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Prevalence and predictors of death and severe disease in patients hospitalized due to COVID-19: A comprehensive systematic review and meta-analysis of 77 studies and 38,000 patients
Open accessPublished version of a preprint
Abstract
Introduction: Progression of COVID-19 to severe disease and death is insufficiently understood. Objective: Summarize the prevalence of risk factors and adverse outcomes and determine their associations in COVID-19 patients who were hospitalized. Methods: We searched Medline, Embase and Web of Science for case-series and observational studies of hospitalized COVID-19 patients through August 31, 2020. Data were analyzed by fixed-effects meta-analysis using Shore’s adjusted confidence intervals to address heterogeneity. Results: Seventy-seven studies comprising 38906 hospitalized patients met inclusion criteria; 21468 from the US-Europe and 9740 from China. Overall prevalence of death [% (95% CI)] from COVID-19 was 20% (18–23%); 23% (19–27%) in the US and Europe and 11% (7–16%) for China. Of those that died, 85% were aged≥60 years, 66% were males, and 66%, 44%, 39%, 37%, and 27% had hypertension, smoking history, diabetes, heart disease, and chronic kidney disease (CKD), respectively. The case fatality risk [%(95% CI)] were 52% (46–60) for heart disease, 51% (43–59) for COPD, 48% (37–63) for chronic kidney disease (CKD), 39% for chronic liver disease (CLD), 28% (23–36%) for hypertension, and 24% (17–33%) for diabetes. Summary relative risk (sRR) of death were higher for age≥60 years [sRR = 3.6; 95% CI: 3.0–4.4], males [1.3; 1.2–1.4], smoking history [1.3; 1.1–1.6], COPD [1.7; 1.4–2.0], hypertension [1.8; 1.6–2.0], diabetes [1.5; 1.4–1.7], heart disease [2.1; 1.8–2.4], CKD [2.5; 2.1–3.0]. The prevalence of hypertension (55%), diabetes (33%), smoking history (23%) and heart disease (17%) among the COVID-19 hospitalized patients in the US were substantially higher than that of the general US population, suggesting increased susceptibility to infection or disease progression for the individuals with comorbidities. Conclusions: Public health screening for COVID-19 can be prioritized based on risk-groups. Appropriately addressing the modifiable risk factors such as smoking, hypertension, and diabetes could reduce morbidity and mortality due to COVID-19; public messaging can be accordingly adapted.
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Flagged first, then by citations
Research works printed but not linked: 2
- A Qin, 2020, China Raises Coronavirus Death Toll by 50% in Wuhan, The New York Times, 2020
- United States Centers for Disease Control and Prevention, 2020, National Diabetes Statistics Report
Cited by
Sorted by citations
The Lancet Commission on lessons for the future from the COVID-19 pandemic
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COVID–19 and chronic kidney disease: an updated overview of reviews
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Metadata
- Authors
- Dorjee, K., Kim, H., Bonomo, E., & Dolma, R.
- Affiliations
- Johns Hopkins University (US)
- Brown University (US)
- Corresponding author
- Dorjee, Kunchok
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2020-12-07
- Volume
- 15
- Issue
- 12
- Pages
- e0243191
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC7721151
- OpenAlex
- W3111018862
- Cited by
- 216
- References
- 123
- Citations by year
- 2026: 2 · 2025: 14 · 2024: 26 · 2023: 44 · 2022: 60 · 2021: 70
- FWCI
- 2.06
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- medRxiv (acceptedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institute of Allergy and Infectious Diseases (K01AI148583)
- UNOPS STOP TB PARTNERSHIP TB REACH (STBP/TBREACH/GSA/W7-7692)
- Johns Hopkins Alliance for a Healthier World (80045453)
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Clinical Neurology › Long-Term Effects of COVID-19
- Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
- Keywords
- COVID-19 pandemic, hospitalized patients, mortality, case fatality, risk factors, severe illness, chronic kidney disease, hypertension, diabetes mellitus, heart disease, chronic obstructive pulmonary disease, chronic liver disease, smoking, old age, sex differences, comorbidities, SARS-CoV-2, risk prediction model, prognostic factors, prognostic score, prognostic score 2
- MeSH terms
- COVID-19, SARS-CoV-2, Age Factors, China, Diabetes Mellitus, Europe, Female, Heart Diseases, Hospitalization, Humans, Hypertension, Male, Risk Factors, Smoking, United States, Comorbidity, Prevalence, Coronavirus Infections, Renal Insufficiency, Chronic, Pandemics
About these checks
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