JMIR Publications

ABSTRACT

Background:

Reliably identifying patients at increased risk for coronavirus disease 2019 (COVID-19) complications could guide clinical decisions, public health policies, and preparedness efforts. Multiple studies have attempted to characterize at-risk patients, using various data sources and methodologies. Most of these studies, however, explored condition-specific patient cohorts (e.g., hospitalized patients) or had limited access to patients’ medical history; thus, investigating related questions and, potentially, obtaining biased results.

Objective:

To identify factors associated with COVID-19 complications from the complete medical records of a nationally representative SARS-CoV-2 infected cohort.

Methods:

We studied the cohort of all SARS-CoV-2 positive individuals, confirmed by polymerase chain reaction testing of either nasopharyngeal or saliva samples, in a nationwide health organization (covering 2.3 million individuals) and identified those who suffered from serious complications (that is, experienced moderate or severe symptoms of COVID-19, admitted to intensive care unit or died). We then compared the prevalence of pre-existing conditions, extracted from electronic health records, between complicated and non-complicated COVID-19 patient cohorts to identify the conditions that significantly increase the risk of disease complications, in various age and sex strata.

Results:

Of the 4,353 SARS-CoV-2 positive individuals, 173 (4%) patients suffered from COVID-19 complications (all above the age of 18 years). Our analysis suggests that cardiovascular and kidney diseases, obesity, and hypertension are significant risk factors for COVID-19 complications, as previously reported. Interestingly, it also indicates that depression (e.g., odds ratio, OR, for males 65 years or older: 2.94, 95% confidence intervals [1.55, 5.58]; P = .014) as well as cognitive and neurological disorder (e.g., OR for individuals ≥ 65 years old: 2.65 [1.69, 4.17]; P < .001) are significant risk factors; and that smoking and background of respiratory diseases do not significantly increase the risk of complications.

Conclusions:

Adjusting existing risk definitions following these observations may improve their accuracy and impact the global pandemic containment and recovery efforts.