Determinants for hospitalisations, intensive care unit admission and death among 20,293 reported COVID-19 cases in Portugal, March to April 2020

• Author(s): Peixoto, Vasco Ricoca ; Vieira, André ; Aguiar, Pedro ; Sousa, Paulo ; Carvalho, Carlos ; Thomas, Daniel ; Abrantes, Alexandre ; Nunes, Carla
• Date: 2021
• Persistent ID: http://hdl.handle.net/10362/125708
• Origin: Repositório Institucional da UNL
• Subject(s): Epidemiology; Public Health, Environmental and Occupational Health; Virology; SDG 3 - Good Health and Well-being
• Document Type: Journal article
• Language: English
• Contributor(s): Comprehensive Health Research Centre (CHRC) - Pólo ENSP; Escola Nacional de Saúde Pública (ENSP); Centro de Investigação em Saúde Pública (CISP/PHRC); RUN

Description

Publisher Copyright: © 2021 European Centre for Disease Prevention and Control (ECDC). All rights reserved.

Background: Determinants of hospitalisation, intensive care unit (ICU) admission and death are still unclear for COVID-19. Few studies have adjusted for confounding for different clinical outcomes including all reported cases within a country. Aim: We used routine surveillance data from Portugal to identify risk factors for severe COVID-19 outcomes, and to support risk stratification, public health interventions, and planning of healthcare resources. Methods: We conducted a retrospective cohort study including 20,293 laboratory- confirmed cases of COVID-19 reported between 1 March and 28 April 2020 through the national epidemiological surveillance system. We calculated absolute risk, relative risk (RR) and adjusted relative risk (aRR) to identify demographic and clinical factors associated with hospitalisation, ICU admission and death using Poisson regressions. Results: Increasing age (≥ 60 years) was the major determinant for all outcomes. Age ≥ 90 years was the strongest determinant of hospital admission (aRR: 6.1), and 70-79 years for ICU (aRR: 10.4). Comorbidities of cardiovascular, immunodeficiency, kidney and lung disease (aRR: 4.3, 2.8, 2.4, 2.0, respectively) had stronger associations with ICU admission, while for death they were kidney, cardiovascular and chronic neurological disease (aRR: 2.9, 2.6, 2.0). Conclusions: Older age was the strongest risk factor for all severe outcomes. These findings from the early stages of the COVID-19 pandemic support risk-stratified public health measures that should prioritise protecting older people. Epidemiological scenarios and clinical guidelines should consider this, even though under-ascertainment should also be considered.