COVID-19 Hospitalization

Assessing impact of underlying medical conditions on hospitalization outcomes

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Patient Medical Conditions

Hospitalization Risk

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Results illustrate how combinations of medical conditions may affect COVID-19 disease severity and illustrates population risk observed with the groups of medical conditions reported within the study. It is not suitable for evaluating the individual risk of patients outside this population. It does not predict outcomes and is not intended to inform clinical decision making. Reported risks were measured in an unvaccinated insured US population during the first year of the COVID-19 pandemic, and may not be representative of individual or population risks outside this setting.

Objective: To compare the risk of COVID-19 hospitalization and medically-attended COVID-19 in unvaccinated adults between individuals who have different comorbidity profiles (Cardiovascular Disease, Chronic Kidney Disease, Diabetes, Chronic Lung Disease, Immunocompromised conditions) and individuals who have none of the conditions included in these comorbidity profiles.

*Comorbidity profiles: Combinations of zero to five categories of conditions that are associated with severe COVID-19: Cardiovascular Disease, Chronic Kidney Disease, Diabetes, Chronic Lung Disease, Immunocompromised conditions, and individuals who have none of the conditions included in these comorbidity profiles.

Data source: This analysis used electronic health record (EHR) data from the Veradigm Network EHR linked to healthcare claims sourced from Komodo Health, both of which are large US-based data sources. The EHR dataset consists of de-identified patient records sourced from ambulatory/outpatient primary care and specialty settings. The healthcare claims data contains de-identified inpatient, outpatient, and pharmacy claims. The integrated EHR/claims dataset has been used extensively in COVID-19 epidemiology research.

Outcome: COVID-19 hospitalization rate defined as time from index date to the first occurrence of COVID-19-illness requiring hospitalization.

Observation period: 03/15/2020 - 12/15/2020 (ancestral strain); Rationale: Estimate impact of comorbidity on COVID-19 outcomes in the absence of authorized/approved vaccines.

Index date: Earliest date of EMR or claims (excluding pharmacy claims) activity during the observation period.

Population: Unvaccinated adults aged 18 years or older on index date who have contact with a healthcare provider (excluding medication prescription and pharmacy fill activity) during the observation period.

Risk groups: Reference group are adults with none of the comorbidities of interest. Risk groups will be defined as having one, two, three, four, or all five of the comorbidities of interest.

Analysis: Unadjusted hazard ratios (HR) of the outcome was estimated using a univariable Cox regression model with comorbidity profiles as the only predictor. Adjusted HRs and corresponding 95% confidence intervals was estimated for COVID-19 hospitalization using a multivariate Cox regression model controlling for age, sex, race, ethnicity, insurance type, and geographic region.

Chronic Lung DiseaseCardiovascular DiseaseDiabetesChronic Kidney DiseaseImmunocompromised conditionsHazard Ratio95% CI
1.5261.482-1.572
1.6041.552-1.657
2.0301.983-2.078
1.9091.784-2.042
1.2031.158-1.250
2.5862.492-2.684
2.4982.405-2.594
2.5112.259-2.792
1.8711.762-1.986
2.6482.566-2.733
2.8972.706-3.102
1.6101.508-1.718
3.3033.143-3.471
2.0091.909-2.115
2.5322.284-2.805
4.0603.928-4.196
4.2974.042-4.568
2.7692.602-2.947
3.8053.519-4.114
2.7602.565-5.970
3.3422.881-3.877
4.8284.634-5.031
2.5852.433-2.746
2.9492.632-3.304
3.4453.149-3.769
7.2436.986-7.509
3.9663.753-4.192
4.4334.041-4.863
4.2473.752-4.808
4.5484.240-4.879
7.0006.631-7.391

About: (1) Use of administrative claims based on codes entered by healthcare providers or billing departments and may be subject to errors and inconsistencies. (2) Generalizability: this analysis included only US adult patients with continuous claims enrollment. (3) Applicability to current COVID-19 disease – the analysis utilized data on COVID-19 outcomes in the absence of authorized/approved vaccines. (4) the adjusted risks for each 'medical condition' are an aggregate and may differ from the individual comorbidities from which they were calculated.