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Underlying Medical Conditions and Severe Illness Among 540,667 Adults Hospitalized With COVID-19, March 2020–March 2021

ORIGINAL RESEARCH — Volume 18 — July 1, 2021

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Figure 1. Prevalence of the most frequent underlying medical conditions in a sample of adults hospitalized with COVID-19 in Premier Healthcare Database Special COVID-19 Release. Underlying medical conditions were defined by 1) using Chronic Condition Indicator to identify chronic International Classification of Diseases, Tenth Revision, Clinical Modification codes; 2) aggregating the codes into a smaller number of categories by using the Clinical Classifications Software Refined (CCSR); 3) a clinical review of CCSR categories that classified CCSR codes as “likely underlying,” “indeterminate,” or “likely acute”; and 4) including only “likely underlying” CCSR categories and excluding “indeterminate” and “likely acute” CCSR categories. Patients coded with both CCSR categories of “diabetes with complication” and “diabetes without complication” (n = 55,141) were classified as having diabetes with complication. The following frequent (present in ≥10.0% of patients) “indeterminate” CCSR categories were excluded: cardiac dysrhythmias (n = 124,367 [23.0%]), heart failure (n = 104,858 [19.4%]), other specified nervous system disorders (n = 89,929 [16.6%]), other specified and unspecified nutritional and metabolic disorders (n = 89,337 [16.5%]), coagulation and hemorrhagic disorders (n = 75,766 [14.0%]), and diseases of white blood cells (n = 57,765 [10.7%]). Abbreviation: COPD, chronic obstructive pulmonary disease.

Prevalence of the most frequent underlying medical conditions in a sample of adults hospitalized with COVID-19 in Premier Healthcare Database Special COVID-19 Release. Underlying medical conditions were defined by 1) using Chronic Condition Indicator to identify chronic International Classification of Diseases, Tenth Revision, Clinical Modification codes; 2) aggregating the codes into a smaller number of categories by using the Clinical Classifications Software Refined (CCSR); 3) a clinical review of CCSR categories that classified CCSR codes as “likely underlying,” “indeterminate,” or “likely acute”; and 4) including only “likely underlying” CCSR categories and excluding “indeterminate” and “likely acute” CCSR categories. Patients coded with both CCSR categories of “diabetes with complication” and “diabetes without complication” (n = 55,141) were classified as having diabetes with complication. The following frequent (present in ≥10.0% of patients) “indeterminate” CCSR categories were excluded: cardiac dysrhythmias (n = 124,367 [23.0%]), heart failure (n = 104,858 [19.4%]), other specified nervous system disorders (n = 89,929 [16.6%]), other specified and unspecified nutritional and metabolic disorders (n = 89,337 [16.5%]), coagulation and hemorrhagic disorders (n = 75,766 [14.0%]), and diseases of white blood cells (n = 57,765 [10.7%]). Abbreviation: COPD, chronic obstructive pulmonary disease.
Underlying Medical Condition No. (%)
Essential hypertension 272,591 (50.4)
Disorders of lipid metabolism 267,057 (49.4)
Obesity 178,153 (33.0)
Diabetes with complication 171,727 (31.8)
Coronary atherosclerosis and other heart disease 134,839 (24.9)
Esophageal disorders 133,954 (24.8)
Chronic kidney disease 132,544 (24.5)
Anxiety and fear-related disorders 98,846 (18.3)
COPD and bronchiectasis 92,193 (17.1)
Thyroid disorders 91,244 (16.9)
Depressive disorders 85,150 (15.7)
Implant device or graft-related encounter 80,947 (15.0)
Sleep–wake disorders 78,241 (14.5)
Neurocognitive disorders 77,817 (14.4)
Osteoarthritis 77,196 (14.3)
Aplastic anemia 63,442 (11.7)
Diabetes without complication 59,813 (11.1)
Asthma 56,566 (10.5)

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Figure 2. Risk ratio (95% CI) of death, invasive mechanical ventilation (IMV), and admission to intensive care unit (ICU), by the number of underlying medical conditions among adults hospitalized with COVID-19 in the Premier Healthcare Database Special COVID-19 Release. Each panel contains the results of a single generalized linear model with Poisson distribution and log link function, adjusted for age group, sex, race/ethnicity, payer type, hospital urbanicity, US Census region of hospital, admission month, and admission month squared as controls. Patients who died without ICU care or IMV were excluded from the sample when estimating the model with the outcome of ICU care or IMV, respectively.

Risk ratio (95% CI) of death, invasive mechanical ventilation (IMV), and admission to intensive care unit (ICU), by the number of underlying medical conditions among adults hospitalized with COVID-19 in the Premier Healthcare Database Special COVID-19 Release. Each panel contains the results of a single generalized linear model with Poisson distribution and log link function, adjusted for age group, sex, race/ethnicity, payer type, hospital urbanicity, US Census region of hospital, admission month, and admission month squared as controls. Patients who died without ICU care or IMV were excluded from the sample when estimating the model with the outcome of ICU care or IMV, respectively.
Outcome Risk Ratio (95% CI)
Death
No conditions Reference
1 condition 1.53 (1.41–1.67)
2–5 conditions 2.55 (2.32–2.80)
6–10 conditions 3.29 (2.98–3.63)
>10 conditions 3.82 (3.45–4.23)
IMV
No conditions Reference
1 condition 1.57 (1.45–1.70)
2-5 conditions 2.91 (2.68–3.15)
6-10 conditions 4.10 (3.75–4.49)
>10 conditions 4.47 (4.07–4.90)
ICU admission
No conditions Reference
1 condition 1.32 (1.27–1.36)
2-5 conditions 1.60 (1.52–1.69)
6-10 conditions 1.84 (1.73–1.97)
>10 conditions 1.96 (1.82–2.11)

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