Risk factors for severity of COVID-19 in hospital patients age 18–29 years

Sandoval, Micaela; Nguyen, Duc T.; Vahidy, Farhaan S.; Graviss, Edward A.

BACKGROUND: Since February 2020, over 2.5 million Texans have been diagnosed with COVID-19, and 20% are young adults at risk for SARS-CoV-2 exposure at work, academic, and social settings. This study investigated demographic and clinical risk factors for severe disease and readmission among young adults 18–29 years old, who were diagnosed at a hospital encounter in Houston, Texas, USA. METHODS AND FINDINGS: A retrospective registry-based chart review was conducted investigating demographic and clinical risk factors for severe COVID-19 among patients aged 18–29 with positive SARS-CoV-2 tests within a large metropolitan healthcare system in Houston, Texas, USA. In the cohort of 1,853 young adult patients diagnosed with COVID-19 infection at a hospital encounter, including 226 pregnant women, 1,438 (78%) scored 0 on the Charlson Comorbidity Index, and 833 (45%) were obese (≥30 kg/m(2)). Within 30 days of their diagnostic encounter, 316 (17%) patients were diagnosed with pneumonia, 148 (8%) received other severe disease diagnoses, and 268 (14%) returned to the hospital after being discharged home. In multivariable logistic regression analyses, increasing age (adjusted odds ratio [aOR] 1.1, 95% confidence interval [CI] 1.1–1.2, p<0.001), male gender (aOR 1.8, 95% CI 1.2–2.7, p = 0.002), Hispanic ethnicity (aOR 1.9, 95% CI 1.2–3.1, p = 0.01), obesity (3.1, 95% CI 1.9–5.1, p<0.001), asthma history (aOR 2.3, 95% CI 1.3–4.0, p = 0.003), congestive heart failure (aOR 6.0, 95% CI 1.5–25.1, p = 0.01), cerebrovascular disease (aOR 4.9, 95% CI 1.7–14.7, p = 0.004), and diabetes (aOR 3.4, 95% CI 1.9–6.2, p<0.001) were predictive of severe disease diagnoses within 30 days. Non-Hispanic Black race (aOR 1.6, 95% CI 1.0–2.4, p = 0.04), obesity (aOR 1.7, 95% CI 1.0–2.9, p = 0.046), asthma history (aOR 1.7, 95% CI 1.0–2.7, p = 0.03), myocardial infarction history (aOR 6.2, 95% CI 1.7–23.3, p = 0.01), and household exposure (aOR 1.5, 95% CI 1.1–2.2, p = 0.02) were predictive of 30-day readmission. CONCLUSIONS: This investigation demonstrated the significant risk of severe disease and readmission among young adult populations, especially marginalized communities and people with comorbidities, including obesity, asthma, cardiovascular disease, and diabetes. Health authorities must emphasize COVID-19 awareness and prevention in young adults and continue investigating risk factors for severe disease, readmission and long-term sequalae.