COVID-19 :Determinants of Hospitalization, ICU and Death among 20,293 reported cases in Portugal

Peixoto, Vasco Ricoca; Vieira, Andre; Aguiar, Pedro; Sousa, Paulo; Carvalho, Carlos; Thomas, Daniel Rhys; Abrantes, Alexandre; Nunes, Carla

Introduction Determinants of hospitalization, intensive care unit (ICU) admission and death are still unclear for Covid-19 and only a few studies have adjusted for confounding for different clinical outcomes including all reported cases in a country in the analysis. We used routine surveillance data from Portugal to identify risk factors for COVID-19 outcomes, in order to support risk stratification, clinical and public health interventions, and to improve scenarios to plan health care resources. Methods We conducted a retrospective cohort study including 20,293 laboratory confirmed cases of COVID-19 in Portugal to 28 April 2020, electronically through the National Epidemic Surveillance System of the Directorate-General of Health(DGS). We calculated absolute risks, relative risks (RR) and adjusted relative risks (aRR) to identify demographic and clinical factors associated with hospitalization, admission to ICU and death using Poisson regressions. Results Increasing age after 60 years was the greatest determinant for all outcomes. Assuming 0-50 years as reference, being aged 80-89 years was the strongest determinant of hospital admission (aRR-5.7), 70-79 years for ICU(aRR-10.4) and >90 years for death(aRR-226.8) with an aRR of 112.7 in those 70-79 . Among comorbidites, Immunodeficiency, cardiac disease, kidney disease, and neurologic disease were independent risk factors for hospitalization (aRR 1.83, 1.79, 1.56, 1.82), for ICU these were cardiac, Immunodeficiency, kidney and lung disease (aRR 4.33, 2.76, 2.43, 2.04), and for death they were kidney, cardiac and chronic neurological disease (aRR: 2.9, 2.6, 2.0) Male gender was a risk factor for all outcomes. There were statistically significant differences for the 3 outcomes between regions. Discussion and Conclusions Older age stands out as the strongest risk factor for all outcomes specially for death as absolute is risk was small for those younger than 50. These findings have implications in terms of risk stratified public health measures that should prioritize protecting older people. Epidemiologic scenarios and clinical guidelines may consider the estimated risks, even though under-ascertainment of mild and asymptomatic cases should be considered in different age groups.