People with co-morbidities 12 times more likely to die of Covid: US study
People with underlying health conditions like heart disease and diabetes are 12 times more likely to die and six times more likely to be hospitalised with severe coronavirus disease (Covid-19) than healthy patients, according to what is the largest yet analysis of patient records to understand how to save lives from the virus that has infected 823,289 and claimed 431, 541 globally (WHO report as on June 15).
One in five (19.5%) people with underlying diseases died compared to 1.6% of those who were healthy, found an analysis of 1.3 million cases and 103,700 deaths in the United States from January 22 through May 30 done by the US Centers for Disease Control and Prevention (CDC), the country’s federal agency. Hospitalisations were also significantly higher in those with chronic diseases, with 45.4% of such people needing to be hospitalised compared to 7.6% with no pre-existing disease.
Of the 1.3 million cases, 14% needed hospitalisation, 2% needed intensive care, and 5% died, but the real death rate is likely to be lower because people with mild or no symptoms often remain undiagnosed, said the CDC. The chances of severe illness and death increase with age, particularly in men and people with underlying health conditions, according to the analysis.
The CDC report is consistent with reports from around the world, including India, where people with other diseases had a higher risk of hospitalisation and death.
In the US, cardiovascular disease (32%), diabetes (30%) and lung disease (18%) are the most common chronic diseases among Covid-19 patients.
Even among young adults below 39 years, the hospitalisation rate in the US is at least four times higher for those with underlying illnesses. Deaths are highest among people 80 years or older, irrespective of whether they had chronic illnesses, but about 50% of all deaths were in that age group with a chronic health illness.
The prevalence of underlying diseases is similar between the sexes, but men with Covid-19 were twice as likely to need hospitalisation, the CDC study found.
In a separate but linked study published in the journal Lancet on Tuesday, an estimated 1.7 billion people -- more than 20% of the world’s population – have at least one underlying health problem such as obesity or heart disease that put them in greater danger of Covid-19 infection.
In India, close to four in five people (78%) diagnosed with Covid-19 have underlying conditions, according to an analysis of data from first 33,050 cases in India reported till April 30. Men accounted for two-thirds of cases, and half (51.2%) of all patients were over 60 years old, said the Union ministry of health analysis.
The risk factors for severe Covid-19 include old age, cardiovascular disease, chronic kidney disease, diabetes, chronic respiratory disease and obesity. “Our clinical experience in India is that those at the highest risk of severe disease and death are Covid-19 patients with any two or more underlying conditions, such as hypertension and kidney disease, or diabetes and chronic lung diseases,” said Dr Randeep Guleria, director, All India Institute of Medical Sciences, New Delhi. In India, an estimated 54.6 million people have heart disease and 70 million people have diabetes , according to estimates based on the Global Burden of Disease Study 2017.
“With testing remaining low and many sick people avoiding hospitals, there is a danger of the death certificates not recording the correct cause of death and Covid-19 being missed, which is why we must study all-cause mortality to see if overall deaths have increased during the pandemic. Also, the advantage of a young demographic is negated if chronic diseases are high in young people and the health systems are weak,” said Dr Dileep Mavalankar, director, Public Health Foundation of India, Gandhinagar.
“In the West, it is easy to track of deaths from to cardiac arrests at home through 911 emergency calls, but it is very difficult to get community-level data from India, where the cause of death often goes unrecorded or it not clinically accurate. There is anecdotal evidence of more people dying at home than the total Covid-19 deaths because many, especially the elderly, are scared to go to hospitals due to corona fears, which leads to delays in treatment and avoidable death,” said Dr Ashok Seth, chief cardiologist and chairman, Fortis Escorts Heart Institute, New Delhi.
In the Lancet study cited above, the authors estimate that 349 million people -- or 4% of the world’s population -- are at high risk of severe disease needing hospitalisation. The modeling used data from the Global Burden of Disease Study 2017, UN population estimates for 2020 and the list of underlying health conditions relevant to Covid-19, as defined by current guidelines.
This risk varied from less than 1% in people under 20 to nearly 20% of those 70 or older, rising to 25% in men over 70 years. The Lancet study also found that twice the number of men as women needed hospitalisation.
Globally, less than 5% people under the 20 have underlying health condition, which is over 66% for those aged 70 and above. Among the more mobile working age population (15 to 64 years), 23% people worldwide are estimated to have at least one underlying condition.
“Our estimates suggest that age-based thresholds for shielding could play a role in reducing deaths and reducing the number of people who require hospital treatment, but the choice of threshold needs to be balanced against the proportion of people of working age affected, as well as the health and economic consequences associated with long periods of isolation,” says Dr Rosalind Eggo from the London School of Hygiene & Tropical Medicine, UK, in a statement.
Along with health and other frontline workers, vaccination in the future must be prioritised for vulnerable populations, including the elderly and people with underlying conditions to save lives. “Not only should the elderly and people with chronic disease follow social distancing and protection norms, such as masks, but so must young people around them to prevent transmission of infection,” said Dr Mavalankar.