Jacob McPadden 1 , Frederick Warner 1 , 3 , H. Patrick Young 2 , 4 , Nathan C. Hurley 5 , Rebecca A. Pulk 6 , Avinainder Singh 4 , Thomas JS Durant 2 , 7 , Guannan Gong 2 , 8 , Nihar Desai 2 , Adrian Haimovich 9 , Richard Andrew Taylor 10 , Murat Gunel 11 , 12 , 13 , 14 , Charles S. Dela Cruz 15 , Shelli F. Farhadian 16 , Jonathan Siner 15 , Merceditas Villanueva 4 , 17 , Keith Churchwell 18 , Allen Hsiao 1 , 19 , Charles J. Torre Jr 7 , 19 , Eric J. Velazquez 3 , Roy S. Herbst 20 , Akiko Iwasaki 21 , 22 , Albert I. Ko 23 , Bobak J. Mortazavi 2 , 3 , 5 , 24 , Harlan M. Krumholz 2 , 3 , 25 , Wade L. Schulz 2 , 7 , *
21 July 2020
Severe acute respiratory syndrome virus (SARS-CoV-2) has infected millions of people worldwide. Our goal was to identify risk factors associated with admission and disease severity in patients with SARS-CoV-2.
This was an observational, retrospective study based on real-world data for 7,995 patients with SARS-CoV-2 from a clinical data repository.
Yale New Haven Health (YNHH) is a five-hospital academic health system serving a diverse patient population with community and teaching facilities in both urban and suburban areas.
The study included adult patients who had SARS-CoV-2 testing at YNHH between March 1 and April 30, 2020.
Primary outcomes were admission and in-hospital mortality for patients with SARS-CoV-2 infection as determined by RT-PCR testing. We also assessed features associated with the need for respiratory support.
Of the 28605 patients tested for SARS-CoV-2, 7995 patients (27.9%) had an infection (median age 52.3 years) and 2154 (26.9%) of these had an associated admission (median age 66.2 years). Of admitted patients, 1633 (75.8%) had a discharge disposition at the end of the study period. Of these, 192 (11.8%) required invasive mechanical ventilation and 227 (13.5%) expired. Increased age and male sex were positively associated with admission and in-hospital mortality (median age 81.9 years), while comorbidities had a much weaker association with the risk of admission or mortality. Black race (OR 1.43, 95%CI 1.14–1.78) and Hispanic ethnicity (OR 1.81, 95%CI 1.50–2.18) were identified as risk factors for admission, but, among discharged patients, age-adjusted in-hospital mortality was not significantly different among racial and ethnic groups.
This observational study identified, among people testing positive for SARS-CoV-2 infection, older age and male sex as the most strongly associated risks for admission and in-hospital mortality in patients with SARS-CoV-2 infection. While minority racial and ethnic groups had increased burden of disease and risk of admission, age-adjusted in-hospital mortality for discharged patients was not significantly different among racial and ethnic groups. Ongoing studies will be needed to continue to evaluate these risks, particularly in the setting of evolving treatment guidelines.