Older Age is Strongest Risk Factor for Ventilation and Death among Veterans with COVID-19

January 28, 2021

Takeaway: Results of a study by VA HSR&D investigators that recently appeared in JAMA Network Open show that showed that older age is the strongest risk factor associated with mechanical ventilation and death among Veterans with COVID-19. Findings also indicate that some risk factors may be reversible or modifiable, thereby reducing the mortality rate of SARS-CoV-2, or they may provide clues as to the pathogenesis of severe, life-threatening SARS-CoV-2.

It remains unclear why some patients infected with SARS-CoV-2 develop the severe complications of coronavirus disease 2019 (COVID-19), which can result in death. This study sought to identify risk factors associated with hospitalization, mechanical ventilation, and death among patients with COVID-19 infection. Using VA data, investigators identified 88,747 Veterans who were tested within VA for COVID-19 between February 28 and May 14, 2020, 11% of whom (10,131) tested positive. Findings show:

• Veterans who tested positive were more likely to be Black (42% vs 25%), obese (45% vs 40%), and to live in states with a high burden of COVID-19 compared to Veterans who tested negative.
• Veterans who tested positive for COVID-19 had a 4.2-fold risk of mechanical ventilation and a 4.4-fold risk of death compared with Veterans who tested negative.
• Most COVID-19 deaths among Veterans in this study were attributed to being age 50 and older (64%), male sex (12%), and having greater comorbidity burden (11%). Many factors previously reported to be associated with mortality in smaller studies were not confirmed, including Black race, Hispanic ethnicity, COPD, hypertension, and smoking.

Impact

Some risk factors may be reversible or modifiable, thereby reducing the mortality rate of SARS-CoV-2, or they may provide clues as to the pathogenesis of severe, life-threatening SARS-CoV-2.

Ioannou G, Locke E, Green P, et al. Risk factors for hospitalization, mechanical ventilation, or death among 10,131 Veterans with SARS-CoV-2 infection. JAMA Network Open. September 23, 2020;3(9):e2022310.