Association between multimorbidity, intensive care unit admission, and death in patients with COVID-19 in Brazil
a cross-section study, 2020
Keywords:
Multimorbidity, Morbidity, COVID-19, Hospitalization, Comorbidity, DeathAbstract
BACKGROUND: Multimorbidity can influence intensive care unit (ICU) admissions and deaths due to coronavirus disease (COVID-19). OBJECTIVE: To analyze the association between multimorbidity, ICU admissions, and deaths due to COVID-19 in Brazil. DESIGN AND SETTING: This cross-sectional study was conducted using data from patients with severe acute respiratory syndrome (SARS) due to COVID-19 recorded in the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) in 2020. METHODS: Descriptive and stratified analyses of multimorbidity were performed based on sociodemographic, ventilatory support, and diagnostic variables. Poisson regression was used to estimate the prevalence ratios. RESULTS: We identified 671,593 cases of SARS caused by COVID-19, of which 62.4% had at least one morbidity. Multimorbidity was associated with male sex, age 60–70 and ≥ 80 years, brown and black skin color, elementary education and high school, ventilatory support, and altered radiologic exams. Moreover, all regions of the country and altered computed tomography due to COVID-19 or other diseases were associated with death; only the northeast region and higher education were associated with ICU admission. CONCLUSION: Our results showed an association between multimorbidity, ICU admission, and death in COVID-19 patients in Brazil.
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References
World Health Organization. WHO Coronavirus (COVID-19) Dashboard. Available from: https://covid19.who.int/. Accessed in 2022 (Jun 16).
Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Guia de vigilância epidemiológica: emergência de saúde pública de importância nacional pela doença pelo coronavírus 2019 – covid-19/Ministério da Saúde, Secretaria de Vigilância em Saúde. Brasília: Ministério da Saúde; 2022. Available from: https://www.gov.br/saude/pt-br/coronavirus/publicacoes-tecnicas/guias-e-planos/guia-de-vigilancia-epidemiologica-covid-19/view. Accessed in 2022 (Jun 16).
Mehmood I, Ijaz M, Ahmad S, et al. SARS-CoV-2: An Update on Genomics, Risk Assessment, Potential Therapeutics and Vaccine Development. Int J Environ Res Public Health. 2021;18(4):1626. PMID: 33567746; https://doi.org/10.3390/ijerph18041626.
Singh R, Kang A, Luo X, et al. COVID-19: Current knowledge in clinical features, immunological responses, and vaccine development. FASEB J. 2021;35(3):e21409. PMID: 33577115; https://doi.org/10.1096/fj.202002662R.
Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential Effects of Coronaviruses on the Cardiovascular System: A Review. JAMA Cardiol. 2020;5(7):831-40. PMID: 32219363; https://doi.org/10.1001/jamacardio.2020.1286.
Nishiga M, Wang DW, Han Y, Lewis DB, Wu JC. COVID-19 and cardiovascular disease: from basic mechanisms to clinical perspectives. Nat Rev Cardiol. 2020;17(9):543-58. PMID: 32690910; https://doi.org/10.1038/s41569-020-0413-9.
Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol. 2020;17(5):259-60. PMID: 32139904; https://doi.org/10.1038/s41569-020-0360-5.
Johnston MC, Crilly M, Black C, Prescott GJ, Mercer SW. Defining and measuring multimorbidity: a systematic review of systematic reviews. Eur J Public Health. 2019;29(1):182-9. PMID: 29878097; https://doi.org/10.1093/eurpub/cky098.
Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62. Erratum in: Lancet. 2020;395(10229):1038. Erratum in: Lancet. 2020;395(10229):1038. PMID: 32171076; https://doi.org/10.1016/S0140-6736(20)30566-3.
Kucirka LM, Norton A, Sheffield JS. Severity of COVID-19 in pregnancy: A review of current evidence. Am J Reprod Immunol. 2020;84(5):e13332. PMID: 32865300; https://doi.org/10.1111/aji.13332.
R Core Team. R: A Language and Environment for Statistical Computing [Internet]. Vienna, Austria: R Foundation for Statistical Computing; 2021. Available from: https://www.r-project.org. Accessed in 2022 (Jun 16).
Coutinho LM, Scazufca M, Menezes PR. Methods for estimating prevalence ratios in cross-sectional studies. Rev Saude Publica. 2008;42(6):992-8. PMID: 19009156; https://doi.org/10.1590/S0034-89102008000600003.
Iaccarino G, Grassi G, Borghi C, et al. Age and Multimorbidity Predict Death Among COVID-19 Patients: Results of the SARS-RAS Study of the Italian Society of Hypertension. Hypertension. 2020;76(2):366-72. PMID: 32564693; https://doi.org/10.1161/HYPERTENSIONAHA.120.15324.
