Characteristics Underlying Mortal COVID-19 Outcomes

Jack Cush, MD

Jul 17, 2020 9:46 am

From January 1, 2020–May 18, 2020, approximately 1.3 million cases of coronavirus disease 2019 (COVID-19) and 83,000 COVID-19–associated deaths were reported in the United States. MMWR reports that COVID-19 mortality is higher in persons with underlying medical conditions and in those aged ≥85 years.

Analysis of supplementary data for 10,647 decedents in 16 public health jurisdictions found that a majority were aged ≥65 years and most had underlying medical conditions. Overall, 34.9% of Hispanic and 29.5% of nonwhite decedents were aged <65 years, compared with 13.2% of white, non-Hispanic decedents. Among decedents aged <65 years, a total of 7.8% died in an emergency department or at home.

Demographic and clinical data about COVID-19 cases are reported to CDC from 50 states, the District of Columbia, New York City, and U.S. territories using a standardized case-report form (case-based surveillance) or in aggregate. Data on 52,166 deaths from 47 jurisdictions among persons with laboratory-confirmed COVID-19 were reported individually to CDC via case-based surveillance during February 12–May 18, 2020.

Among the 52,166 decedents, 55.4% were male, 79.6% were aged ≥65 years, 13.8% were Hispanic/Latino (Hispanic), 21.0% were black, 40.3% were white, 3.9% were Asian, 0.3% were American Indian/Alaska Native (AI/AN), 0.1% were Native Hawaiian or other Pacific Islander (NHPI), 2.6% were multiracial or other race, and race/ethnicity was unknown for 18.0%. Median decedent age was 78 years (interquartile range (IQR) = 67–87 years). Because information about underlying medical conditions was missing for the majority of these decedents (30,725; 58.9%), data regarding medical conditions were not analyzed further using the case-based surveillance data set. Because most decedents reported to the supplementary data program were also reported to case-based surveillance, no statistical comparisons of the decedent characteristics between the data sets were made.

Among the 10,647 COVID-19 decedents for whom supplementary data were collected, 60.6% were male, 74.8% were aged ≥65 years, 24.4% were Hispanic, 24.9% were black, 35.0% were white, 6.3% were Asian, 0.1% were AI/AN, 0.1% were NHPI, 2.9% were multiracial or other race, and race/ethnicity was unknown for 6.3% (Table 1). Decedent age varied by race and ethnicity; median age was 71 years (IQR = 59–81 years) among Hispanic decedents, 72 years (IQR = 62–81 years) among all nonwhite, non-Hispanic decedents, and 81 years (IQR = 71–88 years) among white decedents. The percentages of Hispanic (34.9%) and nonwhite (29.5%) decedents who were aged <65 years were more than twice those of white decedents (13.2%) .

At least one underlying medical condition was reported for 8,134 (76.4%) of decedents for whom supplementary data were collected, including 83.1% of decedents aged <65 years. Overall, the most common underlying medical conditions were cardiovascular disease (60.9%), diabetes mellitus (39.5%), chronic kidney disease (20.8%), and chronic lung disease (19.2%). Among decedents aged <65 years, 83.1% had one or more underlying medical conditions. Among decedents aged ≥85 years, 69.5% had one or more underlying medical conditions. Diabetes was more common among decedents aged <65 years (49.6%) than among those aged ≥85 years (25.9%).

Understanding factors contributing to racial/ethnic mortality differences and out-of-hospital deaths might inform targeted communication to encourage persons in at-risk groups to practice preventive measures and promptly seek medical care if they become ill.