Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Apr 2, 2021
Date Accepted: Apr 1, 2022
Date Submitted to PubMed: Apr 4, 2022
Factors Associated With COVID-19 Death in the United States: Cohort Study
ABSTRACT
Background:
Since the initial COVID-19 cases were identified in the United States in February 2020, the U. S. has experienced a high incidence of the disease . Understanding the risk factors of severe outcomes identifies the most vulnerable populations and helps in decision-making.
Objective:
To assess the factors associated with COVID-19 death from large national individual-level data.
Methods:
A cohort study was conducted using data from the Optum® de-identified COVID-19 Electronic Health Record (EHR) dataset. 1,271,033 adult participants were observed from February 1st to August 31st, 2020 until either their deaths due to COVID-19, deaths due to other reasons, or the end of the study. Cox Proportional Hazards models were constructed to evaluate the risks for each patient characteristic.
Results:
A total of 1,271,033 subjects (mean [SD] age, 52.6 [17.9] years; 507,574 [39.9%] male) were included in the study and 3,315 (0.26%) deaths were attributed to COVID-19. Factors associated with COVID-19 death included older age ( 80 vs 50-59 years old: hazard ratio [HR] 13.28 [95% CI 11.46-15.39]), male sex (HR 1.68 [1.57-1.80]), obesity (BMI 40 vs < 30: HR 1.71 [1.50-1.96]), race (Hispanic White, African American, Asian vs Non-Hispanic White: HR 2.46 [2.01-3.02], HR 2.27 [2.06-2.50], HR 2.06 [1.65-2.57]), region (South, Northeast, Midwest vs West: HR 1.62 [1.33-1.98], HR 2.50 [2.06-3.03], HR 1.35 [1.11-1.64]), chronic respiratory disease (HR 1.21 [1.12-1.32]), cardiac disease (HR 1.10 [1.01-1.19]), diabetes (HR 1.92 [1.75-2.10]), recently diagnosed lung cancer (HR 1.70 [1.14-2.55]), severe reduced kidney function (HR 1.92 [1.69-2.19]), stroke/dementia (HR 1.25 [1.15-1.36]), other neurological diseases (HR 1.77 [1.59-1.98]), organ transplant (HR 1.35 [1.09-1.67]), and other immunosuppressive condition (HR 1.21 [1.01-1.46]).
Conclusions:
This one of the largest national cohort studies in the U.S. identified several patient characteristics associated with COVID-19 death and can serve as the basis of policy-making. The study also offered directions for future studies, including the effect of other socioeconomic factors on the increased risk of minority groups.
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