key: cord-1037166-a9lw6vrs authors: Adams, Mary L; Katz, David L; Grandpre, Joseph title: Population based estimates of comorbidities affecting risk for complications from COVID-19 in the US date: 2020-04-02 journal: nan DOI: 10.1101/2020.03.30.20043919 sha: 395602934e0de622a2aa6d31a73bd9abdcf68bf2 doc_id: 1037166 cord_uid: a9lw6vrs We used 2017 Behavioral Risk Factor Surveillance System (BRFSS) data (N=444,649) to estimate the proportion of US adults who report comorbidities that suggest heightened risk of complications from COVID-19. Co-morbidities included cardiovascular disease, chronic obstructive pulmonary disease (COPD), diabetes, asthma, hypertension, and/or cancer other than skin, based on data from China. Overall 45.4% (95% CI 45.1-45.7) of adults reported any of the 6 comorbidities, increasing from 19.8% (19.1-20.4) for ages 18-29 years to 80.7% (79.5-81.8) for ages 80+ years. State rates ranged from 37.3% (36.2-38.5) in Utah to 58.7% (57.0-60.4) in West Virginia. Rates also varied by race/ethnicity, health insurance status, and employment. Excluded were residents of nursing homes or assisted living facilities. Although almost certainly an underestimate of all adults at risk due to these exclusions, these results should help in estimating healthcare needs for adults with COVID-19 complications living in the community. Since COVID-19 was discovered in China in late 2019, cases have spread far and wide and 38 are putting a strain on healthcare systems in many countries. Data from China indicate that while 39 81% of patients had mild cases, 14% of cases were severe and 5% were critical. (1, 2) . The 40 overall case fatality rate (CFR) in China for 55,924 confirmed cases was 3.8% (3) with 41 increased rates in adults with comorbid conditions including cardiovascular disease (CVD; 42 CFR=13.2%, diabetes (9.2%), chronic respiratory disease (8.0%), hypertension (8.4%), and 43 cancer (7.6%); the case fatality rate for those with none of these comorbid conditions was 1.4% (3). Our objective for this study was to use population based US data to estimate the 45 approximate fraction of adults in the community who might be at heightened risk for 46 complications from COVID-19 because they reported one of the 6 chronic conditions with high 47 CFR in China. in each state by age, gender, race/ethnicity, marital status, education, home ownership, and 57 telephone type and included weights and stratum variables needed for analysis. The median 58 All rights reserved. No reuse allowed without permission. author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint (which was not peer-reviewed) is the The key variable was a composite measure including adults reporting they were ever told 67 they had cardiovascular disease (CVD: a heart attack, angina, coronary heart disease, or a 68 stroke), diabetes, current asthma (included as a chronic respiratory disease (2)), chronic 69 obstructive pulmonary disease (COPD), hypertension, and/ or cancer other than skin. The author/funder, who has granted medRxiv a license to display the preprint in perpetuity. We also used available case fatality rates from China (3) to estimate the fraction of adults 93 in that country with any of the 6 comorbid conditions. We used the formula below and different 94 estimates of the CFR for adults with at least one of the comorbid conditions, ranging from 7.6% -95 13.2%, including 9.28% which was the average, and 8.4% which is the rate for hypertension, the 96 most prevalent comorbid condition (3); 1.4% was the CFR for those with none of the 6 and 3.8% author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint (which was not peer-reviewed) is the West Virginia. Rates also varied by self-reported race/ethnicity, health insurance status, and 116 employment, but not by gender (Table 1) . State results presented in Table 2 list the number of adults in each state at increased risk of 118 complications and the percentage that number represents among all US adults who report at least 119 one of the co-morbidities. These results were obtained directly from Stata which takes into 120 account the complex sample design so will not agree with results obtained by simply dividing the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. We found that 45.4% of US adults, with a wide range across age groups and states, may be 130 at heightened risk of complications from COVID-19 due to existing comorbid conditions. And 131 while the rates increase with age group to about 80% among those ages 70 and older, due to the 132 fact that the majority (71%) of US adults is younger than age 60, 53% of those at heightened risk 133 of complications are also younger than age 60 years. That is consistent with the finding that 134 >60% of adults with multiple (2 or more) chronic conditions were younger than age 65 (7). Many of these younger adults with comorbid conditions may require hospitalization for these 136 complications. Results in Tables 1 and 2 may be helpful to localities planning healthcare system 137 needs for COVID-19. The median value of having any of the co-morbidities for all states is 138 45.3, for planning purposes, states with rates in Table 1 that are above 45.3 might require 139 proportionally more ICU beds and ventilators than those with rates below 45.3. Currently there is a dearth of data on adults at risk for complications from COVID-19 that 141 can be used for comparison. One source is a recent report from the Kaiser Foundation (8) that 142 found 41% of US adults at risk of serious illness from COVID-19, defined as all adults ages 60 143 and older and those 18-59 years with heart disease, cancer, COPD, or diabetes. Note that 144 hypertension, which is the most common comorbid condition, was omitted in that study (8). 145 All rights reserved. No reuse allowed without permission. author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint (which was not peer-reviewed) is the . https://doi.org/10.1101/2020.03.30.20043919 doi: medRxiv preprint 8 From our own estimates of the fraction of adults in China with any of the 6 comorbid conditions, 146 we estimated that fraction as likely between 30.5% and 34% of all adults based on the average 147 case fatality rate or that of the most prevalent condition, and within the range of 20.3-38.7%. From these few comparisons, it appears that the percentage of US adults with comorbid 149 conditions increasing their risk of complications from COVID-19 is even higher than that in author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint (which was not peer-reviewed) is the . https://doi.org/10.1101/2020.03.30.20043919 doi: medRxiv preprint Results showing seasonal flu vaccination rates below 50%, even for those with any of the 6 168 chronic conditions that increase risk of complication from COVID-19, are concerning. Although 169 a vaccine specific for this coronavirus is currently unavailable, results for seasonal flu 170 vaccination suggest that it may not be widely used. It is encouraging that those with any of the 6 171 co-morbidities appear more likely to be vaccinated for seasonal influenza than those with none. author/funder, who has granted medRxiv a license to display the preprint in perpetuity. author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint (which was not peer-reviewed) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint (which was not peer-reviewed) is the . https://doi.org/10.1101/2020.03.30.20043919 doi: medRxiv preprint author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. author/funder, who has granted medRxiv a license to display the preprint in perpetuity. author/funder, who has granted medRxiv a license to display the preprint in perpetuity. author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint (which was not peer-reviewed) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint (which was not peer-reviewed) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint (which was not peer-reviewed) is the . https://doi.org/10.1101/2020.03.30.20043919 doi: medRxiv preprint Characteristics of and important lessons from the coronavirus 198 disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from 199 the Chinese Center for Disease Control and Prevention The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases 202 (COVID-19) -China CCDC Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) 204 [Pdf] -World Health Organization Behavioral Risk Factor Surveillance System (BRFSS) Survey Data and Documentation Behavioral Risk Factor Surveillance System A systematic review of publications assessing reliability 213 and validity of the Behavioral Risk Factor Surveillance System (BRFSS Differences Between Younger and Older US Adults With Multiple Chronic 216 All rights reserved. No reuse allowed without permission author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint (which was not peer-reviewed) is the