Associations of pre-existing comorbidities and COVID-19 in-hospital mortality: an unCoVer analyses

Abstract Background Accumulated evidence on risk factors for adverse COVID-19 outcomes revealed that old age and male sex are main associates, next to pre-existing comorbidities, as analysed from scattered single cohorts of hospitalised COVID-19 patients of accessible electronic medical records. Hence, evidence from federated analyses is called for to provide a more comprehensive and robust analyses of risk factors. Methods Using the unCoVer network, i.e., a research platform of 29 partners for the expert use of patient data as routinely gathered in real-world healthcare settings, present analyses restricted to available data of four hospitals from Spain, Slovakia, Romania and Bosnia and Herzegovina covering 8,287 hospitalised COVID-19 patients. In-hospital death after COVID-19 diagnosis was examined in relation to common pre-existing comorbidities using virtual pooling of logistic regression models adjusted for age and sex. Results Patients were on average 60.1 (± 20.9) years, 50.7% were male, almost half (43.3%) had at least one pre-existing comorbidity (17.4% having obesity, 21.9% hypertension, 18.0% diabetes and 13.7% cardiovascular diseases (CVD)), and 12.6% died during hospitalisation. Patients with comorbidities had a higher risk of mortality that was increasing with the number of comorbidities: from a virtual pooled odds ratio of 1.16 (95%CI: 0.96, 1.40) for one vs none to 1.30 (1.04, 1.64) and 2.14 (1.64, 2.79) for two and three or more comorbidities, respectively. Of the comorbidities, highest risk was seen for CVD (1.68; 1.40, 2.01), followed by hypertension (1.40; 1.19, 1.64) and diabetes (1.27; 1.07, 1.50), and the lowest for obesity (1.13; 0.94, 1.37). Conclusions By federated analyses, this study confirmed that the number of comorbidities was a strong risk factor for in-hospital death after COVID-19, in particular CVD. The unCoVer platform pursues using scattered data sources by innovative computational resources and integrated information for enhanced impact. Key messages Federated analyses, capable of streamlining ethical and legal aspects, provide unique opportunities for robust results to inform public health. Higher COVID-19 in-hospital mortality risk with increasing number of comorbidities.


Background:
Accumulated evidence on risk factors for adverse COVID-19 outcomes revealed that old age and male sex are main associates, next to pre-existing comorbidities, as analysed from scattered single cohorts of hospitalised COVID-19 patients of accessible electronic medical records. Hence, evidence from federated analyses is called for to provide a more comprehensive and robust analyses of risk factors. Methods: Using the unCoVer network, i.e., a research platform of 29 partners for the expert use of patient data as routinely gathered 15th European Public Health Conference 2022 iii317 in real-world healthcare settings, present analyses restricted to available data of four hospitals from Spain, Slovakia, Romania and Bosnia and Herzegovina covering 8,287 hospitalised COVID-19 patients. In-hospital death after COVID-19 diagnosis was examined in relation to common pre-existing comorbidities using virtual pooling of logistic regression models adjusted for age and sex. Results: Patients were on average 60.1 (AE 20.9) years, 50.7% were male, almost half (43.3%) had at least one pre-existing comorbidity (17.4% having obesity, 21.9% hypertension, 18.0% diabetes and 13.7% cardiovascular diseases (CVD)), and 12.6% died during hospitalisation. Patients with comorbidities had a higher risk of mortality that was increasing with the number of comorbidities: from a virtual pooled odds ratio of 1.16 (95%CI: 0.96, 1.40) for one vs none to 1.30 (1.04, 1.64) and 2.14 (1.64, 2.79) for two and three or more comorbidities, respectively. Of the comorbidities, highest risk was seen for CVD (1.68; 1.40, 2.01), followed by hypertension (1.40; 1.19, 1.64) and diabetes (1.27; 1.07, 1.50), and the lowest for obesity (1.13; 0.94, 1.37).

