Population-level COVID-19 mortality risk for non-elderly individuals overall and for non-elderly individuals without underlying diseases in pandemic epicenters

John P. A. Ioannidis; Cathrine Axfors; Despina G. Contopoulos-Ioannidis

The large majority of the deaths in non-elderly individuals occur in patients who have underlying diseases. Based on existing data to-date, 7-9 cardiovascular disease, hypertension, chronic obstructive pulmonary disease and severe asthma, diabetes, kidney failure, severe liver disease, immunodeficiency, and malignancy may confer an increased risk of adverse outcome. Individuals with these diseases should consider that their risk may be higher than average and rigorous prognostic models need to be developed to estimate with accuracy the increased risk. In non-elderly populations, the more prevalent of these conditions is cardiovascular disease and hypertension, with prevalence of approximately 10% in the 20-39 age group and 38% in the 40-59 age group in the USA 24 and similarly high percentages in many other countries. Unfortunately, we could not identify data with the prevalence of these conditions specifically among the non-elderly deceased patients with COVID-19, and we encourage public health authorities to start reporting systematically data on comorbidities according to age strata. However, some data are available for the prevalence of these conditions across all age groups of COVID-19 deaths. For example, in the Netherlands, 49% of individuals dying with COVID-19 had cardiovascular disease or hypertension, and 27% had chronic pulmonary disease. Comparing with the prevalence of these diseases in the general population, 25 it is likely that ~2-fold increases in death risk may be reasonable to expect for people with these conditions in the general population. If so, the risk may remain very low, except in a minority of patients with the most severe manifestations of the underlying diseases.