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Risk for in-hospital Complications associated with COVID-19 and influenza — Veterans Health Administration, United States, October 1, 2018–May 31, 2020
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October 20, 2020
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Corporate Authors:CDC COVID-19 Emergency Response Team. ; Centers for Disease Control and Prevention (U.S.)Epidemic Intelligence Service. ; United States Veterans Administration. Office of Population Health. Public Health Surveillance and Research Group. ; United States Public Health Service. ; Stanford University. School of Medicine. Division of Infectious Diseases & Geographic Medicine.
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Description:What is already known about this topic? Patients hospitalized with COVID-19 are reported to be at risk for respiratory and nonrespiratory Complications.
What is added by this report? Hospitalized patients with COVID-19 in the Veterans Health Administration had a more than five times higher risk for in-hospital death and increased risk for 17 respiratory and nonrespiratory Complications than did hospitalized patients with influenza. The risks for sepsis and respiratory, neurologic, and renal Complications of COVID-19 were higher among non-Hispanic Black or African American and Hispanic patients than among non-Hispanic White patients.
What are the implications for public health practice? Compared with influenza, COVID-19 is associated with increased risk for most respiratory and nonrespiratory Complications. Certain racial and ethnic minority groups are disproportionally affected by COVID-19.
CoronaVirus disease 2019 (COVID-19) is primarily a respiratory illness, although increasing evidence indicates that infection with SARS-CoV-2, the Virus that causes COVID-19, can affect multiple organ systems (1). Data that examine all in-hospital Complications of COVID-19 and that compare these Complications with those associated with other viral respiratory pathogens, such as influenza, are lacking. To assess Complications of COVID-19 and influenza, electronic health records (EHRs) from 3,948 hospitalized patients with COVID-19 (March 1–May 31, 2020) and 5,453 hospitalized patients with influenza (October 1, 2018–February 1, 2020) from the national Veterans Health Administration (VHA), the largest integrated health care system in the United States,* were analyzed. Using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes, Complications in patients with laboratory-confirmed COVID-19 were compared with those in patients with influenza. Risk ratios were calculated and adjusted for age, sex, race/ethnicity, and underlying medical conditions; proportions of Complications were stratified among patients with COVID-19 by race/ethnicity. Patients with COVID-19 had almost 19 times the risk for acute respiratory distress syndrome (ARDS) than did patients with influenza, (adjusted risk ratio [aRR] = 18.60; 95% confidence interval [CI] = 12.40–28.00), and more than twice the risk for myocarditis (2.56; 1.17–5.59), deep vein thrombosis (2.81; 2.04–3.87), pulmonary embolism (2.10; 1.53–2.89), intracranial hemorrhage (2.85; 1.35–6.03), acute hepatitis/liver failure (3.13; 1.92–5.10), bacteremia (2.46; 1.91–3.18), and pressure ulcers (2.65; 2.14–3.27). The risks for exacerbations of asthma (0.27; 0.16–0.44) and chronic obstructive pulmonary disease (COPD) (0.37; 0.32–0.42) were lower among patients with COVID-19 than among those with influenza. The percentage of COVID-19 patients who died while hospitalized (21.0%) was more than five times that of influenza patients (3.8%), and the duration of hospitalization was almost three times longer for COVID-19 patients. Among patients with COVID-19, the risk for respiratory, neurologic, and renal Complications, and sepsis was higher among non-Hispanic Black or African American (Black) patients, patients of other races, and Hispanic or Latino (Hispanic) patients compared with those in non-Hispanic White (White) patients, even after adjusting for age and underlying medical conditions. These findings highlight the higher risk for most Complications associated with COVID-19 compared with influenza and might aid clinicians and researchers in recognizing, monitoring, and managing the spectrum of COVID-19 manifestations. The higher risk for certain Complications among racial and ethnic minority patients provides further evidence that certain racial and ethnic minority groups are disproportionally affected by COVID-19 and that this disparity is not solely accounted for by age and underlying medical conditions.
Suggested citation for this article: Cates J, Lucero-Obusan C, Dahl RM, et al. Risk for In-Hospital Complications Associated with COVID-19 and Influenza — Veterans Health Administration, United States, October 1, 2018–May 31, 2020. MMWR Morb Mortal Wkly Rep. ePub: 20 October 2020
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