Older Age, Comorbidity Burden Contribute to COVID-19-Related Death in Veterans

coronavirus TEM
coronavirus TEM
Deaths related to SARS-CoV-2 infection appear to be highest in patients older than 50 years as well as in men and patients with higher comorbidity burden.

Deaths related to infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease 2019 (COVID-19), were highest in patients older than 50 years as well as in men and patients with higher comorbidity burden, according to study results published in JAMA Network Open.

The longitudinal study included 88,747 patients from the Department of Veterans Affairs (VA) national healthcare system who were tested for SARS-CoV-2 nucleic acid by polymerase chain reaction between February and May 2020. Patients were followed through June 2020. Approximately 11.4% (n=10,131) of the patients in this study tested positive for the virus. 

Electronic medical record data provided information on various adverse outcomes, including data on all-cause mortality. Baseline sociodemographic characteristics, comorbid conditions, symptoms, and laboratory test results were evaluated for associations with these adverse outcomes in time-to-event analyses.

The majority of veterans with SARS-CoV-2 positivity were men (91.0%). Additionally, patients who tested positive were significantly older than those who tested negative (mean age, 63.6 vs 61.6 years, respectively). Compared with negative test results, positive test results for SARS-CoV-2 were also more frequent in Black individuals (41.6% vs 24.6%), in those who met criteria for obesity (44.8% vs 40.2%), and in those who lived in states with high burden of COVID-19 (≥700 deaths/1 million residents: 31.8% vs 10.2%).

Furthermore, individuals who had a positive SARS-CoV-2 test result vs those who tested negative had significantly higher rates of 30-day hospitalization (30.4% vs 29.3%; adjusted hazard ratio [aHR], 1.13; 95% CI, 1.08-1.13), mechanical ventilation (6.7% vs 1.7%; aHR, 4.15; 95% CI, 3.74-4.61), and death (10.8% vs 2.4%; aHR, 4.44; 95% CI, 4.07-4.83). 

The majority of deaths in these patients occurred in those aged 50 years or older (63.4%) as well as those who were men (12.3%) and individuals who had a Charlson Comorbidity Index score of 1 or higher (11.1%).

Baseline characteristics associated with mortality in patients who tested positive included older age (≥80 years vs <50 years: aHR, 60.80; 95% CI, 29.67-124.61), living in a region with high COVID-19 disease burden (≥700 vs <130 deaths per 1 million residents: aHR, 1.21; 95% CI, 1.02-1.45), higher Charlson comorbidity index score (eg, ≥5 vs 0: aHR, 1.93; 95% CI, 1.54-2.42), fever (aHR, 1.51; 95% CI, 1.32-1.72), dyspnea (aHR, 1.78; 95% CI, 1.53-2.07), and abnormalities in aspartate aminotransferase (>89 U/L vs ≤25 U/L: aHR, 1.86; 95% CI, 1.35-2.57), creatinine (>3.80 mg/dL vs 0.98 mg/dL: aHR, 3.79; 95% CI, 2.62-5.48), and neutrophil to lymphocyte ratio (>12.70 vs ≤2.71: aHR, 2.88; 95% CI, 2.12-3.91). 

Study limitations included the predominantly male veteran cohort, the reliance on the International Classification of Diseases and Related Health Problems, Tenth Revision codes to identify comorbid conditions, and the inclusion of only patients who were tested within the VA system.

The researchers suggested that the recognition of risk factors for adverse outcomes of COVID-19, as identified in this study, represent “a preliminary step toward developing prognostic models that will allow for real-time identification of patients most and least likely to benefit from available interventions.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Ioannou GN, Locke E, Green P, et al. Risk factors for hospitalization, mechanical ventilation, or death among 10 131 US veterans with SARS-CoV-2 infection. JAMA Netw Open. Published online September 23, 2020. doi:10.1001/jamanetworkopen.2020.22310