Risk Factors for Coronavirus Disease 2019 (COVID-19)–Associated Hospitalization: COVID-19–Associated Hospitalization Surveillance Network and Behavioral Risk Factor Surveillance System

Jean Y. Ko(Centers for Disease Control and Prevention), Melissa L. Danielson(Centers for Disease Control and Prevention), Machell Town(Centers for Disease Control and Prevention), Gordana Derado(Centers for Disease Control and Prevention), Kurt J. Greenlund(Centers for Disease Control and Prevention), Pam Daily Kirley, Nisha B. Alden(Colorado Department of Public Health and Environment), Kimberly Yousey‐Hindes, Evan J. Anderson(Emory University), Patricia Ryan(Maryland Department of Health), Sue Kim(Michigan Department of Health and Human Services), Ruth Lynfield(Minnesota Department of Health), Salina Torres(New Mexico Department of Health), Grant Barney(New York State Department of Health), Nancy M. Bennett(University of Rochester), Melissa Sutton(Oregon Health Authority), H. Keipp Talbot(Vanderbilt University), Mary Hill(Lake County), Aron J. Hall(Centers for Disease Control and Prevention), Alicia M. Fry(Centers for Disease Control and Prevention), Shikha Garg(Centers for Disease Control and Prevention), Lindsay Kim(Centers for Disease Control and Prevention), COVID-NET Surveillance Team, Michael Whitaker, Alissa O’Halloran, Rachel Holstein, William Garvin, Shua J. Chai, Breanna Kawasaki, James Meek, Kyle P. Openo, Maya Monroe, Justin Henderson, Kathy Como-Sabetti, Sarah Shrum Davis, Nancy Spina, Christina B. Felsen, Nicole West, William Schaffner, Andrea George
Clinical Infectious Diseases
September 17, 2020
10.1093/cid/ciaa1419
Cited by 371Open Access
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Abstract

BACKGROUND: Data on risk factors for coronavirus disease 2019 (COVID-19)-associated hospitalization are needed to guide prevention efforts and clinical care. We sought to identify factors independently associated with COVID-19-associated hospitalizations. METHODS: Community-dwelling adults (aged ≥18 years) in the United States hospitalized with laboratory-confirmed COVID-19 during 1 March-23 June 2020 were identified from the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET), a multistate surveillance system. To calculate hospitalization rates by age, sex, and race/ethnicity strata, COVID-NET data served as the numerator and Behavioral Risk Factor Surveillance System estimates served as the population denominator for characteristics of interest. Underlying medical conditions examined included hypertension, coronary artery disease, history of stroke, diabetes, obesity, severe obesity, chronic kidney disease, asthma, and chronic obstructive pulmonary disease. Generalized Poisson regression models were used to calculate adjusted rate ratios (aRRs) for hospitalization. RESULTS: Among 5416 adults, hospitalization rates (all reported as aRR [95% confidence interval]) were higher among those with ≥3 underlying conditions (vs without) (5.0 [3.9-6.3]), severe obesity (4.4 [3.4-5.7]), chronic kidney disease (4.0 [3.0-5.2]), diabetes (3.2 [2.5-4.1]), obesity (2.9 [2.3-3.5]), hypertension (2.8 [2.3-3.4]), and asthma (1.4 [1.1-1.7]), after adjusting for age, sex, and race/ethnicity. Adjusting for the presence of an individual underlying medical condition, higher hospitalization rates were observed for adults aged ≥65 or 45-64 years (vs 18-44 years), males (vs females), and non-Hispanic black and other race/ethnicities (vs non-Hispanic whites). CONCLUSIONS: Our findings elucidate groups with higher hospitalization risk that may benefit from targeted preventive and therapeutic interventions.

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