Risk Factors for Coronavirus Disease 2019 (COVID-19) Death in a Population Cohort Study from the Western Cape Province, South Africa
Andrew Boulle(University of Cape Town), Mary‐Ann Davies(University of Cape Town), Hannah Hussey(University of Cape Town), Muzzammil Ismail(University of Cape Town), Erna Morden(University of Cape Town), Ziyanda Vundle(Stellenbosch University), Virginia Zweigenthal(University of Cape Town), Hassan Mahomed(Western Cape Department of Health), Masudah Paleker(Western Cape Department of Health), David Pienaar(Western Cape Department of Health), Yamanya Tembo(Western Cape Department of Health), Charlene Lawrence(Western Cape Department of Health), Washiefa Isaacs(Western Cape Department of Health), Hlengani Mathema(National Health Laboratory Service), Derick Allen(University of Cape Town), Taryn Allie(University of Cape Town), Jamy‐Lee Bam(Impact Assessment), Kasturi Buddiga(University of Cape Town), Pierre Dane(University of Cape Town), Alexa Heekes(University of Cape Town), Boitumelo Matlapeng(University of Cape Town), Themba Mutemaringa(University of Cape Town), Luckmore Muzarabani(University of Cape Town), Florence Phelanyane(University of Cape Town), R. Pienaar(Impact Assessment), Catherine Rode(University of Cape Town), Mariette Smith(University of Cape Town), Nicki Tiffin(University of Cape Town), Nesbert Zinyakatira(University of Cape Town), Carol Cragg(Western Cape Department of Health), Frederick Marais(Western Cape Department of Health), Vanessa Mudaly(Western Cape Department of Health), Jacqueline Voget(Western Cape Department of Health), Jody Davids(Western Cape Department of Health), F Roodt(Western Cape Department of Health), Nellis van Zyl Smit(Western Cape Department of Health), Alda Vermeulen(Western Cape Department of Health), Kevin Adams(University of Cape Town), Gordon Audley(University of Cape Town), Kathleen Bateman(University of Cape Town), Peter Beckwith(University of Cape Town), M. Bernon(University of Cape Town), Dirk Blom(University of Cape Town), Linda Boloko(University of Cape Town), Jean Botha(University of Cape Town), Adam Boutall(University of Cape Town), S. Burmeister(University of Cape Town), Lydia Cairncross(University of Cape Town), Greg Calligaro(University of Cape Town), Cecilia Coccia(University of Cape Town), Chadwin Corin(University of Cape Town), Remy Daroowala(University of Cape Town), Joel A. Dave(University of Cape Town), Elsa Du Bruyn(University of Cape Town), Martin De Villiers(University of Cape Town), Mimi Deetlefs(University of Cape Town), Sipho Dlamini(University of Cape Town), Thomas Du Toit(University of Cape Town), Wilhelm Endres(University of Cape Town), Tarin A. Europa(University of Cape Town), Graham Fieggan(University of Cape Town), Anthony Figaji(University of Cape Town), Petro Frankenfeld(University of Cape Town), Elizabeth Gatley(University of Cape Town), Phindile Gina(University of Cape Town), Evashan Govender(University of Cape Town), Rochelle Grobler(University of Cape Town), M. V. Gule(University of Cape Town), Christoff Hanekom(University of Cape Town), Michael Held(University of Cape Town), Alana Heynes(University of Cape Town), Sabelo Hlatswayo(University of Cape Town), Bridget Hodkinson(University of Cape Town), J. A. Holtzhausen(Groote Schuur Hospital), Shakeel Hoosain(University of Cape Town), Ashely Jacobs(University of Cape Town), Miriam Kahn(University of Cape Town), Thania Kahn(University of Cape Town), Arvin Khamajeet(University of Cape Town), Joubin Khan(University of Cape Town), Riaasat Khan(University of Cape Town), Alicia Khululwa Khwitshana(University of Cape Town), Lauren Knight(University of Cape Town), Sharita Kooverjee(University of Cape Town), Rene Krogscheepers(University of Cape Town), Jean Jacque Kruger(University of Cape Town), Suzanne Kuhn(University of Cape Town), Kim Laubscher(University of Cape Town), J. Michael Lazarus(University of Cape Town), Jacque Le Roux(University of Cape Town), Scott Lee Jones(University of Cape Town), Dion Levin(University of Cape Town), Gary Maartens(University of Cape Town), Thina Majola(University of Cape Town), Rodgers Manganyi(University of Cape Town), David Marais(University of Cape Town), Suzaan Marais(University of Cape Town), F J Maritz(University of Cape Town), Deborah Maughan(University of Cape Town), Simthandile Mazondwa(University of Cape Town), Luyanda Mbanga(University of Cape Town), Nomonde Mbatani(University of Cape Town), Bulewa