Impact of dementia, living in a long-term care facility, and physical activity status on COVID-19 severity in older adults
Background: Japan is fast becoming an extremely aged society and older adults are known to be at risk of severe COVID-19. However, the impact of risk factors specific to this population for severe COVID-19 caused by the Omicron variant of concern (VOC) are not yet clear.
Methods: We performed an exploratory analysis using logistic regression to identify risk factors for severe COVID-19 illness among 4,868 older adults with a positive SARS-CoV-2 test result who were admitted to a healthcare facility between 1 January 2022 and 16 May 2022. We then conducted one-to-one propensity score (PS) matching for three factors-dementia, admission from a long-term care facility, and poor physical activity status-and used Fisher's exact test to compare the proportion of severe COVID-19 cases in the matched data. We also estimated the average treatment effect on treated (ATT) in each PS matching analysis. Results: Of the 4,868 cases analyzed, 1,380 were severe. Logistic regression analysis showed that age, male sex, cardiovascular disease, cerebrovascular disease, chronic lung disease, renal failure and/or dialysis, physician-diagnosed obesity, admission from a long-term care facility, and poor physical activity status were risk factors for severe disease. Vaccination and dementia were identified as factors associated with non-severe illness. The ATT for dementia, admission from a long-term care facility, and poor . physical activity status was −0.04 (95% confidence interval −0.07, −0.01), 0.09 (0.06, 0.12), and 0.17 (0.14, 0.19), respectively.
Conclusions: Our results suggest that poor physical activity status and living in a long-term care facility have a substantial impact on the risk of severe COVID-19 caused by the Omicron VOC, while dementia might be associated with non-severe illness. .
Ethics approval . Our study data were provided by Research Electronic Data Capture, a secure, Web-based data capture application hosted at the JCRAC Data Center of the National Center for Global Health and Medicine. The opt-out recruitment method was applied, and informed consents for individuals were waived, as approved by the National Center for Global Health and Medicine Ethics Review Board. Information about the entire research is available through the COVID-19 Registry Japan website (https://covid-registry.ncgm.go.jp/). This study was approved by the National Center for Global Health and Medicine Ethics Review Board (approval number: NCGM-G-003494-0).
Conflict of interest statement All authors have no conflicts of interest to be disclosed.
Authors' contributions ST and NO conceived the study. TA curated the data. ST and TA analyzed and interpreted the data. ST wrote the first draft of the manuscript. All authors critically reviewed the manuscript and approved the final version. .
Asai, Nomoto, Hayakawa, Matsunaga, Tsuzuki et al., Comorbidities as Risk Factors for Severe Disease in Hospitalized Elderly . COVID-19 Patients by Different Age-Groups in Japan
Booth, Reed, Ponzo, Yassaee, Aral et al., Population risk factors for severe disease and mortality in COVID-19: A global systematic review and meta-analysis, PLOS ONE
Bouzid, Visseaux, Kassasseya, Daoud, Fémy et al., Comparison of Patients Infected With Delta Versus Omicron COVID-19 Variants Presenting to Paris Emergency Departments, Annals of Internal Medicine, doi:10.7326/m22-0308
Cdc, Coronavirus Disease
Chen, Bai, Liu, Chen, Liao et al., Distinct Clinical Characteristics and Risk Factors for Mortality in Female Inpatients With Coronavirus Disease 2019 (COVID-19): A Sex-stratified, Large-scale Cohort Study in Wuhan, China, Clin Infect Dis
Chen, Zhou, Dong, Qu, Gong et al., Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study, The Lancet
Core, R: A Language and Environment for Statistical Computing
Dagan, Barda, Kepten, Miron, Perchik et al., BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Mass Vaccination Setting, New England Journal of Medicine
Gier B De, Andeweg, Joosten, Schegget R Ter, Smorenburg et al., Vaccine effectiveness against SARS-CoV-2 transmission and infections among household and other close contacts of confirmed cases, the Netherlands, February to, Eurosurveillance
Guan, Ni, Hu, Liang, Ou et al., Clinical Characteristics of Coronavirus Disease 2019 in China, N Engl J Med
Huang, Wang, Li, Ren, Zhao et al., Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China, The Lancet
July, Pranata, Prevalence of dementia and its impact on mortality in patients with coronavirus disease 2019: A systematic review and meta analysis, Geriatrics & Gerontology International
Kim, Chang, Kim, Min, Yoo et al., The Association of Pre-existing Diagnoses of Alzheimer's Disease and Parkinson's Disease and Coronavirus Disease 2019 Infection, Severity and Mortality: Results From the Korean National Health Insurance Database, Front Aging Neurosci
Lauring, Tenforde, Chappell, Gaglani, Ginde et al., variants in the United States: prospective observational study
Matsunaga, Hayakawa, Asai, Tsuzuki, Terada et al., Clinical characteristics of the first three waves of hospitalised patients with COVID-19 in Japan prior to the widespread use of vaccination: a nationwide observational study, The Lancet Regional Health -Western Pacific
Matsunaga, Hayakawa, Terada, Ohtsu, Asai et al., Clinical epidemiology of hospitalized patients with COVID-19 in Japan: Report of the COVID-19 REGISTRY JAPAN, Clin Infect Dis, doi:10.1093/cid/ciaa1470
Miyashita, Yamada, Mikami, Miyashita, Chopra et al., Impact of dementia on clinical outcomes in elderly patients with coronavirus 2019 ( COVID 19): an experience in New York, Geriatrics & Gerontology International
Modes, Directo, Melgar, Johnson, Yang et al., Clinical Characteristics and Outcomes Among Adults Hospitalized with, MMWR Morbidity and Mortality Weekly Report
Nozaki, Miyano, The necessity of continuous international cooperation for establishing the coronavirus disease 2019 diagnostic capacity despite the challenges of fighting the outbreak in home countries, GHM
Polack, Thomas, Kitchin, Absalon, Gurtman et al., Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine, New England Journal of Medicine, doi:10.1056/NEJMoa2034577
Rosenbaum, Db, The central role of the propensity score in observational studies for causal effects
Steenkamp, Saggers, Bandini, Stranges, Choi et al., Small steps, strong shield: directly measured, moderate physical activity in 65 361 adults is associated with significant protective effects from severe COVID-19 outcomes, British Journal of Sports Medicine
Terada, Ohtsu, Saito, Hayakawa, Tsuzuki et al., Risk factors for severity on admission and the disease progression during hospitalisation in a large cohort of patients with COVID-19 in Japan, BMJ Open
Vlachogiannis, Baker, Georgiopoulos, Lazaridis, Loeff et al., Clinical frailty, and not features of acute infection, is associated with late mortality in COVID 19: a retrospective cohort study, Journal of Cachexia, Sarcopenia and Muscle, doi:10.1002/jcsm.12966
Wang, Davis, Gurney, Xu, COVID 19 and dementia: Analyses of risk, disparity, and outcomes from electronic health records in the US. Alzheimer's & Dementia
Watkins, Mitruka, Dorough, Bressler, Kugeler et al., Characteristics of Reported Deaths Among Fully Vaccinated Persons With Coronavirus Disease 2019-United States, Clinical Infectious Diseases, doi:10.1093/cid/ciac066