Risk Factors for Death Among the First 80 543 Coronavirus Disease 2019 (COVID-19) Cases in China: Relationships Between Age, Underlying Disease, Case Severity, and Region

Author:

Zhang Yanping1,Luo Wei1,Li Qun1,Wang Xijie2,Chen Jin1,Song Qinfeng2,Tu Hong1,Ren Ruiqi1,Li Chao1,Li Dan1,Zhao Jing1,McGoogan Jennifer M1,Shan Duo1,Li Bing1,Zhang Jingxue2,Dong Yanhui2,Jin Yu2,Mao Shuai2,Qian Menbao1,Lv Chao1,Zhu Huihui1,Wang Limin1,Xiao Lin1,Xu Juan1,Yin Dapeng1,Zhou Lei1,Li Zhongjie1,Shi Guoqing1,Dong Xiaoping1,Guan Xuhua3,Gao George F1,Wu Zunyou1,Feng Zijian1

Affiliation:

1. Chinese Center for Disease Control and Prevention, Beijing, China

2. Peking University, Beijing, China

3. Hubei Center for Disease Control and Prevention, Wuhan, China

Abstract

Abstract Background Knowledge of COVID-19 epidemiology remains incomplete and crucial questions persist. We aimed to examine risk factors for COVID-19 death. Methods A total of 80 543 COVID-19 cases reported in China, nationwide, through 8 April 2020 were included. Risk factors for death were investigated by Cox proportional hazards regression and stratified analyses. Results Overall national case-fatality ratio (CFR) was 5.64%. Risk factors for death were older age (≥80: adjusted hazard ratio, 12.58; 95% confidence interval, 6.78–23.33), presence of underlying disease (1.33; 1.19–1.49), worse case severity (severe: 3.86; 3.15–4.73; critical: 11.34; 9.22–13.95), and near-epicenter region (Hubei: 2.64; 2.11–3.30; Wuhan: 6.35; 5.04–8.00). CFR increased from 0.35% (30–39 years) to 18.21% (≥70 years) without underlying disease. Regardless of age, CFR increased from 2.50% for no underlying disease to 7.72% for 1, 13.99% for 2, and 21.99% for ≥3 underlying diseases. CFR increased with worse case severity from 2.80% (mild) to 12.51% (severe) and 48.60% (critical), regardless of region. Compared with other regions, CFR was much higher in Wuhan regardless of case severity (mild: 3.83% vs 0.14% in Hubei and 0.03% elsewhere; moderate: 4.60% vs 0.21% and 0.06%; severe: 15.92% vs 5.84% and 1.86%; and critical: 58.57% vs 49.80% and 18.39%). Conclusions Older patients regardless of underlying disease and patients with underlying disease regardless of age were at elevated risk of death. Higher death rates near the outbreak epicenter and during the surge of cases reflect the deleterious effects of allowing health systems to become overwhelmed.

Funder

Ministry of Science and Technology of the People’s Republic of China

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Microbiology (medical)

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