Multimorbidity and SARS-CoV-2–Related Outcomes: Analysis of a Cohort of Italian Patients
BackgroundSince the outbreak of the COVID-19 pandemic, identifying the main risk factors has been imperative to properly manage the public health challenges that the pandemic exposes, such as organizing effective vaccination campaigns. In addition to gender and age, multimorb...
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
JMIR Publications
2023-02-01
|
| Series: | JMIR Public Health and Surveillance |
| Online Access: | https://publichealth.jmir.org/2023/1/e41404 |
| _version_ | 1827857554491834368 |
|---|---|
| author | Alberto Catalano Lucia Dansero Winston Gilcrease Alessandra Macciotta Carlo Saugo Luca Manfredi Roberto Gnavi Elena Strippoli Nicolás Zengarini Valeria Caramello Giuseppe Costa Carlotta Sacerdote Fulvio Ricceri |
| author_facet | Alberto Catalano Lucia Dansero Winston Gilcrease Alessandra Macciotta Carlo Saugo Luca Manfredi Roberto Gnavi Elena Strippoli Nicolás Zengarini Valeria Caramello Giuseppe Costa Carlotta Sacerdote Fulvio Ricceri |
| author_sort | Alberto Catalano |
| collection | DOAJ |
| description |
BackgroundSince the outbreak of the COVID-19 pandemic, identifying the main risk factors has been imperative to properly manage the public health challenges that the pandemic exposes, such as organizing effective vaccination campaigns. In addition to gender and age, multimorbidity seems to be 1 of the predisposing factors coming out of many studies investigating the possible causes of increased susceptibility to SARS-CoV-2 infection and adverse outcomes. However, only a few studies conducted have used large samples.
ObjectiveThe objective is to evaluate the association between multimorbidity, the probability to be tested, susceptibility, and the severity of SARS-CoV-2 infection in the Piedmont population (Northern Italy, about 4 million inhabitants). For this purpose, we considered 5 main outcomes: access to the swab, positivity to SARS-CoV-2, hospitalization, intensive care unit (ICU) admission, and death within 30 days from the first positive swab.
MethodsData were obtained from different Piedmont health administrative databases. Subjects aged from 45 to 74 years and infections diagnosed from February to May 2020 were considered. Multimorbidity was defined both with the Charlson Comorbidity Index (CCI) and by identifying patients with previous comorbidities, such as diabetes and oncological, cardiovascular, and respiratory diseases. Multivariable logistic regression models (adjusted for age and month of infection and stratified by gender) were performed for each outcome. Analyses were also conducted by separating 2 age groups (45-59 and 60-74 years).
ResultsOf 1,918,549 subjects, 85,348 (4.4%) performed at least 1 swab, of whom 12,793 (14.9%) tested positive for SARS-CoV-2. Of these 12,793 subjects, 4644 (36.3%) were hospitalized, 1508 (11.8%) were admitted to the ICU, and 749 (5.9%) died within 30 days from the first positive swab. Individuals with a higher CCI had a higher probability of being swabbed but a lower probability of testing positive. We observed the same results when analyzing subjects with previous oncological and cardiovascular diseases. Moreover, especially in the youngest group, we identified a greater risk of being hospitalized and dying. Among comorbidities considered in the study, respiratory diseases seemed to be the most likely to increase the risk of having a positive swab and worse disease outcomes.
ConclusionsOur study shows that patients with multimorbidity, although swabbed more frequently, are less likely to get infected with SARS-CoV-2, probably due to greater attention on protective methods. Moreover, a history of respiratory diseases is a risk factor for a worse prognosis of COVID-19. Nonetheless, whatever comorbidities affect the patients, a strong dose-response effect was observed between an increased CCI score and COVID-19 hospitalization, ICU admission, and death. These results are important in terms of public health because they help in identifying a group of subjects who are more prone to worse SARS-CoV-2 outcomes. This information is important for promoting targeted prevention and developing policies for the prioritization of public health interventions. |
| first_indexed | 2024-03-12T12:42:13Z |
| format | Article |
| id | doaj.art-45951b8a7c264291ad4718fa85edd82d |
| institution | Directory Open Access Journal |
| issn | 2369-2960 |
| language | English |
| last_indexed | 2024-03-12T12:42:13Z |
| publishDate | 2023-02-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | JMIR Public Health and Surveillance |
| spelling | doaj.art-45951b8a7c264291ad4718fa85edd82d2023-08-28T23:43:42ZengJMIR PublicationsJMIR Public Health and Surveillance2369-29602023-02-019e4140410.2196/41404Multimorbidity and SARS-CoV-2–Related Outcomes: Analysis of a Cohort of Italian PatientsAlberto Catalanohttps://orcid.org/0000-0003-2597-2060Lucia Danserohttps://orcid.org/0000-0003-2304-5378Winston Gilcreasehttps://orcid.org/0000-0001-5292-2371Alessandra Macciottahttps://orcid.org/0000-0002-0287-7979Carlo Saugohttps://orcid.org/0000-0002-4937-6530Luca Manfredihttps://orcid.org/0000-0002-6530-4326Roberto Gnavihttps://orcid.org/0000-0003-1919-2199Elena Strippolihttps://orcid.org/0000-0001-7120-9205Nicolás Zengarinihttps://orcid.org/0000-0003-1707-9942Valeria Caramellohttps://orcid.org/0000-0002-6106-0432Giuseppe Costahttps://orcid.org/0000-0003-3187-4889Carlotta Sacerdotehttps://orcid.org/0000-0002-8008-5096Fulvio