CDC Study: Underlying Health Conditions Can Increase Risk of Severe COVID-19

Current evidence demonstrates that underlying health conditions can put people at risk for severe coronavirus disease 2019 (COVID-19). As more evidence becomes available, the list of underlying health conditions that are risk factors for COVID-19 complications (e.g. hospitalization, ICU admission, mechanical ventilation, death) continues to grow.^1,2

The CDC revised the list of conditions July 17, 2020 to include cancer as 1 of the risk factors for severe COVID-19.1 Individuals at any age with the following underlying medical conditions are at increased risk of severe COVID-19: cancer, chronic kidney disease, chronic obstructive pulmonary disease (COPD), immunocompromised state from solid organ transplant, obesity (body mass index of 30 or higher), serious cardiovascular conditions (e.g. heart failure, coronary artery disease, cardiomyopathies), sickle cell disease, and type 2 diabetes.¹

CDC Study and Implications

The CDC study estimated county-level prevalence of selected conditions (COPD, heart conditions, diabetes, chronic kidney disease, obesity) associated with severe COVID-19 illness among U.S. adults 18 years and older using survey information from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) and U.S. Census population data among residents in 3142 counties in all 50 states and the District of Columbia.2A total of 437,500 individuals participated in the 2018 BRFSS telephone survey. The study revealed that 40.7% of US adults had at least 1 of 5 underlying medical conditions that would put them at risk for severe COVID-19. Among 3142 counties, the median estimated county prevalence of individuals having any underlying health condition was 47.2%, with a range of 22%-66.2%. Counties with the highest prevalences of any condition were mostly in the Southeastern states, especially Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Tennessee, and West Virginia. Counties in Oklahoma, South Dakota, Texas, and northern Michigan also had high prevalences of underlying health conditions.²

This study provides important data on the high prevalence of underlying health conditions in the US that can be risk factors for COVID-19 complications. Offering a break down by county can also provide critical information for public health outreach and COVID-19 prevention measures. Limitations include that there is the possibility of inaccurate disease state information being self-reported.²

Sickle cell disease and solid organ transplant underlying medical conditions were not included in the BRFSS data, which may have underestimated the results.² Cancer was added to the CDC list of health conditions that are risk factors for severe COVID-19 after this study was conducted, so it was not included in the analysis.

Health Care professionals can play an important role in educating patients about lifestyle modifications including diet, exercise, and smoking cessation to reduce the prevalence of underlying health conditions and COVID-19 complications.2 Individuals with underlying health conditions should try to stay home if possible and avoid cruises and non-essential air travel.1 Mask wearing, frequent hand washing, and social distancing are extremely important if individuals must go to public places. Home delivery of medications, groceries, and other supplies can also help to protect this vulnerable population against COVID-19.¹

REFERENCES

• CDC. Coronavirus disease 2019 (COVID-19): People with certain medical conditions.https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html. Updated July 17, 2020. Accessed July 23, 2020.
• Razzaghi H, Wang Y, Lu H, et al. Estimated County-Level Prevalence of Selected Underlying Medical Conditions Associated with Increased Risk for Severe COVID-19 Illness — United States, 2018. MMWR Morb Mortal Wkly Rep 2020;69:945–950. doi: http://dx.doi.org/10.15585/mmwr.mm6929a1.