Fernández-Niño JA, Guerra-Gómez JA, Idrovo AJ. Multimorbidity patterns among COVID-19 deaths: proposal for the construction of etiological models. Rev Panam Salud Publica. 2020;44:e166. PMID: 33417654; https://doi.org/10.26633/RPSP.2020.166.
Nunes BP, Souza ASS, Nogueira J, et al. Multimorbidity and population at risk for severe COVID-19 in the Brazilian Longitudinal Study of Aging. Cad Saude Publica. 2020;36(12):e00129620. PMID: 33237250; https://doi.org/10.1590/0102-311X00129620.
Maddaloni E, D’Onofrio L, Alessandri F, et al. Cardiometabolic multimorbidity is associated with a worse Covid-19 prognosis than individual cardiometabolic risk factors: a multicentre retrospective study (CoViDiab II). Cardiovasc Diabetol. 2020;19(1):164. PMID: 33004045; https://doi.org/10.1186/s12933-020-01140-2.
McQueenie R, Foster HME, Jani BD, et al. Correction: Multimorbidity, polypharmacy, and COVID-19 infection within the UK Biobank cohort. PLoS One. 2020;15(8):e0238091. Erratum in: PLoS One. 2021;16(5):e0251613. PMID: 32817712; https://doi.org/10.1371/journal. pone.0238091.
Katulanda P, Dissanayake HA, Ranathunga I, et al. Prevention and management of COVID-19 among patients with diabetes: an appraisal of the literature. Diabetologia. 2020;63(8):1440-52. PMID: 32405783; https://doi.org/10.1007/s00125-020-05164-x.
Nanda S, Chacin Suarez AS, Toussaint L, et al. Body Mass Index, Multi-Morbidity, and COVID-19 Risk Factors as Predictors of Severe COVID-19 Outcomes. J Prim Care Community Health. 2021;12:21501327211018559. PMID: 34024181; https://doi.org/10.1177/21501327211018559.
Batista A, Antunes B, Faveret G, et al. Análise socioeconômica da taxa de letalidade da COVID-19 no Brasil. Rio de Janeiro: Núcleo de Operações e Inteligência em Saúde, PUC-RIO; 2020. (Nota técnica 11). Available from: https://ponte.org/wp-content/uploads/2020/05/NT11-An%C3%A1lise-descritiva-dos-casos-de-COVID-19.pdf. Accessed in 2022 (Jun 16).
Apea VJ, Wan YI, Dhairyawan R, et al. Ethnicity and outcomes in patients hospitalised with COVID-19 infection in East London: an observational cohort study. BMJ Open. 2021;11(1):e042140. PMID: 33455936; https://doi.org/10.1136/bmjopen-2020-042140.
Salameh JP, Leeflang MM, Hooft L, et al. Thoracic imaging tests for the diagnosis of COVID-19. Cochrane Database Syst Rev. 2020;9:CD013639. Update in: Cochrane Database Syst Rev. 2020;11:CD013639. PMID: 32997361; https://doi.org/10.1002/14651858.CD013639.pub2.
de Farias LPG, Strabelli DG, Fonseca EKUN, et al. Thoracic tomographic manifestations in symptomatic respiratory patients with COVID-19. Radiol Bras. 2020;53(4):255-61. PMID: 32904780; https://doi.org/10.1590/0100-3984.2020.0030.
Agricola E, Beneduce A, Esposito A, et al. Heart and Lung Multimodality Imaging in COVID-19. JACC Cardiovasc Imaging. 2020;13(8):1792-808. PMID: 32762885; https://doi.org/10.1016/j.jcmg.2020.05.017.
Khan MS, Dogra R, Miriyala LKV, et al. Clinical characteristics and outcomes of patients with Corona Virus Disease 2019 (COVID-19) at Mercy Health Hospitals, Toledo, Ohio. PLoS One. 2021;16(4):e0250400. PMID: 33886663; https://doi.org/10.1371/journal.pone.0250400.
Pastor-Barriuso R, Pérez-Gómez B, Hernán MA, et al. Infection fatality risk for SARS-CoV-2 in community dwelling population of Spain: nationwide seroepidemiological study. BMJ. 2020;371:m4509. PMID: 33246972; https://doi.org/10.1136/bmj.m4509.
Tisminetzky M, Delude C, Hebert T, et al. Age, Multiple Chronic Conditions, and COVID-19: A Literature Review. Newman AB, organizador. J Gerontol A Biol Sci Med Sci. 2022;77(4):872-878. PMID: 33367606; https://doi.org/10.1093/gerona/glaa320.