Cancer and the risk of coronavirus disease 2019 diagnosis, hospitalisation and death: A population‐based multistate cohort study including 4 618 377 adults in Catalonia, Spain

  1. Elena Roel
  2. Andrea Pistillo
  3. Martina Recalde
  4. Sergio Fernández‐Bertolín
  5. María Aragón
  6. Isabelle Soerjomataram
  7. Mazda Jenab
  8. Diana Puente
  9. Daniel Prieto‐Alhambra
  10. Edward Burn
  11. Talita Duarte‐Salles

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Abstract

The relationship between cancer and coronavirus disease 2019 (COVID‐19) infection and severity remains poorly understood. We conducted a population‐based cohort study between 1 March and 6 May 2020 describing the associations between cancer and risk of COVID‐19 diagnosis, hospitalisation and COVID‐19‐related death. Data were obtained from the Information System for Research in Primary Care (SIDIAP) database, including primary care electronic health records from ~80% of the population in Catalonia, Spain. Cancer was defined as any primary invasive malignancy excluding non‐melanoma skin cancer. We estimated adjusted hazard ratios (aHRs) for the risk of COVID‐19 (outpatient) clinical diagnosis, hospitalisation (with or without a prior COVID‐19 diagnosis) and COVID‐19‐related death using Cox proportional hazard regressions. Models were estimated for the overall cancer population and by years since cancer diagnosis (<1 year, 1‐5 years and ≥5 years), sex, age and cancer type; and adjusted for age, sex, smoking status, deprivation and comorbidities. We included 4 618 377 adults, of which 260 667 (5.6%) had a history of cancer. A total of 98 951 individuals (5.5% with cancer) were diagnosed, and 6355 (16.4% with cancer) were directly hospitalised with COVID‐19. Of those diagnosed, 6851 were subsequently hospitalised (10.7% with cancer), and 3227 died without being hospitalised (18.5% with cancer). Among those hospitalised, 1963 (22.5% with cancer) died. Cancer was associated with an increased risk of COVID‐19 diagnosis (aHR: 1.08; 95% confidence interval [1.05‐1.11]), direct COVID‐19 hospitalisation (1.33 [1.24‐1.43]) and death following hospitalisation (1.12 [1.01‐1.25]). These associations were stronger for patients recently diagnosed with cancer, aged <70 years, and with haematological cancers. These patients should be prioritised in COVID‐19 vaccination campaigns and continued non‐pharmaceutical interventions.

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  1. Version published to 10.1002/ijc.33846
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    SciScore for 10.1101/2021.05.18.21257371: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsField Sample Permit: Comorbidities were defined as previously described based on medical diagnosis,[17] and selected due to their relevance to the COVID-19 research field.
    IRB: This study was approved by the Clinical Research Ethics Committee of the IDIAPJGol (project code: 20/070-PCV).
    Sex as a biological variableThird, we further estimated our main models separately for <1-year, 1-5-years, and >5-years cancer patients, and stratified these models by sex (women or men), age (<70 and ≥70 years, 70 years was the median age of patients with cancer), cancer type (haematological or solid cancer, as well as by solid cancer types).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    First, we estimated models for all patients with cancer compared to patients without cancer adjusting for age, sex, the MEDEA deprivation index, smoking status, and all the comorbidities of interest (main models).
    MEDEA
    suggested: (MEDEA, RRID:SCR_013356)

    Results from OddPub: Thank you for sharing your code.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    However, this study also has weaknesses. First, we did not have information on cancer stage nor specific-cancer therapy receipt, and used instead years since cancer diagnosis as a proxy for active/inactive cancer. We also did not have information on the cause of death and considered as COVID-19-related deaths those occurring following a COVID-19 state. However, in patients with cancer, occurrence of death was substantially higher in those diagnosed (11.1%) and hospitalised (24.8%) with COVID-19 than in those without COVID-19 (1.3%), which suggests that we did capture deaths due to COVID-19. In addition, the proportion of deaths among hospitalised patients was in line with prior studies.[27] On the other hand, we cannot discard that some deaths in the general population might have occurred in undiagnosed COVID-19 cases, especially at the beginning of the pandemic. Secondly, due to the nature of our database, our results are not representative of asymptomatic or pauci-symptomatic COVID-19 cases that did not seek medical care. Finally, routinely collected data often raises concerns about data quality and some conditions, including cancer itself, may have been incompletely or inaccurately recorded. However, we used previously validated cancer codes,[19] and we included only individuals with at least one year of prior history available to comprehensively capture baseline characteristics. Prior studies investigating the risk of contracting SARS-CoV-2 in patients with cancer have re...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2021.05.18.21257371v1 on medRxiv