Associação entre comorbidade crônica autorrelatada, ocorrência de hospitalização e óbito em adultos diagnosticados com COVID-19

Abstract

Introduction: The novel coronavirus 2019 disease is an emergent infectious disease caused by the coronavirus that today represents one of the biggest challenges to the public and private health systems in the world. The previous existence of chronic systemic comorbidities in infected individuals have been associated with a higher clinic severity and higher mortality occurrence. Objective: To analyze the association between self-referred chronic comorbidities and the risk of hospitalization and death in individuals with the diagnosis of COVID-19. Material and Methods: This is a transversal, quantitative and analytic study. This is a cross-sectional, quantitative and analytical study. A census was carried out with adults of both sexes, aged 20 to 59 years with a positive diagnosis for COVID-19 treated at municipal health centers. Secondary data from the public electronic records from January 01 to December 21 2021 of the Telemonitoring System and Health Surveillance Information System of the municipality were used. The data collected were subjected to descriptive statistical analysis for frequency and percentages, bivariate analyzes between dependent and independent variables with Pearson's chi-square test and multiple analyzes with the post-hoc test proposed by MacDonald and Gardner. Results: There were 16,658 confirmed cases (male: 7,403 and female: 9,255), 15,907 (95.49%) were not hospitalized, 751 (4.50%) were hospitalized and 125 (0.75%) died after hospitalization. Mortality caused by the infection occurred in 135 (0.81%) of non-hospitalized individuals, of which 30.37% were male aged 50 to 59 years. Among the hospitalized individuals, 626 (83.36%) recovered and 125 (16.64%) died. Self-reported chronic comorbidity was identified in 1,549 (9.29%) adult individuals. The most frequent comorbidities were Diabetes (22.84%), followed by Obesity (20.78%) and cardiovascular disease/Systemic arterial hypertension (19.67%). Among recovered individuals diagnosed with COVID-19 (n=16,523), 1,501 (9.08%) self-reported a diagnosis of one comorbidity, 207 (1.25%) of two, and 27 (0.16%) of three. Of the hospitalized individuals, 187 (77.92%) reported one comorbidity, 43 (17.92%) two and 10 (4.17%) three. Of those who died from the disease (n=260), 48 (18.46%) self-reported the occurrence of a comorbidity, 14 (5.38%) of two and only four individuals (1.53%) self-reported the occurrence of three comorbidities. Comorbidities in general, CVD/SAH, DM and the presence of these two comorbidities were significantly associated with more severe clinical outcomes (p = 0.0001; p = 0.0001; p = 0.0001 and p =0.0001). Discussion: The findings evidenced show that the self-report of chronic comorbidity in individuals with COVID-19 is a determining factor for a higher risk of hospitalization and death in adults. The chance of a worse outcome increases as comorbidities are associated. A greater chance of hospitalization and death was noted in men, aged 50 to 59 years, who self-reported a diagnosis of chronic comorbidity. Conclusion: There was a statistically significant association between DM, CVD/SAH and co-occurrence of CVD/SAH and DM and hospitalization and death. The findings of this study corroborate the need to develop clinical care protocols for individuals with COVID-19 who have some chronic comorbidity in the public health system.