Researchers from the Centers for Disease Control and Prevention (CDC) have found that about 47% of American adults have an underlying condition strongly linked to severe COVID-19 disease.
The model-based study, released today at the CDC Weekly Morbidity and Mortality Report, used self-reported data from the 2018 Behavioral Risk Factor Surveillance System and the US Census.
The researchers analyzed data for the prevalence of chronic obstructive pulmonary disease (COPD), heart disease, diabetes, chronic kidney disease (CKD), and obesity in residents of 3,142 counties in all 50 states and the District of Columbia. They defined obesity as having a body mass index (BMI) of 30 kg / m.two or higher.
They found that prevalence patterns generally followed population distributions, with a high number in large cities, but that these conditions were more prevalent in rural than in urban areas. The counties with the highest prevalence of these conditions were generally grouped in the Southeast and the Appalachians.
Serious COVID-19 disease, which requires hospitalization, intensive care, and mechanical ventilation or leads to death, is more common in the elderly and in those with at least one of the underlying conditions listed above.
A CDC analysis last month of US COVID-19 patient surveillance data from January 22 to May 30 showed that people with underlying conditions were hospitalized six times more often, needing intensive care five times more and had a 12-fold higher death rate than those without these conditions. But today’s report authors noted that the previous study defined obesity as a BMI of 40 kg / m.two or higher and included some conditions with mixed or limited evidence of a link to poor coronavirus outcomes.
Prevalence of underlying conditions in rural and urban counties
The median estimated county prevalence of any underlying disease was 47.2% (range, 22.0% to 66.2%). The number of people with an underlying condition ranged from 4,300 in rural counties to 301,744 in large cities.
The prevalence of obesity was 35.4% (range, 15.2% to 49.9%), while it was 12.8% for diabetes (range, 6.1% to 25.6%), 8.9% for COPD (range, 3.5% to 19.9%), 8.6% for heart disease (range, 3.5% to 15.1%), and 3.4% for CKD, 3.4% (range, 1.8% to 6.2%).
Nationwide, the overall weighted prevalence of adults with underlying chronic conditions was 30.9% for obesity, 11.4% for diabetes, 6.9% for COPD, 6.8% for heart disease, and 3.1% for CKD.
The estimated median prevalence of any underlying condition generally increased with increasing remoteness from the county, which varies from 39.4% in large metropolitan counties to 48.8% in rural ones.
Allocation of resources, preventive health measures.
The authors noted that access to health care resources in some rural counties may be poor, increasing the risk of serious COVID-19 outcomes.
“The findings can help local decision-makers identify areas at increased risk for serious COVID-19 disease in their jurisdictions and guide resource allocation and implementation of community mitigation strategies,” they wrote. “These findings also emphasize the importance of prevention efforts to reduce the prevalence of these underlying medical conditions and their risk factors such as smoking, an unhealthy diet, and lack of physical activity.”
The researchers asked that future studies include weighting the contribution of each underlying disease according to the risk of serious COVID-19 outcomes and identifying and integrating other factors leading to susceptibility to infection and serious outcomes to better estimate the number of people at highest risk for COVID-19 infection.
