-Hindes
  9. Evan J. Anderson
  10. Patricia A. Ryan
  11. Sue Kim
  12. Ruth Lynfield
  13. Salina M. Torres
  14. Grant R. Barney
  15. Nancy M. Bennett
  16. Melissa Sutton
  17. H. Keipp Talbot
  18. Mary Hill
  19. Aron J. Hall
  20. Alicia M. Fry
  21. Shikha Garg
  22. Lindsay Kim
  23. COVID-NET Investigation Group
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Abstract

Background

Identification of risk factors for COVID-19-associated hospitalization is needed to guide prevention and clinical care.

Objective

To examine if age, sex, race/ethnicity, and underlying medical conditions is independently associated with COVID-19-associated hospitalizations.

Design

Cross-sectional.

Setting

70 counties within 12 states participating in the Coronavirus Disease 2019-Associated Hospitalization Surveillance Network (COVID-NET) and a population-based sample of non-hospitalized adults residing in the COVID-NET catchment area from the Behavioral Risk Factor Surveillance System.

Participants

U.S. community-dwelling adults (≥18 years) with laboratory-confirmed COVID-19-associated hospitalizations, March 1- June 23, 2020.

Measurements

Adjusted rate ratios (aRR) of hospitalization by age, sex, race/ethnicity and underlying medical conditions (hypertension, coronary artery disease, history of stroke, diabetes, obesity [BMI ≥30 kg/m 2 ], severe obesity [BMI≥40 kg/m 2 ], chronic kidney disease, asthma, and chronic obstructive pulmonary disease).

Results

Our sample included 5,416 adults with COVID-19-associated hospitalizations. Adults with (versus without) severe obesity (aRR:4.4; 95%CI: 3.4, 5.7), chronic kidney disease (aRR:4.0; 95%CI: 3.0, 5.2), diabetes (aRR:3.2; 95%CI: 2.5, 4.1), obesity (aRR:2.9; 95%CI: 2.3, 3.5), hypertension (aRR:2.8; 95%CI: 2.3, 3.4), and asthma (aRR:1.4; 95%CI: 1.1, 1.7) had higher rates of hospitalization, after adjusting for age, sex, and race/ethnicity. In models adjusting for the presence of an individual underlying medical condition, higher hospitalization rates were observed for adults ≥65 years, 45-64 years (versus 18-44 years), males (versus females), and non-Hispanic black and other race/ethnicities (versus non-Hispanic whites).

Limitations

Interim analysis limited to hospitalizations with underlying medical condition data.

Conclusion

Our findings elucidate groups with higher hospitalization risk that may benefit from targeted preventive and therapeutic interventions.

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