Austrian National Public Health Institute/Gesundheit, Österreich GmbH, Stubenring 6, 1010, Vienna, Austria.
Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tirol, Austria.
Wien Klin Wochenschr. 2022 Dec;134(23-24):856-867. doi: 10.1007/s00508-022-02036-9. Epub 2022 May 24.
The protection of vulnerable populations is a central task in managing the Coronavirus disease 2019 (COVID-19) pandemic to avoid severe courses of COVID-19 and the risk of healthcare system capacity being exceeded. To identify factors of vulnerability in Austria, we assessed the impact of comorbidities on COVID-19 hospitalization, intensive care unit (ICU) admission, and hospital mortality.
A retrospective cohort study was performed including all patients with COVID-19 in the period February 2020 to December 2021 who had a previous inpatient stay in the period 2015-2019 in Austria. All patients with COVID-19 were matched to population controls on age, sex, and healthcare region. Multiple logistic regression was used to estimate adjusted odds ratios (OR) of included factors with 95% confidence intervals (CI).
Hemiplegia or paraplegia constitutes the highest risk factor for hospitalization (OR 1.61, 95% CI 1.44-1.79), followed by COPD (OR 1.48, 95% CI 1.43-1.53) and diabetes without complications (OR 1.41, 95% CI 1.37-1.46). The highest risk factors for ICU admission are renal diseases (OR 1.76, 95% CI 1.61-1.92), diabetes without complications (OR 1.57, 95% CI 1.46-1.69) and COPD (OR 1.53, 95% CI 1.41-1.66). Hemiplegia or paraplegia, renal disease and COPD constitute the highest risk factors for hospital mortality, with ORs of 1.5. Diabetes without complications constitutes a significantly higher risk factor for women with respect to all three endpoints.
We contribute to the literature by identifying sex-specific risk factors. In general, our results are consistent with the literature, particularly regarding diabetes as a risk factor for severe courses of COVID-19. Due to the observational nature of our data, caution is warranted regarding causal interpretation. Our results contribute to the protection of vulnerable populations and may be used for targeting further pharmaceutical interventions.
保护弱势群体是管理 2019 年冠状病毒病（COVID-19）大流行的一项核心任务，以避免 COVID-19 的严重病程和医疗保健系统能力过载的风险。为了确定奥地利的脆弱性因素，我们评估了合并症对 COVID-19 住院、重症监护病房（ICU）入院和医院死亡率的影响。
本研究回顾性队列研究纳入了 2020 年 2 月至 2021 年 12 月期间在奥地利有 COVID-19 病史的所有患者，这些患者在 2015 年至 2019 年期间曾有过住院治疗。所有 COVID-19 患者均按年龄、性别和医疗保健区域与人群对照相匹配。采用多因素逻辑回归估计纳入因素的调整比值比（OR）及其 95%置信区间（CI）。
偏瘫或截瘫是住院的最高风险因素（OR 1.61，95%CI 1.44-1.79），其次是 COPD（OR 1.48，95%CI 1.43-1.53）和无并发症的糖尿病（OR 1.41，95%CI 1.37-1.46）。ICU 入院的最高风险因素是肾脏疾病（OR 1.76，95%CI 1.61-1.92）、无并发症的糖尿病（OR 1.57，95%CI 1.46-1.69）和 COPD（OR 1.53，95%CI 1.41-1.66）。偏瘫或截瘫、肾脏疾病和 COPD 是医院死亡率的最高风险因素，OR 值为 1.5。无并发症的糖尿病对女性而言是所有三个终点的更高风险因素。
我们通过确定性别特异性风险因素为文献做出了贡献。总的来说，我们的结果与文献一致，特别是关于糖尿病是 COVID-19 严重病程的风险因素。由于我们的数据是观察性的，因此在因果解释方面需要谨慎。我们的结果有助于保护弱势群体，并可用于针对进一步的药物干预。
