Associations between chronic conditions and death in hospital among adults (aged 20+ years) during first acute care hospitalizations with a confirmed or suspected COVID-19 diagnosis in Canada

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DOI

https://doi.org/10.1371/journal.pone.0280050

Language of the publication
English
Date
2023-01-04
Type
Article
Author(s)
  • Zakaria, Dianne
  • Aziz, Samina
  • Bartholomew, Sharon
  • Park, Su-Bin
  • Robitaille, Cynthia
  • Weeks, Murray
Publisher
PLoS ONE

Abstract

Purpose: We aimed to quantify life course-specific associations between death in hospital and 30 chronic conditions, and comorbidity among them, in adults (aged 20+ years) during their first acute care hospitalization with a confirmed or suspected COVID-19 diagnosis in Canada. Methods: We identified 35,519 first acute care hospitalizations with a confirmed or suspected COVID-19 diagnosis in the Discharge Abstract Database as of March 31, 2021. For each of five life-course age groups (20–34, 35–49, 50–64, 65–79, and 80+ years), we used multivariable logistic regression to examine associations between death in hospital and 30 chronic conditions, comorbidity, period of admission, and pregnant status, after adjusting for sex and age. Results: About 20.9% of hospitalized patients with COVID-19 died in hospital. Conditions most strongly associated with in-hospital death varied across the life course. Chronic liver disease, other nervous system disorders, and obesity were statistically significantly associated (α = 0.05) with in-hospital death in the 20–34 to 65–79 year age groups, but the magnitude of the associations decreased as age increased. Stroke (aOR = 5.24, 95% CI: 2.63, 9.83) and other inflammatory rheumatic diseases (aOR = 4.37, 95% CI: 1.64, 10.26) were significantly associated with in-hospital death among 35 to 49 year olds only. Among 50+ year olds, more chronic conditions were significantly associated with in-hospital death, but the magnitude of the associations were generally weaker except for Down syndrome in the 50 to 64 (aOR = 8.49, 95% CI: 4.28, 16.28) and 65 to 79 year age groups (aOR = 5.19, 95% CI: 1.44, 20.91). Associations between comorbidity and death also attenuated with age. Among 20 to 34 year olds, the likelihood of death was 19 times greater (aOR = 18.69, 95% CI: 7.69, 48.24) in patients with three or more conditions compared to patients with none of the conditions, while for 80+ year olds the likelihood of death was two times greater (aOR = 2.04, 95% CI: 1.70, 2.45) for patients with six or more conditions compared to patients with none of the conditions. Conclusion: Conditions most strongly associated with in-hospital death among hospitalized adults with COVID-19 vary across the life course, and the impact of chronic conditions and comorbidity attenuate with age.

Plain language summary

We aimed to quantify life course-specific associations between death in hospital and 30 chronic conditions, and comorbidity among them, in adults (aged 20+ years) during their first acute care hospitalization with a confirmed or suspected COVID-19 diagnosis in Canada. We identified 35,519 first acute care hospitalizations with a confirmed or suspected COVID-19 diagnosis in the Discharge Abstract Database as of March 31, 2021. For each of five life-course age groups (20-34, 35-49, 50-64, 65-79, and 80+ years), we used multivariable logistic regression to examine associations between death in hospital and 30 chronic conditions, comorbidity, period of admission, and pregnant status, after adjusting for sex and age. Conditions most strongly associated with in-hospital death among hospitalized adults with COVID-19 vary across the life course, and the impact of chronic conditions and comorbidity attenuate with age.

Subject

  • Health

Keywords

  • COVID 19,
  • Age groups,
  • Hospitalizations,
  • Down syndrome,
  • Pregnancy,
  • Adults,
  • Obesity,
  • Virus testing

Rights

Pagination

1-17

Peer review

Yes

Identifiers

Government document number
36598923
ISSN
1932-6203

Article

Journal title
PLoS ONE
Journal volume
18
Journal issue
1

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Collection(s)

Communicable diseases

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