Conclusions:
By federated analyses, this study confirmed that the number of comorbidities was a strong risk factor for in-hospital death after COVID-19, in particular CVD. The unCoVer platform pursues using scattered data sources by innovative computational resources and integrated information for enhanced impact.

Key messages:
Federated analyses, capable of streamlining ethical and legal aspects, provide unique opportunities for robust results to inform public health.
Higher COVID-19 in-hospital mortality risk with increasing number of comorbidities.

Background:
The COVID-19 pandemic led to important disruptions in surgical activity. The aim of this study was to evaluate the impact of COVID-19 on abdominal surgery outcomes in the region of Piedmont, in northern Italy.

Methods:
Data were gathered from 42 hospitals participating in the regional surveillance network from 2018 to 2020. SSI, overall mortality and case fatality rates (CFR) were calculated, comparing 2020 to mean 2018-19 data. Chi-squared tests were used to assess both the differences among the proportion of urgent and oncological procedures (based on ICD-9-CM codes) and rates between the two periods. Subgroup analyses on 2020 data were carried out comparing urgent vs. elective and oncological vs. non-oncological procedures using chi-squared tests. Analyses were performed using SPSS v. 28.0.1.0. Results: 5407 procedures were recorded in 2018-19; 310 SSIs and 120 deaths were observed. The mean proportions of urgent and oncological operations were, respectively, 21.90% and 43.24%. In 2020, 1057 procedures were recorded, along with 44 SSIs and 29 deaths. 34.44% of procedures were urgent and 39.74% oncological. The mean 2018-2019 SSI rate was 5.73%, with an overall mortality of 2.22% and a CFR of 7.42%. The SSI rate in 2020 was 4.16%, with an overall mortality of 2.74% and a CFR of 9.09%. The proportion of urgent procedures significantly differed between the two periods (p < 0.001), as did the proportion of oncological procedures and SSI rates (both p = 0.05). Considering 2020, significant differences were found comparing overall mortality between urgent vs. elective procedures (4.95% vs. 1.59%, p = 0.002) and comparing SSI rates between oncological vs. non-oncological patients (3.57% vs. 2.20%, p = 0.02).

Conclusions:
During the pandemic, patients undergoing surgical procedures significantly differed, reflecting public health decisions. Even though these differences did not reach statistical significance, overall mortality and CFR increased in 2020.

Key messages:
Results of this study suggest the COVID-19 pandemic had a negative impact on outcomes after abdominal surgery. Further longer-term studies are needed to assess the impact of policies implemented during the pandemic, to help inform future pandemic plans.

Background:
The COVID-19 pandemic has severely impacted older people. The disease and the measures to combat it have had a differential impact according to gender, with higher mortality rates in men and worse psychological and social consequences in women. The objective of this work is to analyze the changes in perceived health of older people in Europe during the first months of the pandemic and to assess the combined role of age and gender.

Methods:
Wave 8 data of SHARE-corona (Survey of Health, Aging and Retirement in Europe) (n = 51,695, aged!50) collected between Jun-Aug 2020 were used. Perceived health status was explored with a question on whether there has been a change compared with the health status before the COVID-19 outbreak (response options: worse, the same and better). Twoway ANOVA with interaction and Student's t-test with Bonferroni correction were used to compare the effects of gender and age group (50-59 years, 60-69 years, 70-79 years, and !80) in changes in perceived health.

Results:
Differences in perceived health were observed by age, as well as by gender in participants aged !70 years (F = 91.94; p < 0.001). These differences were significant both by gender (F = 19.39; p < 0.001) and age (F = 191.79; p < 0.001). No interaction was detected between both factors (p = 0.170), which allowed their effect to be studied individually. Among the people who reported a worsening in their perceived health, women aged 70 to 79 years predominated (11.1%), followed by men aged 80 and over (15.3%) and women of the same age group (16.4%).

Conclusions:
The results suggest an association between the change in perceived health during the pandemic and age. Women have a slightly worse health status than men in all age groups. Therefore, gender can be considered as an influential factor in