Mbena(University of Cape Town), Graeme Meintjes(University of Cape Town), Marc Mendelson(University of Cape Town), Ernst Lodewicus Möller(University of Cape Town), Allison Moore(University of Cape Town), Babalwa Ndebele(University of Cape Town), Marc Nortje(University of Cape Town), Ntobeko Ntusi(University of Cape Town), Funeka Nyengane(University of Cape Town), Chima Ofoegbu(University of Cape Town), Nectarios Papavarnavas(University of Cape Town), Jonny Peter(University of Cape Town), H Pickard(University of Cape Town), Kent Pluke(University of Cape Town), Peter J Raubenheimer(University of Cape Town), Gordon Robertson(University of Cape Town), Julius Rozmiarek(University of Cape Town), Abdul‐Rauf Sayed(University of Cape Town), Matthias Scriba(University of Cape Town), Hennie Sekhukhune(University of Cape Town), Prasun Singh(University of Cape Town), Elsabe Smith(University of Cape Town), Vuyolwethu Soldati(University of Cape Town), Cari Stek(University of Cape Town), Robert van den berg(University of Cape Town), Le Roux van der Merwe(University of Cape Town), P.A. Venter(University of Cape Town), Barbra Vermooten(University of Cape Town), Gerrit Viljoen(University of Cape Town), Santhuri Viranna(University of Cape Town), J. Vogel(University of Cape Town), Nokubonga Vundla(University of Cape Town), Sean Wasserman(University of Cape Town), Eddy Zitha(University of Cape Town), Vanessa Lomas-Marais(University of Cape Town), Annie Lombard(University of Cape Town), Katrin Stuve(University of Cape Town), Werner Viljoen(University of Cape Town), De Vries Basson(Karl Bremer Hospital), Sue Le Roux(Karl Bremer Hospital), Ethel Linden-Mars(Karl Bremer Hospital), Lizanne Victor(Karl Bremer Hospital), Mark Wates(Karl Bremer Hospital), Elbe Zwanepoel(Karl Bremer Hospital), Nabilah Ebrahim, Sa’ad Lahri, Ayanda Trevor Mnguni, Thomas Crede(Western Cape Department of Health), Martin de Man(Western Cape Department of Health), Katya Evans(Western Cape Department of Health), Clint Hendrikse(Western Cape Department of Health), Jonathan Naudé(Western Cape Department of Health), Moosa Parak(Western Cape Department of Health), Patrick Szymanski(Western Cape Department of Health), Candice Van Koningsbruggen(Western Cape Department of Health), Riezaah Abrahams(Stellenbosch University), Brian Allwood(Stellenbosch University), Christoffel Botha(Stellenbosch University), Matthys Henndrik Botha(Stellenbosch University), Alistair G.B. Broadhurst(Stellenbosch University), Dirkie Claasen(Stellenbosch University), Che Daniel(Stellenbosch University), R Dawood(Stellenbosch University), Marié Du Preez(Stellenbosch University), N Du Toit(Stellenbosch University), Kobie Erasmus(Tygerberg Hospital), Coenraad F.N. Koegelenberg(Stellenbosch University), Shiraaz Gabriel(Stellenbosch University), Susan Hugo(Stellenbosch University), Thabiet Jardine(Stellenbosch University), Clint Johannes(Stellenbosch University), Sumanth Karamchand(Stellenbosch University), Usha Lalla(Stellenbosch University), Eduard Langenegger(Stellenbosch University), Eize Louw(Stellenbosch University), Boitumelo Mashigo(Stellenbosch University), Nonte Mhlana(Stellenbosch University), Chizama Mnqwazi(Stellenbosch University), Ashley Moodley(Stellenbosch University), Desiree Moodley(Stellenbosch University), Muhammad Moolla(Stellenbosch University), Abdurasiet Mowlana(Stellenbosch University), André Nortje(Stellenbosch University), Elzanne Olivier(Stellenbosch University), Arifa Parker(Stellenbosch University), Chané Paulsen(Stellenbosch University), Hans Prozesky(Stellenbosch University), J W Rood(Stellenbosch University), Tholakele Sabela(Stellenbosch University), Neshaad Schrueder(Stellenbosch University), Nokwanda Sithole(Stellenbosch University), Sthembiso Sithole(Stellenbosch University), Jantjie Taljaard(Stellenbosch University), Gideon Titus(Stellenbosch University), Tian Van Der Merwe(Stellenbosch University), Marije Van Schalkwyk(Stellenbosch University), Luthando Vazi(Stellenbosch University), Abraham Viljoen(Stellenbosch University), Mogamat‐Yazied Chothia(Stellenbosch University), Vanessa Naidoo, Lee Wallis(University of Cape Town), Mumtaz Abbass(Western Cape Department of Health), Juanita Arendse(Western Cape Department of Health), Rizqa Armien(Western Cape Department of Health), Rochelle Bailey(Western Cape Department of Health), Muideen Bello(Western Cape Department of Health), Rachel Carelse(Western Cape Department of Health), Sheron Forgus(Western Cape