What is the risk of underlying diseases in adults with covid-19?

Among COVID-19 inmates, there were more with underlying illnesses than in the general population, a new study shows.

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Cardiovascular disease, cancer, type 2 diabetes, and chronic obstructive pulmonary disease (COPD) were mentioned early as underlying diseases with an increased risk of a serious course of hospitalization with COVID-19. The Norwegian Directorate of Health, the Norwegian Cancer Registry and the National Institute of Public Health have investigated in a joint study whether this is true, and we have also shed light on whether people with covid-19 have other diseases in addition to the mentioned for the first time.

Methodological weaknesses

Until now, research in this field has been characterized by methodological shortcomings. Unfortunately, this also applies to our study. People with underlying diseases have been tested for COVID-19 more often than healthy people. We lack information about the people who tested negative for COVID-19.

We also know that people with underlying illnesses are admitted to the hospital more often compared to otherwise healthy people with the same symptoms. Therefore, information on underlying diseases among hospitalized covid-19 patients will also be affected by what we call screening. Therefore, the results of studies on disease states among patients infected and hospitalized with COVID-19 are affected by methodological deficiencies and should be interpreted with caution.

Various with underlying diseases

Our study showed that there were more people with various underlying diseases among those admitted with COVID-19 than the proportion who had an underlying disease in the general population.

However, among the people who registered with a positive test for COVID-19, but were not admitted to the hospital, there was no difference between the people who tested positive and the general population.

We use data from the Norwegian Patient Registry, Municipal Registry of Patients and Users and Infectious Disease Notification System (MSIS) for adults aged 20 and over for the period 1.3.2020-13.5.2020 to describe the proportion of states of Selected disease among adults with proven COVID-19 and among hospitalized COVID-19 patients compared to the general population. In all analyzes, the distribution by sex and age was taken into account.

Of all the people who tested positive for COVID-19, 7,632 (93%) were 20 years or older, and 1,025 (13.4%) had been hospitalized. The mean length of stay was eight days and the mean length of stay was six days. Among hospitalized patients with covid-19, there were more patients with cardiovascular disease (18.3 percent versus 15.6 percent), cancer (6.9 percent versus 5.4 percent), type 2 diabetes ( 8.6 percent versus 5.2 percent). percent) and chronic obstructive pulmonary disease (3.8 percent versus 2.7 percent) than in the general population, and there were also more who had two or more of these diseases.

Small gender differences

All conditions occurred more frequently with increasing age. There were small differences between women and men. We also found that the proportion of covid-19 patients with asthma, other chronic lung diseases, cancer during treatment in the last three and six months, complications of hypertension, obesity and overweight, neurological disorders, and heart and kidney failure was higher than in the general population. There was little difference in the proportion with different disease states between the positive COVID-19 test and the general population. The results are based on a study recently published in the Journal of the Norwegian Medical Association.

It is important to follow the evolution more thoroughly

Among hospitalized patients with COVID-19, there were more with underlying conditions than in the general population. This may mean that they have a more serious course of the disease or that they are admitted more often than a healthy person.

We know that people with underlying conditions like cancer or diabetes tend to be admitted to the hospital more often than people who are otherwise healthy and have the same symptoms. Therefore, the results should be interpreted with caution.

As in most other studies, the analyzes are based on population groups in which there will be a selection both to be tested for sars-cov-2 and to be admitted with covid-19. It has great significance for the results. However, this overview of the underlying disease states among adults with COVID-19 is a good and important basis for further development in Norway.

How to strengthen the knowledge base?

A registration link with personal data that includes everyone who was tested for COVID-19, not just those who tested positive, could have helped better answer questions about the risk of infection.

Such data would include information on possible disease states among those who tested negative and were not admitted. In this way, we would have better control over the extent to which the results are affected by the selection.

The National Institute of Public Health is now in the process of establishing these good systems and registering links so that it can perform analyzes of even higher quality. It is important to follow who gets seriously ill and not least the long-term consequences of the illness.

Authors of the article:

Wenche Nystad, epidemiologist with a doctorate and senior researcher at the National Institute of Public Health.

Vidar Hjellvik, Dr. scientist, statistician and senior researcher at the National Institute of Public Health.

Inger Kristin Larsen, epidemiologist with a doctorate and researcher at the Cancer Registry

Inger Ariansen, doctor with doctorate and senior researcher at the National Institute of Public Health.

Inger Johanne Bakken, dr.ing. and Senior Advisor to the Norwegian Health Directorate.

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