Assessment of mortality from COVID-19 in a multicultural multi-ethnic patient population.

BACKGROUND: Studies indicate that ethnicity and socioeconomic disparity are significant facilitators for COVID-19 mortality. The United Arab Emirates, distinctly has a population of almost 12% citizens and the rest, immigrants, are mainly unskilled labourers. The disparate socio-economic structure, crowded housing conditions, and multi-ethnic population offer a unique set of challenges in COVID-19 management. METHODS: Patient characteristics, comorbidities, and clinical outcomes data from the electronic patient medical records were retrospectively extracted from the hospital information system of the two designated public COVID-19 referral hospitals. Chi-square test, logistic regression, and odds ratio were used to analyse the variables. RESULTS: From, the total of 3072 patients, less than one-fifth were females; the Asian population (71.2%);followed by Middle Eastern Arabs (23.3%) were the most infected by the virus. Diabetes Mellitus (26.8%), hypertension (25.7%) and heart disease (9.6%) were the most prevalent comorbidities observed among COVID-19 patients. Kidney disease as comorbidity significantly diminished the survival rates (Crude OR 9.6, 95% CI (5.6-16.6), p < 0.001) and (Adjusted OR 5.7 95% CI (3.0 - 10.8), p < 0.001), as compared to those patients without kidney disease. Similarly, the higher age of patients between 51 and 65 years, significantly decreased the odds for survival (Crude OR 14.1 95% CI (3.4-58.4), p < 0.001) and (Adjusted OR 12.3 95% CI (2.9 - 52.4), p < 0.001). Patient age beyond 66 years, further significantly decreased the odds for survival (Crude OR 36.1 95% CI (8.5-154.1), p < 0.001), and (Adjusted OR 26.6 95% CI (5.7 - 123.8), p < 0.001). CONCLUSION: Our study indicates that older ages above 51 years and kidney disease increased mortality significantly in COVID-19 patients. Ethnicity was not significantly associated with mortality in the UAE population. Our findings are important in the management of the COVID-19 disease in the region with similar economic, social, cultural, and ethnic backgrounds.

Higher Mortality from Covid19 in Patients with Renal Dysfunction in A Multicultural Multi-Ethnic Population (preprint)

Background Despite previous exposure to coronavirus epidemics a few years ago, limited clinical and epidemiological information is available from the United Arab Emirates (UAE). The UAE is the second most affected country amongst the Gulf Cooperation Council Countries by Covid19. Distinctly, the UAE has a population of almost 9.2 million, with fewer than 12% UAE nationals, and the rest immigrants, mainly unskilled labourers. The disparate socio-economic structure, crowded housing conditions, multi-ethnic, multicultural population offers a unique set of challenges in Covid19 disease management.Methods In order to assess patient characteristics and survival for patients infected with Covid19, electronic patient data was retrospectively abstracted from the medical records of two designated public Covid19 referral hospitals, and subjected to statistical analysis.Results From, the total of 3072 patients, less than one-fifth were females, the Asian population (71.2%), followed by Middle Eastern Arabs (23.3%) were the most infected by the virus. Mortality was low among the Asian population. Diabetes Mellitus (26.8%, p < 0.001), hypertension (25.7%, p < 0.001), and heart disease (9.6%, p < 0.01) were the most prevalent comorbidities observed and decreased survival by 2–3 fold. Kidney disease escalated mortality rate by almost eight-fold high (19.4%, p < 0.001), as compared to patients without kidney disease. Higher age of patients between 51 and 65 years, significantly decreased the odds for survival (Crude OR 14.1, p<,0.001) and (Adjusted OR 12.3, p < 0.001), and patient age beyond 66 years, further significantly decreased the odds for survival (Crude OR 36.1, p < 0.001) and (Adjusted OR 26.6,p < 0.001). Kidney disease as comorbidity significantly diminished the survival rates (Crude OR 9.6,p < 0.001) and (Adjusted OR 5.7, p < 0.001), as compared to those without kidney dysfunction.Conclusion Although Asian population was the highest infected by Covd19, their mortality rate was low (2.6%), compared to other nationalities. Older ages above 51 years decreased the odds of survival significantly. Despite other comorbidity risks, kidney dysfunction contributed to enhanced mortality by over eight-fold and reduced the odds of survival (Adjusted OR 26.6), compared to those patients without kidney dysfunction. Our findings are important in the management of the Covid19 disease in the region with similar economic, social, cultural and ethnic background.

The First Consecutive 5000 Patients with Coronavirus Disease 2019 from Qatar; a Nation-wide Cohort Study (preprint)

BackgroundThere are limited data on Coronavirus Disease 2019 (COVID-19) outcomes at a national level, and none after 60 days of follow up. The aim of this study was to describe national, 60-day all-cause mortality associated with COVID-19, and to identify risk factors associated with admission to an intensive care unit (ICU). MethodsThis was a retrospective cohort study including the first consecutive 5000 patients with COVID-19 in Qatar who completed 60 days of follow up by June 17, 2020. Outcomes included all-cause mortality at 60 days after COVID-19 diagnosis, and risk factors for admission to ICU. ResultsIncluded patients were diagnosed with COVID-19 between February 28 and April 17, 2020. The majority (4436, 88.7%) were males and the median age was 35 years [interquartile range (IQR) 28- 43]. By 60 days after COVID-19 diagnosis, 14 patients (0.28%) had died, 10 (0.2%) were still in hospital, and two (0.04%) were still in ICU. Fatal COVID-19 cases had a median age of 59.5 years (IQR 55.8-68), and were mostly males (13, 92.9%). All included pregnant women (26, 0.5%), children (131, 2.6%), and healthcare workers (135, 2.7%) were alive and not hospitalized at the end of follow up. A total of 1424 patients (28.5%) required hospitalization, out of which 108 (7.6%) were admitted to ICU. Most frequent co-morbidities in hospitalized adults were diabetes (23.2%), and hypertension (20.7%). Multivariable logistic regression showed that older age [adjusted odds ratio (aOR) 1.041, 95% confidence interval (CI) 1.022-1.061 per year increase; P <0.001], male sex (aOR 4.375, 95% CI 1.964-9.744; P <0.001), diabetes (aOR 1.698, 95% CI 1.050-2.746; P 0.031), chronic kidney disease (aOR 3.590, 95% CI 1.596-8.079, P 0.002), and higher BMI (aOR 1.067, 95% CI 1.027-1.108 per unit increase; P 0.001), were all independently associated with increased risk of ICU admission. ConclusionsIn a relatively younger national cohort with a low co-morbidity burden, COVID-19 was associated with low all-cause mortality. Independent risk factors for ICU admission included older age, male sex, higher BMI, and co-existing diabetes or chronic kidney disease.