BACKGROUND: At the beginning of June 2020, there were nearly 7 million reported cases of coronavirus disease 2019 (COVID-19) worldwide and over 400,000 deaths in people with COVID-19 . The objective of this study was to determine associations between comorbidities listed in the Charlson comorbidity index and mortality among patients in the United States with COVID-19 .
METHODS AND FINDINGS: A retrospective cohort study of adults with COVID-19 from 24 healthcare organizations in the US was conducted . The study included adults aged 18-90 years with COVID-19 coded in their electronic medical records between January 20 , 2020, and May 26 , 2020 . Results were also stratified by age groups (< 50 years , 50-69 years, or 70-90 years). A total of 31,461 patients were included . Median age was 50 years (interquartile range [IQR], 35-63) and 54.5% (n = 17,155) were female . The most common comorbidities listed in the Charlson comorbidity index were chronic pulmonary disease (17.5%, n = 5,513) and diabetes mellitus (15.0%, n = 4,710). Multivariate logistic regression analyses showed older age (odds ratio [OR] per year 1.06; 95% confidence interval [CI] 1.06-1.07; p <0.001), male sex (OR 1.75; 95% CI 1.55-1.98; p <0.001), being black or African American compared to white (OR 1.50; 95% CI 1.31-1.71; p <0.001), myocardial infarction (OR 1.97; 95% CI 1.64-2.35; p <0.001), congestive heart failure (OR 1.42; 95% CI 1.21-1.67; p <0.001), dementia (OR 1.29; 95% CI 1.07-1.56; p = 0.008), chronic pulmonary disease (OR 1.24; 95% CI 1.08-1.43; p = 0.003), mild liver disease (OR 1.26; 95% CI 1.00-1.59; p = 0.046), moderate/severe liver disease (OR 2.62; 95% CI 1.53-4.47; p <0.001), renal disease (OR 2.13; 95% CI 1.84-2.46; p <0.001), and metastatic solid tumor (OR 1.70; 95% CI 1.19-2.43; p = 0.004) were associated with higher odds of mortality with COVID-19 . Older age, male sex, and being black or African American (compared to being white) remained significantly associated with higher odds of death in age-stratified analyses . There were differences in which comorbidities were significantly associated with mortality between age groups . Limitations include that the data were collected from the healthcare organization electronic medical record databases and some comorbidities may be underreported and ethnicity was unknown for 24% of participants . Deaths during an inpatient or outpatient visit at the participating healthcare organizations were recorded; however, deaths occurring outside of the hospital setting are not well captured .
CONCLUSIONS: Identifying patient characteristics and conditions associated with mortality with COVID-19 is important for hypothesis generating for clinical trials and to develop targeted intervention strategies.