Young adults with underlying conditions such as morbid obesity, diabetes and hypertension are at the highest risk of being placed on a ventilator or dying from COVID-19, according to a study of 3,000 hospitalized patients aged 18 to 34. It confirmed first and foremost that black and Hispanic people have been the worst affected by the pandemic: they accounted for 57 percent of all young adults who were hospitalized and 49 percent of those who died or needed ventilation, representing about a third of all young people.
The analysis, ‘Clinical Outcomes in Young US Adults Hospitalized With COVID-19’, published in the journal JAMA Internal Medicine, investigated the clinical profile and outcomes of young adults (defined by the US Census as age 18-34 years) who required hospitalisation for COVID-19 in the US. Led by Dr Scott D Solomon, Cardiovascular Division, Brigham and Women’s Hospital, researchers reported the comorbidities and outcomes during COVID-19 hospitalisation (defined using diagnosis, procedure, or billing ICD-10 codes). Intensive care utilisation was defined by a billing code for intensive care unit room or daily ventilator management.
From 780,969 adults discharged between April and June 2020, some 63,103 (8.1%) had the ICD-10 code for COVID-19, and 3,222 (5%) were nonpregnant young adults (age 18-34 years) admitted to 419 US hospitals. The mean (SD) age was 28.3 (4.4) years and a majority were male (1,849/57.6%) and black or Hispanic (1,838/57.0%). In total, 1,187 (36.8%) had obesity, 789 (24.5%) morbid obesity, 588 (18.2%) diabetes and 519 (16.1%) hypertension.
More than one in five (684 patients/21%) required intensive care, 331 (10%) required mechanical ventilation and 88 (2.7%) died. Vasopressors or inotropes were used for 217 patients (7%), central venous catheters for 283 (9%) and arterial catheters for 192 (6%). The median length of stay was 4 days and 99 (3%) were discharged to a post-acute care facility.
Morbid obesity (vs no obesity) and hypertension were associated with greater risk of death or mechanical ventilation (both p<0.001), as was male sex (p=0.001). However, death or mechanical ventilation did not vary significantly with race and ethnicity. One hundred and forty patients (41%) with morbid obesity died or required ventilation. In univariable analysis, diabetes was also associated with increased risk of this outcome (p< .001) but was not statistically significance after adjustment (p=0.06). Patients with multiple risk factors (morbid obesity, hypertension and diabetes) faced risks similar to 8,862 middle-aged (age 35-64 years) adults with COVID-19 infection without these conditions.
“Given the sharply rising rates of COVID-19 infection in young adults, these findings underscore the importance of infection prevention measures in this age group,” the authors concluded.
In an Editorial Note, Dr Mitchell H Katz, NYC Health and Hospitals, New York and Deputy Editor, JAMA Internal Medicine, wrote: “Combined with what we know about the greater risk of older persons, what does this study tell us about COVID-19 and young adults? First, while young adults are much less likely than older persons to become seriously ill, if they reach the point of hospitalization, their risks are substantial. Second, obesity, hypertension, and male sex put patients of all ages at greater risk. As obesity and hypertension are preventable and treatable conditions, reducing the risk of serious COVID 19 illness should be added to the already long list of reasons to increase medical and public health efforts in young adults to promote healthful diets and increased exercise.”
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