Outcomes from COVID-19 across the range of frailty: excess mortality in fitter older people
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BRIEF REPORT
Outcomes from COVID‑19 across the range of frailty: excess mortality in fitter older people Amy Miles1 · Thomas E. Webb1 · Benjamin C. Mcloughlin1 · Imran Mannan1 · Arshad Rather1 · Paul Knopp1 · Daniel Davis1,2 Received: 22 May 2020 / Accepted: 2 July 2020 © The Author(s) 2020
Key summary points Aim To describe associations between frailty, ethnicity, socioeconomic position and mortality in a cohort of older patients presenting to hospital with COVID-19. Findings Frailty did not appear to be associated with mortality rates after COVID-19, though an interaction was evident indicating much larger excess mortality in fitter, compared with frailer patients. Message Frailty may not be a good measure of prognosis in COVID-19 and different mechanisms may underlie pathways to death depending on pre-morbid frailty. Abstract Purpose Our aim was to quantify the mortality from COVID-19 and identify any interactions with frailty and other demographic factors. Methods Hospitalised patients aged ≥ 70 were included, comparing COVID-19 cases with non-COVID-19 controls admitted over the same period. Frailty was prospectively measured and mortality ascertained through linkage with national and local statutory reports. Results In 217 COVID-19 cases and 160 controls, older age and South Asian ethnicity, though not socioeconomic position, were associated with higher mortality. For frailty, differences in effect size were evident between cases (HR 1.02, 95% CI 0.93–1.12) and controls (HR 1.99, 95% CI 1.46–2.72), with an interaction term (HR 0.51, 95% CI 0.37–0.71) in multivariable models. Conclusions Our findings suggest that (1) frailty is not a good discriminator of prognosis in COVID-19 and (2) pathways to mortality may differ in fitter compared with frailer older patients. Keywords COVID-19 · Frailty · Mortality · Epidemiology
Introduction
Amy Miles and Thomas E. Webb contributed equally. * Daniel Davis [email protected] 1
Department of Medicine for the Elderly, University College London Hospitals NHS Foundation Trust, London WC1E 7HB, UK
Department of Population Science and Experimental Medicine, MRC Unit for Lifelong Health and Ageing at UCL, 1‑19 Torrington Place, London, UK
2
While it is clear that mortality from SARS-CoV-2 infection (COVID-19) increases with age [1–3], the association between frailty and mortality is not well understood [4, 5]. This relationship has clinical implications as the National Institute for Health and Care Excellence (NICE) guidelines in England and Wales recommend the integration of a frailty assessment into algorithms used to guide decisions including admission to critical care [6]. Furthermore, other demographic factors relevant to mortality such as ethnicity or socioeconomic position have yet to be comprehensively described in relation to COVID-19 [7, 8].
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Our aim was to investigate the relationship between frailty, ethnicity, socioeconomic position and mortality in a cohort of older patients presenting to hospital with COV
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