ABSTRACT
Introduction: New York City has been one of the largest epicenters of the COVID-19 pandemic. This provided a wealth of data to examine the characteristics of COVID-19 patients in this multi-ethnic city, while assessing the contributions of cardio-metabolic burden and pulmonary conditions as potential “at-risk” conditions for COVID- 19. We assessed the relative contribution of common upper and lower airway pulmonary diseases in determining the likelihood of COVID- 19-related mortality independent of other medical conditions, health risks, and sociodemographic factors. Methods: We analyzed data from one of the largest US-based case series of patients with COVID-19, captured from an academic health network in NYC. A total of 11,512 hospitalized patients (March 2-May 24, 2020) were tested with 4,446 (38.62%) receiving a positive diagnosis for COVID-19. EHR queries yielded age at time of testing, sex, race/ethnicity aggregated as non-Hispanic black, Asian and Hispanic referenced to non-Hispanic white;cardio-metabolic conditions (hypertension, hyperlipidemia, diabetes, obesity, peripheral artery disease, and coronary artery disease);pulmonary disease (e.g., COPD, sleep apnea, or asthma);autoimmune disease;and cancer. Mortality was based on the patient state (alive or deceased) at the moment of discharge. We included only patients who had been discharged alive or had expired. Anaconda Python 3.7 was used to perform all analyses. Results: Among patients testing positive, 959 (21.57%) died of COVID-19-related complications at the hospital. Multivariateadjusted Cox proportional hazards modeling showed mortality risks were strongly associated with greater age (HR=1.05;95%CI:1.04- 1.05), ethnic minority (HR=1.26;95%CI:1.10-1.44), low household income (HR=1.29;95%CI:1.11, 1.49), and male sex (HR=0.85;95%CI:0.74, 0.97). Higher mortality risks were also associated with a history of COPD (HR=1.27;95%CI:1.02-1.58), obesity (HR=1.19;95%CI:1.04-1.37) and peripheral artery disease (HR=1.33;95%CI:1.05-1.69). We observed a significantly higher rate of COVID- 19 cases (43.8% vs 39.6%, p<0.05) among patients with sleep apnea (7.72%). However, they did not have a significantly higher mortality rate (13.0% vs 11.8%, NS), although they experienced a longer hospital stay (7.1±7.7 vs 6.1±7.5, p<0.01). Conclusion: Patients with COPD had the highest odds of COVID- 19 mortality. Sociodemographic factors including increased age, male sex, low household income, ethnic minority status were also independently associated with greater mortality risks.