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Purpose: There is a lack of information of the difference in sex-aggregated prevalence of comorbid noncommunicable disease (NCD) in patients hospitalized with COVID-19 in Iran. This study aimed to evaluate sex differences in the relation between medical comorbidities and subsequent death in patients hospitalized with COVID-19. Methods: All subsequently hospitalized patients with a diagnosis of moderate to severe COVID-19 since February 19th to June 14th, 2020, in Isfahan, Iran, were recruited in the ongoing I-CORE Registry. Real-time reverse-transcription polymerase chain reaction (RT-PCR) testing was done upon admission. Data on preexisting comorbid NCDs including hypertension, coronary heart disease (CHD), diabetes mellitus (DM), cancers, chronic renal disease (CRD), and chronic respiratory disease were collected through self-reported questionnaires. Results: Overall, 12,620 individuals were enrolled in this registry of which 4,356 were positive for the COVID-19 RT-PCR test. In the whole population, in women, DM, hypertension, and CHD, and in men, DM, CHD, and hypertension were, respectively, the most frequent comorbidities. The frequency of at least one NCD did not differ between men and women, but a greater proportion of women had two or more NCDs. Increasing the number of comorbidities was associated with higher death frequency and mortality risk in the unadjusted model but remained no longer significant after adjustment for age. There was no statistically significant difference in this regard between men and women. Conclusion: Overall, we found that DM, hypertension, and CHD were the most frequent comorbidities. Although comorbidities were more frequent among women, mortality risk did not significantly differ between men and women.
ABSTRACT
Background: The first confirmed case of COVID-19 in Iran was reported in February 2019. The current study aimed to investigate the epidemiological aspects of COVID-19 disease in Isfahan province and evaluate the chances of infection and death in the population. Materials and Methods: In this cross-sectional study, 21,203 confirmed cases of COVID-19, based on the polymerase chain reaction test, referred to outpatient facilities from February 2019 to July 2020 in Isfahan province are studied. Disease incidence, mortality, and case fatality rate, as well as odds ratio (OR) of infection and death, were calculated and analyzed using SPSS version 20. Results: The highest incidence of the disease was within the age group of 30–39 years 4911 (23.9%) and males 11,561 (54.5%). Mortality in people over 80 years (207 [32.9%]), men (370 cases [58.7%]), diabetics (182 cases [28.9%]), and people with cardiovascular disease (165 people [26.2%]) was more. In multivariate analysis, patients with a cancer diagnosis had the highest OR of death (OR = 4.03 confidence interval [CI]: 2.56–6.35) (P < 0.001), followed by those with immune deficiency disease (OR = 2.46 CI: 1.07–5.63) (P = 0.03). As the number of comorbidities increased, the risk of death increased in the total population, so that in patients with more than 4 underlying diseases, compared to the group without disease, the chance of death increased 6.33 times. Conclusion: This study showed that people with cancer and chronic respiratory disease had a higher chance of COVID-19 infection. People over the age of 60, people with cancer, and immunodeficiency also had a higher chance of COVID-19 mortalityW.
ABSTRACT
Background: The first confirmed case of COVID-19 in Iran was reported in February 2019. The current study aimed to investigate the epidemiological aspects of COVID-19 disease in Isfahan province and evaluate the chances of infection and death in the population. Materials and Methods: In this cross-sectional study, 21,203 confirmed cases of COVID-19, based on the polymerase chain reaction test, referred to outpatient facilities from February 2019 to July 2020 in Isfahan province are studied. Disease incidence, mortality, and case fatality rate, as well as odds ratio (OR) of infection and death, were calculated and analyzed using SPSS version 20. Results: The highest incidence of the disease was within the age group of 30-39 years 4911 (23.9%) and males 11,561 (54.5%). Mortality in people over 80 years (207 [32.9%]), men (370 cases [58.7%]), diabetics (182 cases [28.9%]), and people with cardiovascular disease (165 people [26.2%]) was more. In multivariate analysis, patients with a cancer diagnosis had the highest OR of death (OR = 4.03 confidence interval [CI]: 2.56-6.35) (P < 0.001), followed by those with immune deficiency disease (OR = 2.46 CI: 1.07-5.63) (P = 0.03). As the number of comorbidities increased, the risk of death increased in the total population, so that in patients with more than 4 underlying diseases, compared to the group without disease, the chance of death increased 6.33 times. Conclusion: This study showed that people with cancer and chronic respiratory disease had a higher chance of COVID-19 infection. People over the age of 60, people with cancer, and immunodeficiency also had a higher chance of COVID-19 mortalityW.
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Background: The Isfahan COVID Cohort (ICC) study was designed to investigate the short- and long-term consequences of patients with COVID-19 in Iran. This report presents the rationale, methodology, and initial results of ICC. Materials and Methods: ICC is a 5-year multicentric prospective cohort study that is ongoing on two groups including 5000 patients hospitalized with moderate or severe and 800 nonhospitalized patients with mild or asymptomatic COVID-19 in Isfahan. The ICC endpoints are morbidity, mortality, incident cases, or worsening of underlying noncommunicable diseases (NCDs) and their risk factors. In the current analysis, we examined the persistent symptoms and incident NCDs or risk factors in 819 previously hospitalized patients who completed 1-year follow-up. Results: The two most common symptoms were joint pain/myalgia (19.7%) and dry cough/dyspnea (18.7%). Around 60% of patients had at least one symptom which was more common among women than men and in middle aged than younger or older patients. Female (odds ratio [OR] =1.88, 95% confidence interval [CI]: 1.39-2.55) and highly-educated patients (OR = 2.18, 95% CI: 1.56-3.04) had higher risk of having any symptom in 1-year follow-up. New cases of hypertension followed by diabetes then coronary heart disease (CHD) were the most common incident NCDs. Conclusion: During 1-year follow-up after hospital discharge, about 60% of patients experienced persistent symptoms. Incident hypertension, diabetes, and CHD were the most common events seen. Close monitoring and extensive health services with integrative approaches are needed to improve the health status of these patients.
