Age differences in clinical features and outcomes in patients with COVID-19, Jiangsu, China: a retrospective, multicentre cohort study

BMJ Open. 2020 Oct 5;10(10):e039887. doi: 10.1136/bmjopen-2020-039887.

Abstract

Objectives: To determine the age-specific clinical presentations and incidence of adverse outcomes among patients with COVID-19 in Jiangsu, China.

Design and setting: Retrospective, multicentre cohort study performed at 24 hospitals in Jiangsu, China.

Participants: 625 patients with COVID-19 enrolled between 10 January and 15 March 2020.

Results: Of the 625 patients (median age, 46 years; 329 (52.6%) men), 37 (5.9%) were children (18 years or younger), 261 (41.8%) young adults (19-44 years), 248 (39.7%) middle-aged adults (45-64 years) and 79 (12.6%) elderly adults (65 years or older). The incidence of hypertension, coronary heart disease, chronic obstructive pulmonary disease and diabetes comorbidities increased with age (trend test, p<0.0001, p=0.0003, p<0.0001 and p<0.0001, respectively). Fever, cough and shortness of breath occurred more commonly among older patients, especially the elderly, compared with children (χ2 test, p=0.0008, 0.0146 and 0.0282, respectively). The quadrant score and pulmonary opacity score increased with age (trend test, both p<0.0001). Older patients had many significantly different laboratory parameters from younger patients. Elderly patients had the highest proportion of severe or critically-ill cases (33.0%, χ2 test p<0.0001), intensive care unit use (35.4%, χ2 test p<0.0001), respiratory failure (31.6%, χ2 test p<0.0001) and the longest hospital stay (median 21 days, Kruskal-Wallis test p<0.0001).

Conclusions: Elderly (≥65 years) patients with COVID-19 had the highest risk of severe or critical illness, intensive care use, respiratory failure and the longest hospital stay, which may be due partly to their having a higher incidence of comorbidities and poor immune responses to COVID-19.

Keywords: epidemiology; infectious diseases; public health.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Age Factors*
  • Aged
  • Betacoronavirus / isolation & purification
  • COVID-19
  • China / epidemiology
  • Cohort Studies
  • Comorbidity
  • Coronavirus Infections* / diagnosis
  • Coronavirus Infections* / epidemiology
  • Coronavirus Infections* / physiopathology
  • Critical Care* / methods
  • Critical Care* / statistics & numerical data
  • Critical Illness / epidemiology
  • Female
  • Humans
  • Lung / diagnostic imaging*
  • Male
  • Middle Aged
  • Pandemics*
  • Pneumonia, Viral* / diagnosis
  • Pneumonia, Viral* / epidemiology
  • Pneumonia, Viral* / physiopathology
  • Retrospective Studies
  • Risk Assessment
  • SARS-CoV-2
  • Severity of Illness Index
  • Symptom Assessment* / methods
  • Symptom Assessment* / statistics & numerical data