Characteristics and predictors of hospitalization and death in the first 11 122 cases with a positive RT-PCR test for SARS-CoV-2 in Denmark: a nationwide cohort
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Abstract
Background
Population-level knowledge on individuals at high risk of severe and fatal coronavirus disease 2019 (COVID-19) is urgently needed to inform targeted protection strategies in the general population.
Methods
We examined characteristics and predictors of hospitalization and death in a nationwide cohort of all Danish individuals tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from 27 February 2020 until 19 May 2020.
Results
We identified 11 122 SARS-CoV-2 polymerase chain reaction-positive cases of whom 80% were community-managed and 20% were hospitalized. Thirty-day all-cause mortality was 5.2%. Age was strongly associated with fatal disease {odds ratio [OR] 15 [95% confidence interval (CI): 9–26] for 70–79 years, increasing to OR 90 (95% CI: 50–162) for ≥90 years, when compared with cases aged 50–59 years and adjusted for sex and number of co-morbidities}. Similarly, the number of co-morbidities was associated with fatal disease [OR 5.2 (95% CI: 3.4–8.0), for cases with at least four co-morbidities vs no co-morbidities] and 79% of fatal cases had at least two co-morbidities. Most major chronic diseases were associated with hospitalization, with ORs ranging from 1.3–1.4 (e.g. stroke, ischaemic heart disease) to 2.6–3.4 (e.g. heart failure, hospital-diagnosed kidney disease, organ transplantation) and with mortality with ORs ranging from 1.1–1.3 (e.g. ischaemic heart disease, hypertension) to 2.5–3.2 (e.g. major psychiatric disorder, organ transplantation). In the absence of co-morbidities, mortality was <5% in persons aged ≤80 years.
Conclusions
In this nationwide population-based COVID-19 study, increasing age and multimorbidity were strongly associated with hospitalization and death. In the absence of co-morbidities, the mortality was, however, <5% until the age of 80 years.
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SciScore for 10.1101/2020.05.24.20111823: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: Other: According to Danish law, studies based entirely on registry data do not require approval from an ethics review board. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Population-based registries allowed for complete, independent individual-level ascertainment of all previous …
SciScore for 10.1101/2020.05.24.20111823: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: Other: According to Danish law, studies based entirely on registry data do not require approval from an ethics review board. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Population-based registries allowed for complete, independent individual-level ascertainment of all previous hospital contacts and prescription drug use, overcoming limitations of missing data in previous reports. Such complete mapping of medical history allowed us to establish any effect modification caused by increasing age and number of comorbidities. The existence of associations between largely any comorbidities and the risk of hospitalization and death due to COVID-19 in our study is in accordance with previous studies of both COVID-19-patients18,19 and patients with severe influenza,20 thus suggesting resemblances between COVID-19 and other severe respiratory infections with regards to populations at risk. Among the most frequent comorbidities in our population, hypertension, obesity and diabetes seemed to be clear predictors of both hospitalization and fatal disease, which corroborates previous hospital-based outcome studies 21,22 and underscores the probable importance of metabolic health in COVID-19 outcomes.23 Our data add important new knowledge on the possible role of hospital-diagnosed kidney disease and organ transplantation as strong risk factors, and furthermore suggest that people with alcohol/substance abuse and psychiatric illness may be an especially vulnerable group, possibly in line with the socioeconomic disparities that have been observed during the COVID-19 epidemic.24,25 Importantly, the assessment of predictors in our study was performed without ha...
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.
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SciScore for 10.1101/2020.05.24.20111823: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Other According to Danish law , studies based entirely on registry data do not require approval from an ethics review board. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable Thus, the proportion of women increased from 32% in the initial stage (when travelers were frequently tested) to 62% during the reopening stage (when healthcare workers were frequently tested). Table 2: Resources
Results from OddPub: We did not find a statement about open data. We also did not find a statement about open code. Researchers are encouraged to share open data when possible (see Nature blog).
About SciScore
Sc…
SciScore for 10.1101/2020.05.24.20111823: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Other According to Danish law , studies based entirely on registry data do not require approval from an ethics review board. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable Thus, the proportion of women increased from 32% in the initial stage (when travelers were frequently tested) to 62% during the reopening stage (when healthcare workers were frequently tested). Table 2: Resources
Results from OddPub: We did not find a statement about open data. We also did not find a statement about open code. Researchers are encouraged to share open data when possible (see Nature blog).
About SciScore
SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore is not a substitute for expert review. SciScore checks for the presence and correctness of RRIDs (research resource identifiers) in the manuscript, and detects sentences that appear to be missing RRIDs. SciScore also checks to make sure that rigor criteria are addressed by authors. It does this by detecting sentences that discuss criteria such as blinding or power analysis. SciScore does not guarantee that the rigor criteria that it detects are appropriate for the particular study. Instead it assists authors, editors, and reviewers by drawing attention to sections of the manuscript that contain or should contain various rigor criteria and key resources. For details on the results shown here, including references cited, please follow this link.
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