ABSTRACT
OBJECTIVE: Population-based clinical data on COVID-19 is scarce. This study analyzed distinct clinical characteristics of COVID-19 and relationships with lethality among adults. METHODS: Retrospective cohort that included all population >=50 years with a laboratory-confirmed COVID-19 in Tarragona, Spain, during 01/03/2020-30/06/2020. Treatment setting (outpatient/hospital/nursing-home), pre-existing comorbidities, signs/symptoms, clinical course, severity and lethality (death from any cause in-hospital or within the first 30-day after the diagnosis) were determined. Chi squared and Fisher's test were used to compare percentages. RESULTS: Of the 536 overall cases (mean age: 74 years;43.8% male), 150 (28%) were outpatient, 179 (33.4%) were hospitalised and 207 (38.6%) happened in nursing-home/social-health centres. The most prevalent symptoms were fever (57.9%), cough (49.8%), dyspnea (41.5%), general discomfort (36.2%), fatigue (24.4%), diarrhea (19.6%), myalgias (17.3%), headache (14.6%), confusion/lethargy (14.6%), thoracic pain (10%), anosmia (9.8%), disgeusia/ageusia (8.1%) and sore throat (7.7%). Global lethality was 23.1% (1.7% in 50-64 years vs 25.5% in 65-79 years vs 38.7% in >=80 years, p<0.001;26.8% in men vs 20.3% in women, p=0.075;3.3% in outpatient vs 29.6% in hospitalised vs 31.9% in nursing-home/social-health centres, p<0.001). By symptomatology, maximum lethality was observed among patients with confusion/lethargy (77.6%) and minimum among those with ageusia/disgeusia (4.8%), anosmia (3.9%) or myalgias (1.1%). By pre-existing comorbidities, greater lethality happened among patients with neurologic (36.7%), renal (35.4%) and cardiac disease (35.3%). CONCLUSIONS: There was a relatively great lethality of COVID-19 among the general population >=50 years across the first epidemic wave in the study setting. Increasing age, male sex, nursing-home residence and several signs/symptoms and comorbidities were associated with higher mortality.
ABSTRACT
OBJECTIVE: Population-based data on the current Covid-19 pandemic is scarce. This study investigated incidence and risk to suffer Covid-19 by baseline underlying conditions in people ≥50 years in Tarragona region across march-april 2020. METHODS: Population-based retrospective cohort study involving 79,071 adults ≥50 years-old in Tarragona region (Southern Catalonia, Spain). Cohort characteristics (age, sex, residence, vaccinations history and comorbidities) were established at baseline, and Covid-19 cases occurring between 01/03/2020-30/04/2020 were registered. Cox regression analysis calculating Hazard ratios (HRs) adjusted by age, sex and comorbidities was used to estimate risk for Covid-19. RESULTS: Across study period, 1,547 cohort members were PCR tested (22.6% positive) and 367 were presumptive cases without PCR tested. Considering PCR-confirmed Covid-19, incidence (per 100,000 persons-period) was 441 overall (248, 141, 424, 1,303 and 3,135 in 50-59, 60-69, 70-79, 80-89 and ≥90 years-old, respectively;380 in men and 497 in women;259 in community-dwelling and 10,571 in nursing-home). By comorbidities, maximum incidence emerged among persons with neurological disease (2,723), atrial fibrillation (1,348), chronic renal failure (1,050), cardiac disease (856), respiratory disease (798) and diabetes (706). Lower incidence appeared in rheumatic diseases (230) and smokers (180). In multivariable analysis focused on community-dwelling individuals (N=77,671), only cardiac disease (HR: 1.47;95% CI: 1.01-2.15;p=0.045) and respiratory disease (HR: 1.75;95% CI: 1.00-3.02;p=0.051) were associated with an increased risk, whereas smoking (HR:0.43;95% CI: 0.25-0.74;p=0.002) and influenza vaccinated (HR: 0.63;95% CI: 0.43-0.92;p=0.015) appeared associated with a decreased risk. CONCLUSIONS: Apart of increasing age and nursing-home residence, chronic respiratory and cardiac disease appear at increased risk for suffering covid19. This study investigated population-based incidence of Covid-19 infection by underlying conditions among adults ≥50 years in Tarragona (Southern Catalonia, Spain) across two first months pandemic period.