Who is at risk of most severe outcomes from infection?

in #covid3 years ago

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https://www.nature.com/articles/s41586-020-2521-4

People want to ignore race on coronavirus risk, but even adjusting for many COVID comorbidities and social/material deprivation (social determinants of health) you get noticeable racial disparities on COVID mortality hazard ratios. It isn't as clean of a discussion as people make it. It is a relevant part of a holistic view of coronavirus risk.

(This dataset is from the UK, but similar findings for the US).

Be careful with the negative hazard ratios on smoking and hypertension. These are fully-adjusted HRs for the other covariates. Smoking in particular has not been seen as protective for coronavirus

For smoking they note in the study they did sensitivity analyses. The fully adjusted topline HR for current smokers shouldn't be overinterpreted as controlling for COPD (which smoking causes) mediates the risk. When they just adjusted for age, sex, deprivation, and race, smoking has a non-significant positive HR. So they conclude that smoking is unlikely to be protective, but likely isn't a huge added risk factor.

For hypertension there could definitely be more confounds. Like some pharmaceutical effect or health-seeking correlation. They did a sensitivity analysis that was just age and sex that was 1.09 HR point estimate statistically significant. With obesity and diabetes mediating the adjusted HR.

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