Multimorbidity patterns among COVID-19 deaths: proposal for the construction of etiological models
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Abstract
Objectives. To describe patterns of multimorbidity among fatal cases of COVID-19, and to propose a classification of patients based on age and multimorbidity patterns to begin the construction of etiological models.
Methods. Data of Colombian confirmed deaths of COVID-19 until June 11, 2020, were included in this analysis (n=1488 deaths). Relationships between COVID-19, combinations of health conditions and age were explored using locally weighted polynomial regressions.
Results. The most frequent health conditions were high blood pressure, respiratory disease, diabetes, cardiovascular disease, and kidney disease. Dyads more frequents were high blood pressure with diabetes, cardiovascular disease or respiratory disease. Some multimorbidity patterns increase probability of death among older individuals, whereas other patterns are not age-related, or decrease the probability of death among older people. Not all multimorbidity increases with age, as is commonly thought. Obesity, alone or with other diseases, was associated with a higher risk of severity among young people, while the risk of the high blood pressure/diabetes dyad tends to have an inverted U distribution in relation with age.
Conclusions. Classification of individuals according to multimorbidity in the medical management of COVID-19 patients is important to determine the possible etiological models and to define patient triage for hospitalization. Moreover, identification of non-infected individuals with high-risk ages and multimorbidity patterns serves to define possible interventions of selective confinement or special management.
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SciScore for 10.1101/2020.07.28.20163816: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. 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:Results presented here should be interpreted taking into account some methodological limitations. First, in this study other conditions that have been used in multimorbidity indices were not available: (osteo)arthritis, …
SciScore for 10.1101/2020.07.28.20163816: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. 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:Results presented here should be interpreted taking into account some methodological limitations. First, in this study other conditions that have been used in multimorbidity indices were not available: (osteo)arthritis, depression, hearth failure, depression, osteoporosis, PAVK, vision problems, dementia, hearing problems and angina pectoris13. Colombian official database only includes the 10 conditions reported in this study. However, with the exception of heart failure and angina, all other conditions have higher prevalences among older adults. For this reason they would not be directly associated with the risk of becoming infected or dying from COVID-19. Heart failure and angina would be covered by the label “cardiovascular disease”, so we consider that the most relevant morbidities associated with COVID-19 severity were considered. Another limitation is related to the non-inclusion of socioeconomic health conditions, disability and functional dependence, geriatric syndromes, and mental health problems (mainly depression and dementia). which although their relationship with the probability of death is more direct, if they are theoretically part of multimorbidity from a broader perspective8, and could indirectly affect the clinical outcome of the disease, by affecting access to health services, adherence to treatment or its effectiveness, as well as the biological interaction of the underlying conditions. Although the analyses presented here are limited to the patterns of m...
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.
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- No protocol registration statement was detected.
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SciScore for 10.1101/2020.07.28.20163816: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. 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:
Results presented here should be interpreted taking into account some methodological limitations. First, in this study other conditions that have been used in multimorbidity indices were not available: (osteo)arthritis, …
SciScore for 10.1101/2020.07.28.20163816: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. 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:
Results presented here should be interpreted taking into account some methodological limitations. First, in this study other conditions that have been used in multimorbidity indices were not available: (osteo)arthritis, depression, hearth failure, depression, osteoporosis, PAVK, vision problems, dementia, hearing problems and angina pectoris13. Colombian official database only includes the 10 conditions reported in this study. However, with the exception of heart failure and angina, all other conditions have higher prevalences among older adults. For this reason they would not be directly associated with the risk of becoming infected or dying from COVID-19. Heart failure and angina would be covered by the label "cardiovascular disease", so we consider that the most relevant morbidities associated with COVID-19 severity were considered. Another limitation is related to the non-inclusion of socioeconomic health conditions, disability and functional dependence, geriatric syndromes, and mental health problems (mainly depression and dementia). which although their relationship with the probability of death is more direct, if they are theoretically part of multimorbidity from a broader perspective8, and could indirectly affect the clinical outcome of the disease, by affecting access to health services, adherence to treatment or its effectiveness, as well as the biological interaction of the underlying conditions. Although the analyses presented here are limited to the patterns of multimorbidity with the highest occurrence, it is important to note that this situation can occur with diseases of lesser occurrence (including neglected diseases) which could be important in some regions. In this case, the medical care becomes a big challenge for clinicians. In conclusion, in this study the patterns of multimorbidity among people diagnosed with COVID-19 in Colombia during the acute period of infection were presented. Undoubtedly, in the future, more multimorbidity patterns will be known. Similar analyses in different regions that incorporate the different epidemiological patterns31 may facilitate the care of people with COVID-19.
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.
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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SciScore for 10.1101/2020.07.28.20163816: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. 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:
Results presented here should be interpreted taking into account some methodological limitations. First, in this study other conditions that have been used in multimorbidity indices were not available: (osteo)arthritis, …
SciScore for 10.1101/2020.07.28.20163816: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. 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:
Results presented here should be interpreted taking into account some methodological limitations. First, in this study other conditions that have been used in multimorbidity indices were not available: (osteo)arthritis, depression, hearth failure, depression, osteoporosis, PAVK, vision problems, dementia, hearing problems and angina pectoris13. Colombian official database only includes the 10 conditions reported in this study. However, with the exception of heart failure and angina, all other conditions have higher prevalences among older adults. For this reason they would not be directly associated with the risk of becoming infected or dying from COVID-19. Heart failure and angina would be covered by the label "cardiovascular disease", so we consider that the most relevant morbidities associated with COVID-19 severity were considered. Another limitation is related to the non-inclusion of socioeconomic health conditions, disability and functional dependence, geriatric syndromes, and mental health problems (mainly depression and dementia). which although their relationship with the probability of death is more direct, if they are theoretically part of multimorbidity from a broader perspective8, and could indirectly affect the clinical outcome of the disease, by affecting access to health services, adherence to treatment or its effectiveness, as well as the biological interaction of the underlying conditions. Although the analyses presented here are limited to the patterns of multimorbidity with the highest occurrence, it is important to note that this situation can occur with diseases of lesser occurrence (including neglected diseases) which could be important in some regions. In this case, the medical care becomes a big challenge for clinicians. In conclusion, in this study the patterns of multimorbidity among people diagnosed with COVID-19 in Colombia during the acute period of infection were presented. Undoubtedly, in the future, more multimorbidity patterns will be known. Similar analyses in different regions that incorporate the different epidemiological patterns31 may facilitate the care of people with COVID-19.
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.
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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