Risk of clinical severity by age and race/ethnicity among adults hospitalized for COVID-19 — United States, March–September 2020

Pennington, Audrey F; Kompaniyets, Lyudmyla; Summers, April D; Danielson, Melissa L; Goodman, Alyson B; Chevinsky, Jennifer R; Preston, Leigh Ellyn; Schieber, Lyna Z; Namulanda, Gonza; Courtney, Joseph; Strosnider, Heather M; Boehmer, Tegan K; Mac Kenzie, William R; Baggs, James; Gundlapalli, Adi V

BACKGROUND: Older adults and people from certain racial and ethnic groups are disproportionately represented in COVID-19 hospitalizations and deaths. METHODS: Using data from the Premier Healthcare Database on 181,813 hospitalized adults diagnosed with COVID-19 during March–September 2020 we applied multivariable log-binomial regression to assess the associations between age and race/ethnicity and COVID-19 clinical severity (intensive care unit [ICU] admission, invasive mechanical ventilation [IMV], and death); and determine whether the impact of age on clinical severity differs by race/ethnicity. RESULTS: Overall, 84,497 (47%) patients were admitted to the ICU, 29,078 (16%) received IMV, and 27,864 (15%) died in the hospital. Increased age was strongly associated with clinical severity when controlling for underlying medical conditions and other covariates; the strength of this association differed by race/ethnicity. Compared with non-Hispanic White patients, risk of death was lower among non-Hispanic Black patients (adjusted risk ratio [95% CI]: 0.96 [0.92, 0.99]), and higher among Hispanic/Latino patients (RR [95% CI]: 1.15 [1.09, 1.20]), non-Hispanic Asian patients (RR [95% CI]: 1.16 [1.09, 1.23]), and patients of other racial and ethnic groups (RR [95% CI]: 1.13 [1.06, 1.21]). Risk of ICU admission and IMV was elevated among some racial and ethnic groups. CONCLUSIONS: These results indicate that age is a driver of poor outcomes among hospitalized persons with COVID-19. Additionally, clinical severity may be elevated among patients of some racial and ethnic minority groups. Public health strategies to reduce SARS-CoV-2 infection rates among older adults and racial and ethnic minorities are essential to reduce poor outcomes.