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Background: The first case of Covid-19 disease was identified in Iran on February 19, 2020, and spread rapidly throughout the country. The aim of this study was to investigate the characteristics of COVID-19 hospitalized patients in Isfahan province of Iran from February 29, 2020, to July 21, 2020, and evaluate the effect of health system screening on the final outcome patients. Methods: In this cross-sectional study, all patients with positive COVID-19 PCR test and patients with negative PCR test but suspected clinical symptoms of COVID 19, admitted to Isfahan hospitals from February 29 to July 21were included in the study and the epidemiological characteristics of patients such as demographic characteristics, underlying disease, early signs and symptoms and the final outcomes of patients were analyzed using SPSS software version 20. Results: Of 11817 inpatients with COVID-19, 6590 (55.9%) were male, 1222 (10.4%) died, 9759 (82.8%) were discharged, and 4324 (36.7%) of hospitalized patients were asymptomatic. Among the hospitalized patients, 4642 (35.8%) had received primary screening services, and the mean age of the screened patients was statistically significantly higher than the group without primary screening (58.9±20.61, 55.08±21.57, P=0.068). 6914 (64.6%) of hospitalized patients had a positive initial PCR test, which was statistically significantly higher in patients with diabetes and an early symptom of sore throat. The Odds Ratio (OR) of readmission was most significantly associated with underlying cancer (OR=3.05, CI 95% 1.31-7.1) (P=0.011). The rate of readmission was statistically significantly higher in elderly, rural residents, and patients with underlying disease, diabetic, and hypertensive patients (P<0.05). Conclusion: This study showed that about half of the people who tested positive for COVID- 19 needed to be hospitalized, and about 9 percent mostly diabetic and hypertensive patients, needed readmission. More than half of the hospitalized people were not screened by the health system. However, screening by the health system had no effect on the length of hospital stay and disease outcome.
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Background: COVID-19 pandemic placed immense pressure on health systems. The current study aimed to evaluate the symptoms of COVID-19 in Isfahan province and their association with disease outcome. Materials and Methods: In this cross-sectional study, which was conducted on patients with a definite diagnosis of COVID-19, as a part of the investigations performed by the Deputy for Public Health of the Isfahan University of Medical Sciences, the frequency of underlying diseases, and general, respiratory, gastrointestinal, neurological, renal, cardiac, dermal, hearing symptoms are assessed using a checklist. The participants were followed up 1 month after definitive diagnosis, and the outcome of the disease (recovery or death) was recorded. Results: Of 300 patients, 143 (47.4%) were male and 157 (52.6%) were female. The mean age of patients was 43 ± 17.84 years. Muscle pain and fatigue were the most common early symptoms (63% and 60.3%, respectively). Age, sex, level of education, and occupation of patients and general, respiratory, and gastrointestinal symptoms and underlying diseases of respiratory disease showed a statistically significant association with the disease outcome (P < 0.05). Conclusion: General, respiratory, and gastrointestinal symptoms were associated with an increased risk of death due to COVID-19. General, visual, and hearing symptoms, and diabetes, cardiovascular diseases, and respiratory disease had a statistically significant association with the hospitalization of patients.
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BACKGROUND: There are no data on the association between clinical course and comorbidity in Iranian patients with COVID-19. AIMS: To determine noncommunicable disease (NCD), clinical characteristics and prognosis of patients hospitalized with COVID-19 in Isfahan, Islamic Republic of Iran. METHODS: This multicentric retrospective observational study was performed on all patients hospitalized with COVID-19 in Isfahan from 17 February to 6 April 2020. We recruited 5055 patients. Data on clinical course and comorbid NCDs such as hypertension, coronary heart disease (CHD), diabetes mellitus (DM), cancer, chronic kidney disease (CKD) and chronic respiratory disease (CRD) were collected. Statistical analyses were done by Mann-Whitney U, χ2 and logistic regression tests using Stata version 14. RESULTS: DM and hypertension were the most prevalent comorbidities in patients with positive and negative reverse transcription polymerase chain reaction (RT-PCR). Odds ratio (95% confidence interval) of mortality-associated factors was significant for DM [1.35 (1.07-1.70)], CHD [1.58 (1.26-1.96)], CRD [2.18 (1.58-3.0)], and cancer [3.55 (2.42-5.21)]. These results remained significant for cancer after adjustment for age, sex and clinical factors. Among patients with positive RT-PCR, death was significantly associated with CRD and cancer, while this association disappeared after adjustment for all potential confounders. There was a significant association between NCDs and higher occurrence of low oxygen saturation, mechanical ventilation requirement and intensive care unit admission after adjustment for age and sex. CONCLUSION: The presence of NCDs alone did not increase mortality in patients with COVID-19, after adjustment for all potential confounders including clinical factors.