Clinical Epidemiology and Risk Factors for Critical Outcomes Among Vaccinated and Unvaccinated Adults Hospitalized With COVID-19—VISION Network, 10 States, June 2021–March 2023

Details

• Alternative Title:
  Clin Infect Dis
• Personal Author:
  Griggs, Eric P. ; Mitchell, Patrick K. ; Lazariu, Victoria ; Gaglani, Manjusha ; McEvoy, Charlene ; Klein, Nicola P. ; Valvi, Nimish R. ; Irving, Stephanie A. ; Kojima, Noah ; Stenehjem, Edward ; Crane, Bradley ; Rao, Suchitra ; Grannis, Shaun J. ; Embi, Peter J. ; Kharbanda, Anupam B. ; Ong, Toan C. ; Natarajan, Karthik ; Dascomb, Kristin ; Naleway, Allison L. ; Bassett, Elizabeth ; DeSilva, Malini B. ; Dickerson, Monica ; Konatham, Deepika ; Fireman, Bruce ; Allen, Katie S. ; Barron, Michelle A. ; Beaton, Maura ; Arndorfer, Julie ; Vazquez-Benitez, Gabriela ; Garg, Shikha ; Murthy, Kempapura ; Goddard, Kristin ; Dixon, Brian E. ; Han, Jungmi ; Grisel, Nancy ; Raiyani, Chandni ; Lewis, Ned ; Fadel, William F. ; Stockwell, Melissa S. ; Mamawala, Mufaddal ; Hansen, John ; Zerbo, Ousseny ; Patel, Palak ; Link-Gelles, Ruth ; Adams, Katherine ; Tenforde, Mark W.
• Description:
  Background.
  
  The epidemiology of coronavirus disease 2019 (COVID-19) continues to develop with emerging variants, expanding population-level immunity, and advances in clinical care. We describe changes in the clinical epidemiology of COVID-19 hospitalizations and risk factors for critical outcomes over time.
  
  Methods.
  
  We included adults aged ≥18 years from 10 states hospitalized with COVID-19 June 2021–March 2023. We evaluated changes in demographics, clinical characteristics, and critical outcomes (intensive care unit admission and/or death) and evaluated critical outcomes risk factors (risk ratios [RRs]), stratified by COVID-19 vaccination status.
  
  Results.
  
  A total of 60 488 COVID-19–associated hospitalizations were included in the analysis. Among those hospitalized, median age increased from 60 to 75 years, proportion vaccinated increased from 18.2% to 70.1%, and critical outcomes declined from 24.8% to 19.4% (all P < .001) between the Delta (June–December, 2021) and post-BA.4/BA.5 (September 2022–March 2023) periods. Hospitalization events with critical outcomes had a higher proportion of ≥4 categories of medical condition categories assessed (32.8%) compared to all hospitalizations (23.0%). Critical outcome risk factors were similar for unvaccinated and vaccinated populations; presence of ≥4 medical condition categories was most strongly associated with risk of critical outcomes regardless of vaccine status (unvaccinated: adjusted RR, 2.27 [95% confidence interval {CI}, 2.14–2.41]; vaccinated: adjusted RR, 1.73 [95% CI, 1.56–1.92]) across periods.
  
  Conclusions.
  
  The proportion of adults hospitalized with COVID-19 who experienced critical outcomes decreased with time, and median patient age increased with time. Multimorbidity was most strongly associated with critical outcomes.
  
  
• Subjects:
  Adolescent Adult Aged COVID-19 COVID-19 Vaccines Hospitalization Humans Immunity, Herd Middle Aged Risk Factors
• Keywords:
  Clinical Epidemiology Critical Disease Death Hospitalization
• Source:
  Clin Infect Dis. 78(2):338-348
• Pubmed ID:
  37633258
• Pubmed Central ID:
  PMC11293024
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/ ; 75D30120C07986/CC/CDC HHSUnited States/
• Volume:
  78
• Issue:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:073d9cfb52bab7d3a565928982829c9ece87ea37e451529c1e193f2bbe19f117b5645a2da43b5a89790188e5a23fafa57774128e9a670f5e1fdbe9221e04d1f5
• Download URL:
  https://stacks.cdc.gov/view/cdc/159534/cdc_159534_DS1.pdf
• File Type:
  [PDF - 846.09 KB ]