April 1, 2020

COVID-19: CDC describes prevalence of selected underlying health conditions among patients in US

According to the US Centers for Disease Control and Prevention's latest Morbidity and Mortality Weekly Report, based on preliminary US data, persons with underlying health conditions, such as diabetes mellitus, chronic lung disease, and cardiovascular disease, appear to be at higher risk for severe COVID-19–associated disease than persons without these conditions.

The report analyzed data from laboratory-confirmed COVID-19 cases reported to CDC from 50 states, four US territories and affiliated islands, the District of Columbia, and New York City with February 12–March 28, 2020 onset dates. Cases among persons repatriated to the United States from Wuhan, China, and the Diamond Princess cruise ship were excluded.

According to the report, public health departments reported cases to CDC using a standardized case report form that captures information on the following conditions and potential risk factors: chronic lung disease (inclusive of asthma, chronic obstructive pulmonary disease [COPD], and emphysema); diabetes mellitus; cardiovascular disease; chronic renal disease; chronic liver disease; immunocompromised condition; neurologic disorder, neurodevelopmental, or intellectual disability; pregnancy; current smoking status; former smoking status; or other chronic disease.

As of March 28, 2020, a total of 122,653 laboratory-confirmed COVID-19 cases and 2,112 deaths were reported to CDC. Case report forms were submitted to CDC for 74,439 (60.7%) cases. 

The report noted that data on presence or absence of underlying health conditions and other recognized risk factors for severe outcomes from respiratory infections (i.e. smoking and pregnancy) were available for 7,162 (5.8%) patients. Approximately one third of these patients (2,692, 37.6%) had at least one underlying condition or risk factor. 

According to the report, diabetes mellitus (784, 10.9%), chronic lung disease (656, 9.2%), and cardiovascular disease (647, 9.0%) were the most frequently reported conditions among all cases. Among 457 ICU admissions and 1,037 non-ICU hospitalizations, 358 (78%) and 732 (71%) respectively occurred among persons with one or more reported underlying health conditions. 

In contrast, 1,388 of 5,143 (27%) COVID-19 patients who were not hospitalized were reported to have at least one underlying health condition.

Meanwhile, based on the data tabulated in the report, among 525 COVID-19 patients with unknown hospitalization status, 214 (41%) of them were reported to have at least one underlying health condition.

The report also highlighted that among patients aged ≥19 years, the percentage of non-ICU hospitalizations was higher among those with underlying health conditions (27.3%–29.8%) than among those without underlying health conditions (7.2%–7.8%); the percentage of cases that resulted in an ICU admission was also higher for those with underlying health conditions (13.3%–14.5%) than those without these conditions (2.2%–2.4%). 

The report added that small numbers of COVID-19 patients aged <19 years were reported to be hospitalized (48) or admitted to an ICU (eight). In contrast, 335 patients aged <19 years were not hospitalized and 1,342 had missing data on hospitalization. 

In addition, among all COVID-19 patients with complete information on underlying conditions or risk factors, 184 deaths occurred (all among patients aged ≥19 years); 173 deaths (94%) were reported among patients with at least one underlying condition.

The CDC noted that the findings in the report are subject to limitations including the data were preliminary, and the analysis was limited by missing data because of the burden placed on reporting health departments with rapidly rising case counts, and no conclusions could be drawn about underlying conditions that were not included in the case report form. The CDC also added that “for some underlying health conditions and risk factors, including neurologic disorders, chronic liver disease, being a current smoker, and pregnancy, few severe outcomes were reported; therefore, conclusions cannot be drawn about the risk for severe COVID-19 among persons in these groups”. 

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