Comorbidities associated with mortality in 31,461 adults with COVID-19 in the United States: A federated electronic medical record analysis

Autoři: Stephanie L. Harrison aff001;  Elnara Fazio-Eynullayeva aff002;  Deirdre A. Lane aff001;  Paula Underhill aff004;  Gregory Y. H. Lip aff001
Působiště autorů: Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom aff001;  TriNetX, Inc., Cambridge, Massachusetts, United States of America aff002;  Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark aff003;  TriNetX, Inc., London, United Kingdom aff004
Vyšlo v časopise: Comorbidities associated with mortality in 31,461 adults with COVID-19 in the United States: A federated electronic medical record analysis. PLoS Med 17(9): e32767. doi:10.1371/journal.pmed.1003321
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003321



At the beginning of June 2020, there were nearly 7 million reported cases of coronavirus disease 2019 (COVID-19) worldwide and over 400,000 deaths in people with COVID-19. The objective of this study was to determine associations between comorbidities listed in the Charlson comorbidity index and mortality among patients in the United States with COVID-19.

Methods and findings

A retrospective cohort study of adults with COVID-19 from 24 healthcare organizations in the US was conducted. The study included adults aged 18–90 years with COVID-19 coded in their electronic medical records between January 20, 2020, and May 26, 2020. Results were also stratified by age groups (<50 years, 50–69 years, or 70–90 years). A total of 31,461 patients were included. Median age was 50 years (interquartile range [IQR], 35–63) and 54.5% (n = 17,155) were female. The most common comorbidities listed in the Charlson comorbidity index were chronic pulmonary disease (17.5%, n = 5,513) and diabetes mellitus (15.0%, n = 4,710). Multivariate logistic regression analyses showed older age (odds ratio [OR] per year 1.06; 95% confidence interval [CI] 1.06–1.07; p < 0.001), male sex (OR 1.75; 95% CI 1.55–1.98; p < 0.001), being black or African American compared to white (OR 1.50; 95% CI 1.31–1.71; p < 0.001), myocardial infarction (OR 1.97; 95% CI 1.64–2.35; p < 0.001), congestive heart failure (OR 1.42; 95% CI 1.21–1.67; p < 0.001), dementia (OR 1.29; 95% CI 1.07–1.56; p = 0.008), chronic pulmonary disease (OR 1.24; 95% CI 1.08–1.43; p = 0.003), mild liver disease (OR 1.26; 95% CI 1.00–1.59; p = 0.046), moderate/severe liver disease (OR 2.62; 95% CI 1.53–4.47; p < 0.001), renal disease (OR 2.13; 95% CI 1.84–2.46; p < 0.001), and metastatic solid tumor (OR 1.70; 95% CI 1.19–2.43; p = 0.004) were associated with higher odds of mortality with COVID-19. Older age, male sex, and being black or African American (compared to being white) remained significantly associated with higher odds of death in age-stratified analyses. There were differences in which comorbidities were significantly associated with mortality between age groups. Limitations include that the data were collected from the healthcare organization electronic medical record databases and some comorbidities may be underreported and ethnicity was unknown for 24% of participants. Deaths during an inpatient or outpatient visit at the participating healthcare organizations were recorded; however, deaths occurring outside of the hospital setting are not well captured.


Identifying patient characteristics and conditions associated with mortality with COVID-19 is important for hypothesis generating for clinical trials and to develop targeted intervention strategies.

Klíčová slova:

African American people – Age groups – COVID 19 – Electronic medical records – Ethnic epidemiology – Heart failure – Liver diseases – Myocardial infarction


1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. New Eng J Med. 2020;382(8): 727–33. doi: 10.1056/NEJMoa2001017 31978945

2. Holshue ML, DeBolt C, Lindquist S, Lofy KH, Wiesman J, Bruce H, et al. First Case of 2019 Novel Coronavirus in the United States. New Eng J Med. 2020;382(10): c929–36. doi: 10.1056/NEJMoa2001191 32004427

3. European Centre for Disease Prevention and Control. Situation update worldwide, as of 9 June 2020. Available from: [cited 2020 June 9]

4. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229): 1054–62. doi: 10.1016/S0140-6736(20)30566-3 32171076

5. Du R-H, Liang L-R, Yang C-Q, Wang W, Cao T-Z, Li M, et al. Predictors of Mortality for Patients with COVID-19 Pneumonia Caused by SARS-CoV-2: A Prospective Cohort Study. Eur Respir J. 2020;55(5): 2000524. doi: 10.1183/13993003.00524-2020 32269088

6. Verity R, Okell LC, Dorigatti I, Winskill P, Whittaker C, Imai N, et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis. 2020;20(6): 669–677. doi: 10.1016/S1473-3099(20)30243-7 32240634

7. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020. doi: 10.1001/jama.2020.6775 32320003

8. Yang X, Yu Y, Xu J, Shu H, Xia Ja, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;S2213-600(20) 30079–5. doi: 10.1016/S2213-2600(20)30079-5 32105632

9. Yancy CW. COVID-19 and African Americans. JAMA. 2020; 323(19): 1891–1892. doi: 10.1001/jama.2020.6548 32293639

10. Rimmer A. Covid-19: Two thirds of healthcare workers who have died were from ethnic minorities. BMJ. 2020;369: m1621. doi: 10.1136/bmj.m1621 32327412

11. Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, et al. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiology. 2020. doi: 10.1001/jamacardio.2020.0950 32211816

12. Henry BM, Lippi G. Chronic kidney disease is associated with severe coronavirus disease 2019 (COVID-19) infection. Int Urol Nephrol. 2020. doi: 10.1007/s11255-020-02451-9 32222883

13. Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci. 2004;59(3): 255–63. doi: 10.1093/gerona/59.3.m255 15031310

14. National Institute for Health and Care Excellence. COVID-19 rapid guideline: critical care in adults 2020. 2020 Apr 29 [cited 2020 May 4]. Available from:

15. Centers for Disease Control and Prevention. ICD-10-CM Official Coding Guidelines—Supplement Coding encounters related to COVID-19 Coronavirus Outbreak. 2020 Feb 20 [cited 2020 Jun 8]. Available from:

16. Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med care. 2005;43(11): 1130–9. doi: 10.1097/01.mlr.0000182534.19832.83 16224307

17. Singh B, Singh A, Ahmed A, Wilson GA, Pickering BW, Herasevich V, et al. Derivation and validation of automated electronic search strategies to extract Charlson comorbidities from electronic medical records. Mayo Clin Proc. 2012;87(9): 817–24. doi: 10.1016/j.mayocp.2012.04.015 22958988

18. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4): 344–9. doi: 10.1016/j.jclinepi.2007.11.008 18313558

19. Docherty AB, Harrison EM, Green CA, Hardwick HE, Pius R, Norman L, et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ. 2020;369:m1985. doi: 10.1136/bmj.m1985 32444460

20. Singh S, Khan A. Clinical Characteristics and Outcomes of COVID-19 Among Patients with Pre-Existing Liver Disease in United States: A Multi-Center Research Network Study. Gastroenterology. 2020;S0016-5085(20): 30585–0. doi: 10.1053/j.gastro.2020.04.064 32376408

21. Chong WF, Ding YY, Heng BH. A comparison of comorbidities obtained from hospital administrative data and medical charts in older patients with pneumonia. BMC Health Serv Res. 2011;11:105–. doi: 10.1186/1472-6963-11-105 21586172

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PLOS Medicine

2020 Číslo 9

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