Age-specific associations between underlying health conditions and hospitalisation, death and in-hospital death among confirmed COVID-19 cases: a multi-country study based on surveillance data, June to December 2020

Tjede Funk, Francesco Innocenti, Joana Gomes Dias, Lina Nerlander, Tanya Melillo, Charmaine Gauci, Jackie M. Melillo, Patrik Lenz, Helena Sebestova, Pavel Slezak, Iva Vlckova, Jacob Dag Berild, Camilla Mauroy, Elina Seppälä, Ragnhild Tønnessen, Anne Vergison, Joël Mossong, Silvana Masi, Laetitia Huiart, Gillian CullenNiamh Murphy, Lois O'Connor, Joan O'Donnell, Piers Mook, Richard G. Pebody, Nick Bundle

Research output: Contribution to journalArticlepeer-review

Abstract

BackgroundUnderlying conditions are risk factors for severe COVID-19 outcomes but evidence is limited about how risks differ with age.AimWe sought to estimate age-specific associations between underlying conditions and hospitalisation, death and in-hospital death among COVID-19 cases.MethodsWe analysed case-based COVID-19 data submitted to The European Surveillance System between 2 June and 13 December 2020 by nine European countries. Eleven underlying conditions among cases with only one condition and the number of underlying conditions among multimorbid cases were used as exposures. Adjusted odds ratios (aOR) were estimated using 39 different age-adjusted and age-interaction multivariable logistic regression models, with marginal means from the latter used to estimate probabilities of severe outcome for each condition-age group combination.ResultsCancer, cardiac disorder, diabetes, immunodeficiency, kidney, liver and lung disease, neurological disorders and obesity were associated with elevated risk (aOR: 1.5-5.6) of hospitalisation and death, after controlling for age, sex, reporting period and country. As age increased, age-specific aOR were lower and predicted probabilities higher. However, for some conditions, predicted probabilities were at least as high in younger individuals with the condition as in older cases without it. In multimorbid patients, the aOR for severe disease increased with number of conditions for all outcomes and in all age groups.ConclusionWhile supporting age-based vaccine roll-out, our findings could inform a more nuanced, age- and condition-specific approach to vaccine prioritisation. This is relevant as countries consider vaccination of younger people, boosters and dosing intervals in response to vaccine escape variants.

Original languageEnglish
JournalEurosurveillance
Volume27
Issue number35
DOIs
Publication statusPublished - 1 Sep 2022
Externally publishedYes

Keywords

  • COVID-19
  • SARS-CoV-2
  • death
  • hospitalisation
  • in-hospital death
  • underlying health conditions

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