Table 2. Adjusted Risk Ratios (95% CI) of ICU Admission, IMV, and Death, by Frequent Underlying Medical Conditionsa Among Adults Hospitalized With COVID-19 in Premier Healthcare Database Special COVID-19 Release (PHD-SR), March 2020–March 2021.
| Underlying Medical Condition (CCSR Category)b | Death |
IMV |
ICU Admission |
|||
|---|---|---|---|---|---|---|
| Full Modelc | Restricted Modeld | Full Modelc | Restricted Modeld | Full Modelc | Restricted Modeld | |
| Higher risk of death, IMV, and ICU admissione | ||||||
| Obesity | 1.30 (1.27–1.33) | 1.37 (1.34–1.41) | 1.50 (1.46–1.54) | 1.62 (1.58–1.67) | 1.16 (1.14–1.18) | 1.20 (1.18–1.23) |
| Anxiety and fear-related disorders | 1.28 (1.25–1.31) | 1.29 (1.26–1.32) | 1.37 (1.34–1.40) | 1.38 (1.34–1.41) | 1.14 (1.13–1.16) | 1.16 (1.14–1.18) |
| Diabetes with complication | 1.26 (1.24–1.28) | 1.44 (1.41–1.46) | 1.43 (1.40–1.46) | 1.63 (1.59–1.66) | 1.16 (1.15–1.18) | 1.24 (1.21–1.26) |
| Chronic kidney disease | 1.21 (1.19–1.24) | 1.52 (1.49–1.55) | 1.08 (1.05–1.11) | 1.46 (1.43–1.50) | 1.03 (1.02–1.04) | 1.18 (1.16–1.20) |
| Neurocognitive disorders | 1.18 (1.15–1.21) | 1.19 (1.16–1.21) | 1.00 (0.97–1.03) | 1.01 (0.98–1.04) | 1.04 (1.03–1.06) | 1.05 (1.03–1.07) |
| Chronic obstructive pulmonary disease and bronchiectasis | 1.18 (1.16–1.20) | 1.27 (1.24–1.29) | 1.18 (1.16–1.21) | 1.30 (1.27–1.33) | 1.09 (1.08–1.10) | 1.14 (1.12–1.16) |
| Aplastic anemia | 1.17 (1.14–1.19) | 1.46 (1.42–1.49) | 1.21 (1.18–1.25) | 1.49 (1.45–1.53) | 1.11 (1.09–1.12) | 1.21 (1.19–1.24) |
| Coronary atherosclerosis and other heart disease | 1.14 (1.12–1.16) | 1.28 (1.26–1.30) | 1.10 (1.08–1.12) | 1.27 (1.25–1.30) | 1.08 (1.06–1.09) | 1.15 (1.13–1.17) |
| Thyroid disorders | 1.04 (1.02–1.06) | 1.10 (1.08–1.12) | 1.05 (1.03–1.07) | 1.12 (1.09–1.14) | 1.04 (1.03–1.05) | 1.07 (1.06–1.08) |
| Lower risk or nonsignificant difference in the risk of death, IMV, and ICU admissione | ||||||
| Diabetes without complication | 0.94 (0.91–0.97) | 0.88 (0.85–0.90) | 0.91 (0.88–0.94) | 0.91 (0.87–0.94) | 0.98 (0.97–0.998) | 0.98 (0.97–0.99) |
| Essential hypertension | 0.92 (0.90–0.93) | 0.83 (0.81–0.84) | 0.94 (0.92–0.95) | 0.90 (0.88–0.91) | 0.99 (0.97–0.999) | 0.97 (0.96–0.99) |
| Disorders of lipid metabolism | 0.94 (0.92–0.95) | 1.07 (1.05–1.09) | 0.96 (0.94–0.98) | 1.13 (1.11–1.16) | 0.99 (0.98–1.00) | 1.07 (1.05–1.09) |
| Sleep–wake disorders | 0.94 (0.92–0.96) | 1.12 (1.10–1.14) | 1.00 (0.98–1.03) | 1.27 (1.23–1.30) | 0.99 (0.98–1.01) | 1.10 (1.08–1.12) |
| Esophageal disorders | 0.96 (0.94–0.97) | 1.03 (1.02–1.05) | 0.95 (0.93–0.96) | 1.05 (1.02–1.07) | 0.98 (0.97–0.99) | 1.03 (1.01–1.05) |
| Depressive disorders | 0.89 (0.87–0.90) | 1.04 (1.02–1.06) | 0.86 (0.84–0.88) | 1.04 (1.02–1.07) | 0.96 (0.94–0.97) | 1.05 (1.03–1.07) |
| Osteoarthritis | 0.91 (0.90–0.93) | 1.00 (0.98–1.02) | 0.88 (0.86–0.90) | 1.00 (0.97–1.02) | 0.95 (0.93–0.97) | 1.01 (0.98–1.03) |
| Implant device or graft related encounter | 0.98 (0.97–1.00) | 1.09 (1.08–1.11) | 0.91 (0.89–0.93) | 1.04 (1.02–1.07) | 0.98 (0.96–0.99) | 1.04 (1.02–1.06) |
| Asthma | 0.91 (0.89–0.94) | 0.95 (0.93–0.97) | 0.96 (0.94–0.99) | 1.03 (1.01–1.06) | 1.01 (0.99–1.02) | 1.04 (1.02–1.05) |
| No. of observations | 540,667 | 540,667 | 506,288 | 506,288 | 523,088 | 523,088 |
Abbreviations: ICU, intensive care unit; IMV, invasive mechanical ventilation; CCSR, Clinical Classifications Software Refined.
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 meaningful categories by using the CCSR; 3) a clinical review of CCSR categories that classified the CCSR codes as “likely underlying,” “indeterminate,” and “likely acute”; and 4) including only “likely underlying” CCSR categories and excluding “indeterminate” and “likely acute” CCSR categories.
The reference category for each condition is the absence of that condition; the reference category for diabetes with complication and diabetes without complication is the absence of diabetes.
Full model: Each column includes the results of a single generalized linear model (with Poisson distribution and log link function) that includes all 18 of the most frequent underlying medical conditions (reference: absence of the condition), age group, sex, race/ethnicity, payer type, hospital urbanicity, US Census region of hospital, admission month, and admission month squared.
Restricted model: Each column includes the results of 18 general linear models (with Poisson distribution and log link function), each including only the underlying medical condition (reference: absence of the condition), age group, sex, race/ethnicity, payer type, hospital urbanicity, US Census region of hospital, admission month, and admission month squared. Patients who died without using ICU care or IMV were excluded from the sample when estimating the model with the outcome of ICU care or IMV, respectively.
Based on the results from the full model.