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Characteristics asssociated with hospitalization among patients with COVID-19 —metropolitan Atlanta, Georgia, March–April 2020
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June 17, 2020
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Description:What is already known about this topic?: Hospitalized COVID-19 patients are more commonly older, male, of black race, and have underlying conditions. Less is known about factors increasing risk for hospitalization.
What is added by this report?: Data for 220 hospitalized and 311 nonhospitalized COVID-19 patients from six metropolitan Atlanta hospitals and associated outpatient clinics found that older age, black race, diabetes, lack of insurance, male sex, smoking, and obesity were independently associated with hospitalization.
What are the implications for public health practice?: To reduce severe outcomes from COVID-19, measures to prevent infection with SARS-COV-2 should be emphasized for persons at highest risk for hospitalization with COVID-19. Potential barriers to the ability to adhere to these measures need to be addressed.
The first reported U.S. case of coronaVirus disease 2019 (COVID-19) was detected in January 2020 (1). As of June 15, 2020, approximately 2 million cases and 115,000 COVID-19–associated deaths have been reported in the United States* Reports of U.S. patients hospitalized with SARS-CoV-2 infection (the Virus that causes COVID-19) describe high proportions of older, male, and black persons (2–4). Similarly, when comparing hospitalized patients with catchment area populations or nonhospitalized COVID-19 patients, high proportions have underlying conditions, including diabetes mellitus, hypertension, obesity, cardiovascular disease, chronic kidney disease, or chronic respiratory disease (3,4). For this report, data were abstracted from the medical records of 220 hospitalized and 311 nonhospitalized patients aged ≥18 years with laboratory-confirmed COVID-19 from six acute care hospitals and associated outpatient clinics in metropolitan Atlanta, Georgia. Multivariable analyses were performed to identify patient characteristics associated with hospitalization. The following characteristics were independently associated with hospitalization: age ≥65 years (adjusted odds ratio [aOR] = 3.4), black race (aOR = 3.2), having diabetes mellitus (aOR = 3.1), lack of insurance (aOR = 2.8), male sex (aOR = 2.4), smoking (aOR = 2.3), and obesity (aOR = 1.9). Infection with SARS-CoV-2 can lead to severe outcomes, including death, and measures to protect persons from infection, such as staying at home, social distancing (5), and awareness and management of underlying conditions should be emphasized for those at highest risk for hospitalization with COVID-19. Measures that prevent the spread of infection to others, such as wearing cloth face coverings (6), should be used whenever possible to protect groups at high risk. Potential barriers to the ability to adhere to these measures need to be addressed.
Patients were selected from six acute care hospitals and associated outpatient clinics affiliated with a single academic health care system in metropolitan Atlanta. Hospitalized patients were selected sequentially from hospital-provided lists of patients aged ≥18 years who were hospitalized with laboratory-confirmed COVID-19 (defined as a positive real-time reverse transcription–polymerase chain reaction [RT-PCR] test result for SARS-CoV-2) during March 1–30. The 220 selected hospitalized patients were described previously (2); hospitalizations included stays for observation and deaths that occurred in an emergency department (ED). All 311 nonhospitalized patients (i.e., evaluated at outpatient clinics or an ED and not admitted) aged ≥18 years with laboratory-confirmed COVID-19 during March 1–April 7, were included, unless they stayed for observation or died in an ED. During April 8–May 1, trained personnel abstracted information from electronic medical records on patient demographics, occupation, underlying conditions, and symptoms using REDCap software (version 8.8.0; Vanderbilt University) (7). This investigation was determined by CDC to be public health Surveillance and by the Georgia Department of Public Health as an institutional review board–exempt public health evaluation.
Suggested citation for this article: Killerby ME, Link-Gelles R, Haight SC, et al. Characteristics Associated with Hospitalization Among Patients with COVID-19 — Metropolitan Atlanta, Georgia, March–April 2020. MMWR Morb Mortal Wkly Rep. ePub: 17 June 2020.
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