COVID-19: mortality association with hypertension decreases with age

  • Williamson EJ & al.
  • Nature
  • 8 Jul 2020

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • Most COVID-19-related deaths among nonwhite populations are not attributable to existing comorbidities.
  • In COVID-19, the association of hypertension with mortality attenuates with age.

Why this matters

  • Education about prevention should target vulnerable at-risk populations about factors exacerbating poor COVID-19 outcomes, including smoking and obesity.

Key results

  • 17,278,392 adults.
  • COVID-19 deaths: 0.06% (10,926).
  • Mortality risk factors (adjusted HRs; 95% CIs):
    • Age ≥80 vs 50-59 years: 20.61 (18.72-22.70).
    • Male sex: 1.59 (1.53-1.65). 
    • Black African ancestry: 1.48 (1.30-1.69).
    • South Asian ancestry: 1.44 (1.32-1.58).
    • Most deprived quintile on index of multiple deprivation: 1.80 (1.69-1.91).
    • Obesity (BMI >40 kg/m2): 1.92 (1.72-2.13).
    • Smoking (adjusted for age, sex, deprivation, ethnicity): 1.07 (0.98-1.18).
  • Increased risk (adjusted HRs; 95% CIs) with hypertension persisted to age
    • 18 to
    • 40 to
    • 50 to
    • 60 to
    • 70 to
    • ≥80 years: 0.73 (0.69-0.78).

Study design

  • Retrospective analysis of pseudonymously linked National Health Service electronic health records of factors linked to COVID-19-related deaths. 
  • Funding: None.

Limitations

  • Case, mortality misclassifications. 
  • Limited generalizability.
  • Missing ethnicity, obesity, smoking confounders.