Riccerihttps://orcid.org/0000-0001-8749-9737 BackgroundSince the outbreak of the COVID-19 pandemic, identifying the main risk factors has been imperative to properly manage the public health challenges that the pandemic exposes, such as organizing effective vaccination campaigns. In addition to gender and age, multimorbidity seems to be 1 of the predisposing factors coming out of many studies investigating the possible causes of increased susceptibility to SARS-CoV-2 infection and adverse outcomes. However, only a few studies conducted have used large samples. ObjectiveThe objective is to evaluate the association between multimorbidity, the probability to be tested, susceptibility, and the severity of SARS-CoV-2 infection in the Piedmont population (Northern Italy, about 4 million inhabitants). For this purpose, we considered 5 main outcomes: access to the swab, positivity to SARS-CoV-2, hospitalization, intensive care unit (ICU) admission, and death within 30 days from the first positive swab. MethodsData were obtained from different Piedmont health administrative databases. Subjects aged from 45 to 74 years and infections diagnosed from February to May 2020 were considered. Multimorbidity was defined both with the Charlson Comorbidity Index (CCI) and by identifying patients with previous comorbidities, such as diabetes and oncological, cardiovascular, and respiratory diseases. Multivariable logistic regression models (adjusted for age and month of infection and stratified by gender) were performed for each outcome. Analyses were also conducted by separating 2 age groups (45-59 and 60-74 years). ResultsOf 1,918,549 subjects, 85,348 (4.4%) performed at least 1 swab, of whom 12,793 (14.9%) tested positive for SARS-CoV-2. Of these 12,793 subjects, 4644 (36.3%) were hospitalized, 1508 (11.8%) were admitted to the ICU, and 749 (5.9%) died within 30 days from the first positive swab. Individuals with a higher CCI had a higher probability of being swabbed but a lower probability of testing positive. We observed the same results when analyzing subjects with previous oncological and cardiovascular diseases. Moreover, especially in the youngest group, we identified a greater risk of being hospitalized and dying. Among comorbidities considered in the study, respiratory diseases seemed to be the most likely to increase the risk of having a positive swab and worse disease outcomes. ConclusionsOur study shows that patients with multimorbidity, although swabbed more frequently, are less likely to get infected with SARS-CoV-2, probably due to greater attention on protective methods. Moreover, a history of respiratory diseases is a risk factor for a worse prognosis of COVID-19. Nonetheless, whatever comorbidities affect the patients, a strong dose-response effect was observed between an increased CCI score and COVID-19 hospitalization, ICU admission, and death. These results are important in terms of public health because they help in identifying a group of subjects who are more prone to worse SARS-CoV-2 outcomes. This information is important for promoting targeted prevention and developing policies for the prioritization of public health interventions.https://publichealth.jmir.org/2023/1/e41404 |
| spellingShingle | Alberto Catalano Lucia Dansero Winston Gilcrease Alessandra Macciotta Carlo Saugo Luca Manfredi Roberto Gnavi Elena Strippoli Nicolás Zengarini Valeria Caramello Giuseppe Costa Carlotta Sacerdote Fulvio Ricceri Multimorbidity and SARS-CoV-2–Related Outcomes: Analysis of a Cohort of Italian Patients JMIR Public Health and Surveillance |
| title | Multimorbidity and SARS-CoV-2–Related Outcomes: Analysis of a Cohort of Italian Patients |
| title_full | Multimorbidity and SARS-CoV-2–Related Outcomes: Analysis of a Cohort of Italian Patients |
| title_fullStr | Multimorbidity and SARS-CoV-2–Related Outcomes: Analysis of a Cohort of Italian Patients |
| title_full_unstemmed | Multimorbidity and SARS-CoV-2–Related Outcomes: Analysis of a Cohort of Italian Patients |
| title_short | Multimorbidity and SARS-CoV-2–Related Outcomes: Analysis of a Cohort of Italian Patients |
| title_sort | multimorbidity and sars cov 2 related outcomes analysis of a cohort of italian patients |
| url | https://publichealth.jmir.org/2023/1/e41404 |
| work_keys_str_mv | AT albertocatalano multimorbidityandsarscov2relatedoutcomesanalysisofacohortofitalianpatients AT luciadansero multimorbidityandsarscov2relatedoutcomesanalysisofacohortofitalianpatients AT winstongilcrease multimorbidityandsarscov2relatedoutcomesanalysisofacohortofitalianpatients AT alessandramacciotta multimorbidityandsarscov2relatedoutcomesanalysisofacohortofitalianpatients AT carlosaugo multimorbidityandsarscov2relatedoutcomesanalysisofacohortofitalianpatients AT lucamanfredi multimorbidityandsarscov2relatedoutcomesanalysisofacohortofitalianpatients AT robertognavi multimorbidityandsarscov2relatedoutcomesanalysisofacohortofitalianpatients AT elenastrippoli multimorbidityandsarscov2relatedoutcomesanalysisofacohortofitalianpatients AT nicolaszengarini multimorbidityandsarscov2relatedoutcomesanalysisofacohortofitalianpatients AT valeriacaramello multimorbidityandsarscov2relatedoutcomesanalysisofacohortofitalianpatients AT giuseppecosta multimorbidityandsarscov2relatedoutcomesanalysisofacohortofitalianpatients AT carlottasacerdote multimorbidityandsarscov2relatedoutcomesanalysisofacohortofitalianpatients AT fulvioricceri multimorbidityandsarscov2relatedoutcomesanalysisofacohortofitalianpatients |