Department of Health), Nosi Kalawe(Western Cape Department of Health), Saadiq Kariem(Western Cape Department of Health), Mariska Kotze(Western Cape Department of Health), Jonathan Lucas(Western Cape Department of Health), Juanita McClaughlin(Western Cape Department of Health), Kathleen Murie(Western Cape Department of Health), Leilah Najjaar(Western Cape Department of Health), Liesel Petersen(Western Cape Department of Health), James Porter(Western Cape Department of Health), Melanie Shaw(Western Cape Department of Health), Dusica Stapar(Western Cape Department of Health), Michelle Williams(Western Cape Department of Health), Linda Aldum(City of Cape Town), Natacha Berkowitz(City of Cape Town), Raakhee Girran(City of Cape Town), Kevin Lee(City of Cape Town), Lenny Naidoo(City of Cape Town), Caroline Neumuller(City of Cape Town), Kim Anderson(University of Cape Town), Kerrin Begg(University of Cape Town), Lisa Boerlage(University of Cape Town), Morna Cornell(University of Cape Town), Renée de Waal(University of Cape Town), Lilian Dudley(Western Cape Department of Health), René English(Western Cape Department of Health), Jonathan Euvrard(University of Cape Town), Pam Groenewald(South African Medical Research Council), Nisha Jacob(University of Cape Town), Heather B. Jaspan(University of Cape Town), Emma Kalk(University of Cape Town), Naomi Levitt(University of Cape Town), Thokozile R. Malaba(University of Cape Town), Patience Nyakato(University of Cape Town), Gabriela Patten(University of Cape Town), Helen Schneider(University of the Western Cape), Maylene Shung King(University of Cape Town), Priscilla Ruvimbo Tsondai(University of Cape Town), James Van Duuren(University of Cape Town), Nienke van Schaik, Lucille Blumberg(National Health Laboratory Service), Cheryl Cohen(National Health Laboratory Service), Nelesh P. Govender(National Health Laboratory Service), Waasila Jassat(National Health Laboratory Service), Tendesayi Kufa(National Health Laboratory Service), Kerrigan McCarthy(National Health Laboratory Service), Lynn Morris(National Health Laboratory Service), Marvin Hsiao(National Health Laboratory Service), Ruan Marais(National Health Laboratory Service), Jon Ambler(University of Cape Town), Olina Ngwenya(University of Cape Town), Richard Osei‐Yeboah(University of Cape Town), Leigh F. Johnson(University of Cape Town), Reshma Kassanjee(University of Cape Town), Tsaone Tamuhla(University of Cape Town)
Cited by 598Open Access
Abstract
BACKGROUND: Risk factors for coronavirus disease 2019 (COVID-19) death in sub-Saharan Africa and the effects of human immunodeficiency virus (HIV) and tuberculosis on COVID-19 outcomes are unknown. METHODS: We conducted a population cohort study using linked data from adults attending public-sector health facilities in the Western Cape, South Africa. We used Cox proportional hazards models, adjusted for age, sex, location, and comorbidities, to examine the associations between HIV, tuberculosis, and COVID-19 death from 1 March to 9 June 2020 among (1) public-sector "active patients" (≥1 visit in the 3 years before March 2020); (2) laboratory-diagnosed COVID-19 cases; and (3) hospitalized COVID-19 cases. We calculated the standardized mortality ratio (SMR) for COVID-19, comparing adults living with and without HIV using modeled population estimates. RESULTS: Among 3 460 932 patients (16% living with HIV), 22 308 were diagnosed with COVID-19, of whom 625 died. COVID-19 death was associated with male sex, increasing age, diabetes, hypertension, and chronic kidney disease. HIV was associated with COVID-19 mortality (adjusted hazard ratio [aHR], 2.14; 95% confidence interval [CI], 1.70-2.70), with similar risks across strata of viral loads and immunosuppression. Current and previous diagnoses of tuberculosis were associated with COVID-19 death (aHR, 2.70 [95% CI, 1.81-4.04] and 1.51 [95% CI, 1.18-1.93], respectively). The SMR for COVID-19 death associated with HIV was 2.39 (95% CI, 1.96-2.86); population attributable fraction 8.5% (95% CI, 6.1-11.1). CONCLUSIONS: While our findings may overestimate HIV- and tuberculosis-associated COVID-19 mortality risks due to residual confounding, both living with HIV and having current tuberculosis were independently associated with increased COVID-19 mortality. The associations between age, sex, and other comorbidities and COVID-19 mortality were similar to those in other settings.
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