What Factors Increase the Risk of Complications in SARS-CoV-2-Infected Patients? A Cohort Study in a Nationwide Israeli Health Organization

JMIR Public Health Surveill. 2020 Aug 25;6(3):e20872. doi: 10.2196/20872.


Background: Reliably identifying patients at increased risk for coronavirus disease (COVID-19) complications could guide clinical decisions, public health policies, and preparedness efforts. Multiple studies have attempted to characterize at-risk patients, using various data sources and methodologies. Most of these studies, however, explored condition-specific patient cohorts (eg, hospitalized patients) or had limited access to patients' medical history, thus, investigating related questions and, potentially, obtaining biased results.

Objective: This study aimed to identify factors associated with COVID-19 complications from the complete medical records of a nationally representative cohort of patients, with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Methods: We studied a cohort of all SARS-CoV-2-positive individuals, confirmed by polymerase chain reaction testing of either nasopharyngeal or saliva samples, in a nationwide health organization (covering 2.3 million individuals) and identified those who suffered from serious complications (ie, experienced moderate or severe symptoms of COVID-19, admitted to the intensive care unit, or died). We then compared the prevalence of pre-existing conditions, extracted from electronic health records, between complicated and noncomplicated COVID-19 patient cohorts to identify the conditions that significantly increase the risk of disease complications, in various age and sex strata.

Results: Of the 4353 SARS-CoV-2-positive individuals, 173 (4%) patients suffered from COVID-19 complications (all age ≥18 years). Our analysis suggests that cardiovascular and kidney diseases, obesity, and hypertension are significant risk factors for COVID-19 complications. It also indicates that depression (eg, males ≥65 years: odds ratio [OR] 2.94, 95% CI 1.55-5.58; P=.01) as well as cognitive and neurological disorders (eg, individuals ≥65 years old: OR 2.65, 95% CI 1.69-4.17; P<.001) are significant risk factors. Smoking and presence of respiratory diseases do not significantly increase the risk of complications.

Conclusions: Our analysis agrees with previous studies on multiple risk factors, including hypertension and obesity. It also finds depression as well as cognitive and neurological disorders, but not smoking and respiratory diseases, to be significantly associated with COVID-19 complications. Adjusting existing risk definitions following these observations may improve their accuracy and impact the global pandemic containment and recovery efforts.

Keywords: COVID-19; SARS-CoV-2; complications; risk factors.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • COVID-19
  • Cohort Studies
  • Coronavirus Infections / complications*
  • Coronavirus Infections / epidemiology
  • Female
  • Humans
  • Israel / epidemiology
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / epidemiology
  • Risk Factors
  • Young Adult