Data_Sheet_1_Age-Adjusted Associations Between Comorbidity and Outcomes of COVID-19: A Review of the Evidence From the Early Stages of the Pandemic.PDF

Objectives: Early in the COVID-19 pandemic, people with underlying comorbidities were overrepresented in hospitalised cases of COVID-19, but the relationship between comorbidity and COVID-19 outcomes was complicated by potential confounding by age. This review therefore sought to characterise the international evidence base available in the early stages of the pandemic on the association between comorbidities and progression to severe disease, critical care, or death, after accounting for age, among hospitalised patients with COVID-19.Methods: We conducted a rapid, comprehensive review of the literature (to 14 May 2020), to assess the international evidence on the age-adjusted association between comorbidities and severe COVID-19 progression or death, among hospitalised COVID-19 patients – the only population for whom studies were available at that time.Results: After screening 1,100 studies, we identified 14 eligible for inclusion. Overall, evidence for obesity and cancer increasing risk of severe disease or death was most consistent. Most studies found that having at least one of obesity, diabetes mellitus, hypertension, heart disease, cancer, or chronic lung disease was significantly associated with worse outcomes following hospitalisation. Associations were more consistent for mortality than other outcomes. Increasing numbers of comorbidities and obesity both showed a dose-response relationship. Quality and reporting were suboptimal in these rapidly conducted studies, and there was a clear need for additional studies using population-based samples.Conclusions: This review summarises the most robust evidence on this topic that was available in the first few months of the pandemic. It was clear at this early stage that COVID-19 would go on to exacerbate existing health inequalities unless actions were taken to reduce pre-existing vulnerabilities and target control measures to protect groups with chronic health conditions.

目标：在COVID-19大流行初期，患有潜在合并症的人群在COVID-19住院病例中占比过高，但合并症与COVID-19结局之间的关系因年龄的可能混杂因素而变得复杂。因此，本研究旨在描述大流行早期阶段关于合并症与严重疾病进展、重症监护或死亡之间关联的国际证据基础，并考虑到年龄因素，针对COVID-19住院患者。方法：我们进行了一项快速、全面的文献综述（至2020年5月14日），以评估国际证据在调整年龄后，合并症与严重COVID-19进展或死亡之间的关联性，这是当时唯一有研究可用的住院COVID-19患者群体。结果：在筛选了1,100项研究后，我们确定了14项符合纳入标准的研究。总体而言，肥胖和癌症增加严重疾病或死亡风险的证据最为一致。大多数研究发现，至少患有肥胖、糖尿病、高血压、心脏病、癌症或慢性肺疾病与住院后的不良结局显著相关。死亡结局的关联性比其他结局更为一致。合并症数量增加和肥胖均显示出剂量-反应关系。这些快速开展的研究在质量和报告方面存在不足，并且迫切需要使用基于人群的样本进行更多研究。结论：本综述总结了大流行初期几个月内关于这一主题最可靠的证据。在早期阶段，COVID-19将继续加剧现有的健康不平等现象，除非采取行动减少现有的脆弱性，并将控制措施针对具有慢性健康条件的人群。