Population attributable fractions of underlying medical conditions for COVID-19 diagnosis and COVID-19 hospitalizations, ventilations, and deaths among adults in the United States

Abstract Background Several underlying medical conditions have been reported to be associated with an increased risk of COVID-19 disease, hospitalization, and death. Population attributable fractions (PAFs) describing the proportion of disease burden attributable to underlying medical conditions for COVID-19 diagnosis and outcomes have not been reported. Methods A retrospective population-based cohort study was conducted using Optum’s de-identified Clinformatics ® Data Mart database. Individuals were followed from January 20, 2020 – December 31, 2020 for diagnosis and clinical progression, including hospitalization, intensive care unit admission, intubation and mechanical ventilation or extracorporeal membrane oxygenation, and death. Adjusted rate ratios and PAFs of underlying medical conditions for COVID-19 diagnosis and disease progression outcomes were estimated by age (years; 18-49, 50-64, 65-74, ≥75), sex, and race/ethnicity. Results Of 10,679,566 cohort members, 391,964 (3.7%) were diagnosed with COVID-19, of whom 87,526 (22.3%) were hospitalized. Of those hospitalized, 26,640 (30.4%) died. Overall, cardiovascular disease and diabetes had the highest PAFs for COVID-19 diagnosis and outcomes of increasing severity across age groups (up to 0.49 and 0.35, respectively). Among adults ≥75, neurologic disease had the second highest PAFs (0.05‒0.27) after cardiovascular disease (0.26‒0.44). PAFs were generally higher in Black persons than in other race/ethnicity groups for the same conditions, particularly in the two younger age groups. Conclusions A substantial fraction of the COVID-19 disease burden in the US is attributable to cardiovascular disease and diabetes, highlighting the continued importance of COVID-19 prevention (e.g., vaccination, mask wearing, social distancing) and disease management of patients with certain underlying medical conditions.