Risk Factors for COVID-19-associated hospitalization: COVID-19-Associated Hospitalization Surveillance Network and Behavioral Risk Factor Surveillance System

Ko, J. Y.; Danielson, M. L.; Town, M.; Derado, G.; Greenland, K. J.; Daily Kirley, P.; Alden, N. B.; Yousey-Hindes, K.; Anderson, E. J.; Ryan, P. A.; Kim, S.; Lynfield, R.; Torres, S. M.; Barney, G. R.; Bennett, N. M.; Sutton, M.; Talbot, H. K.; Hill, M.; Hall, A. J.; Fry, A. M.; Garg, S.; Kim, L.; Group, COVID-NET Investigation

Background: Identification of risk factors for COVID-19-associated hospitalization is needed to guide prevention and clinical care. Objective: To examine if age, sex, race/ethnicity, and underlying medical conditions is independently associated with COVID-19-associated hospitalizations. Design: Cross-sectional. Setting: 70 counties within 12 states participating in the Coronavirus Disease 2019-Associated Hospitalization Surveillance Network (COVID-NET) and a population-based sample of non-hospitalized adults residing in the COVID-NET catchment area from the Behavioral Risk Factor Surveillance System. Participants: U.S. community-dwelling adults ([≥]18 years) with laboratory-confirmed COVID-19-associated hospitalizations, March 1- June 23, 2020. Measurements: Adjusted rate ratios (aRR) of hospitalization by age, sex, race/ethnicity and underlying medical conditions (hypertension, coronary artery disease, history of stroke, diabetes, obesity [BMI [≥]30 kg/m2], severe obesity [BMI[≥]40 kg/m2], chronic kidney disease, asthma, and chronic obstructive pulmonary disease). Results: Our sample included 5,416 adults with COVID-19-associated hospitalizations. Adults with (versus without) severe obesity (aRR:4.4; 95%CI: 3.4, 5.7), chronic kidney disease (aRR:4.0; 95%CI: 3.0, 5.2), diabetes (aRR:3.2; 95%CI: 2.5, 4.1), obesity (aRR:2.9; 95%CI: 2.3, 3.5), hypertension (aRR:2.8; 95%CI: 2.3, 3.4), and asthma (aRR:1.4; 95%CI: 1.1, 1.7) had higher rates of hospitalization, after adjusting for age, sex, and race/ethnicity. In models adjusting for the presence of an individual underlying medical condition, higher hospitalization rates were observed for adults [≥]65 years, 45-64 years (versus 18-44 years), males (versus females), and non-Hispanic black and other race/ethnicities (versus non-Hispanic whites). Limitations: Interim analysis limited to hospitalizations with underlying medical condition data. Conclusion: Our findings elucidate groups with higher hospitalization risk that may benefit from targeted preventive and therapeutic interventions.