Understanding COVID-19 Severity with Hospitalization and Mortality based off Age and Demographic


Exact estimates of hospitalization and fatality rates for SARS-CoV-2 are rare among populations without previous exposure, particularly within demographic subgroups.

Doctor helping COVID patients.

Doctor helping COVID patients.

Image credits: Unsplash

In a study conducted in the United States from May 1 to December 1, 2020, before vaccines became available, researchers aim to estimate rates among persons with SARS-CoV-2. This study found that both hospitalization and fatality rates generally increased with age. Fatality rates were highest for individuals over 85 years of age at 24%, while the lowest fatality rates were observed in children aged 1 to 14 years at 0.01%. Age-adjusted case hospitalization rates were highest among African American or Black, not Hispanic persons, at 14%, and case-fatality rates were highest among Asian or Pacific Islander, not Hispanic persons, at 4.4%.

Among hospitalized patients, 18% died, and among those admitted to an intensive care unit (ICU), 44.2% died. Male patients exhibited higher hospitalization (6.2% vs. 5.2%) and fatality rates (1.9% vs. 1.5%) compared to female patients.

“Age was a primary driver of SARS-CoV-2 hospitalization and death; rates had a U-shaped curve, being higher in infants, lowest in children 5 to 14 years of age, and highest among persons >65 years of age, confirming previous reports,” according to the investigators. “Other studies have identified older age and underlying medical conditions as risk factors for severe COVID-19 outcomes, including hospitalization, admission to an ICU, requiring mechanical ventilation, and death.”

Main Takeaways

  1. There is a significant impact of age and demographic factors on COVID-19 severity, with higher hospitalization and fatality rates observed among older individuals and certain racial/ethnic groups. This highlights the importance of tailored interventions for vulnerable populations.
  2. The findings emphasize the pressing need for targeted public health interventions to address disparities in COVID-19 outcomes. This includes initiatives aimed at reducing hospitalization and mortality rates among high-risk groups, such as older adults and specific racial/ethnic communities.
  3. The study highlights the critical role of robust surveillance data in informing effective public health responses. It calls for improvements in data collection methods and standardized reporting practices to ensure accurate analyses and guide future pandemic responses.

The researchers employed data analysis techniques to estimate hospitalization and fatality rates among persons with SARS-CoV-2 infection in the US during the specified time frame. They utilized demographic information and adjusted for age to analyze variations across different population groups.

“Fatality rates were lowest for children 1–14 years of age (0.01%), in keeping with previous reports,” according to the investigators. “We found that male persons had higher hospitalization rates than female persons except in the 15–24- and 25–34-year age groups, and that male persons, except infants, had higher fatality rates than female persons.”

The limitations stem from using data from only 21 jurisdictions for hospitalization rate calculations and 22 for fatality rate calculations, out of the 56 jurisdictions reporting to the CDC. While this selective inclusion strengthens the study by ensuring a high percentage of case reports contain valid, no missing hospitalization or death data, a notable portion lacks race and ethnicity information, hindering comprehensive analysis. Recommendations urge improved race and ethnicity reporting in surveillance data. The comparison of age-adjusted rates among racial and ethnic groups doesn't address variations in underlying disease prevalence. Testing focused on individuals seeking medical care, possibly missing cases with mild or no symptoms. Inconsistencies in death definitions across jurisdictions highlight the need for standardized definitions during a pandemic.

“Both unadjusted and age-adjusted hospitalization and fatality rates showed differences by race and ethnicity; the highest hospitalization rate was for the African American or Black, not Hispanic category, and the highest fatality rates were for the Asian or Pacific Islander and African American or Black, not Hispanic categories. We found that almost half of persons admitted to an ICU died, similar to studies of <400 persons conducted in Seattle (50%), Washington (52%), and New York City (78%),” according to the investigators.

In summary, this study highlights the critical role of surveillance data in informing effective public health responses, especially in addressing disparities among vulnerable populations. The identified variations in hospitalization and fatality rates underscore the urgent need for targeted interventions. Improving data collection methods and standardizing reporting practices are essential for accurate analyses during pandemics.

Griffin I, King J, Lyons B, et al. Estimates of SARS-CoV-2 Hospitalization and Fatality Rates in the Prevaccination Period, United States. Emerging Infectious Diseases. 2024;30(6):1144-1153. doi: 10.3201/eid3006.231285
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