Chronic Conditions as Risk Factors for COVID-19–Associated Hospitalization Among Adults, 2020–2023
Year: 2025
Type: article
Study design: Observational Study
Abstract: INTRODUCTION: Chronic conditions associated with COVID-19 hospitalization were identified early in the pandemic when underlying population immunity was low. Updated information on risk factors for COVID-19 hospitalization is needed. METHODS: Surveillance and cross-sectional survey data were combined to compare COVID-19 hospitalization rates in adults aged ≥18 years with and without 9 chronic conditions in 98 counties across 13 states. Hospitalization counts were obtained from the COVID-19-associated Hospitalization Surveillance Network. The adult population with and without chronic conditions was estimated from U.S. Census data and the Behavioral Risk Factor Surveillance System. Adjusted rate ratios were estimated using Poisson regression with Monte Carlo simulation, adjusting for age group, sex, and race and ethnicity. RESULTS: From October 2022 through September 2023 (2022-2023), COVID-19 hospitalization rates were greater among adults with chronic kidney disease (adjusted rate ratio [95% uncertainty interval]=4.5 [3.4-5.9]), diabetes (2.2 [1.7-2.8]), stroke (2.1 [1.5-2.9]), severe obesity (2.0 [1.5-2.8]), coronary artery disease (2.0 [1.5-2.5]), chronic obstructive pulmonary disease (1.9 [1.5-2.5]), smoking (1.5 [1.2-2.0]), and asthma (1.5 [1.1-2.0]) than among adults without a given condition. Nonsevere obesity was not associated with increased risk. Hospitalization rates were 18.0 times higher among adults aged ≥75 years than among those aged 18-49 years. Hospitalized adults in 2022-2023 were more likely to be aged ≥75 years or to have ≥3 chronic conditions than in earlier seasons (2020-2022). CONCLUSIONS: Of 9 chronic conditions assessed, 8 were associated with increased risk of COVID-19 hospitalization; risk varied by condition and age. Older age was the strongest risk factor. Findings can guide prevention and treatment by identifying populations at greatest risk of COVID-19 hospitalization.
Authors: Sarah Hamid, Gordana Derado, Huong Pham, Rebecca C. Woodruff, Michael Melgar, Jeremy L. Roland, Breanna Kawasaki, James Meek, Lucy S. Witt, Maya L. Monroe, Libby Reeg, Erica Martin, Jennifer E. Akpo, Grant Barney, Christina B. Felsen, Nancy Moran, Melissa Sutton, H. Keipp Talbot, Ashley Swain, Fiona P. Havers, Christopher A. Taylor
Institutions: Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Epidemic Intelligence Service, National Center for Chronic Disease Prevention and Health Promotion, Colorado Department of Public Health and Environment, Yale University, Emory University, Maryland Department of Health, Michigan Department of Health and Human Services, Minnesota Department of Health, New Mexico Department of Health, New York State Department of Health, University of Rochester Medicine, University of Rochester, Ohio Department of Health, Oregon Health Authority, Vanderbilt University Medical Center
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,300
Awards: G1308113280, G1936376703
OpenAlex ID: W4417507032