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A major new study of a million and a half adults who tested positive for Covid-19 in Ireland has revealed that age and underlying conditions were the greatest risk factors for ICU admissions and deaths.
For deaths, age was the overwhelming factor, with those who died having an average age of 75 years, compared to 59 years for hospital admissions.
Examination of pseudonymised data from the Central Statistics Office showed the average age of those who tested positive was 42, while 53 per cent were male.
The analysis covered all 1.4 million adult patients who tested positive with Covid-19 between April 2020 and December 2022, and were registered in the Computerised Infectious Disease Reporting system.
The findings mirror global trends, along with providing the most far-reaching national dataset to date on mortality drivers in the pandemic in Ireland.
The authors concluded: “This comprehensive study confirmed international findings associated with poor outcomes in Covid-19.
“Whilst clinical indications for ICU admission and overall mortality may differ in hospitalised patients, the main drivers of mortality are age, underlying conditions, and disease severity, irrespective of location.”
The community-wide study, led by University College Dublin researchers including Professors Cecily Kelleher and Patricia Fitzpatrick, found current and ex-smokers were more than twice as likely to be admitted to intensive care.
Men faced significantly higher risks – at 1.8 times more likely – than women of being admitted to intensive care, and people with underlying conditions were about 10 times more likely to end up in ICU.
One of the authors, Prof Kelleher said: “We found so strongly that age and underlying conditions were very important.
“When you’re looking at a population this size, this reinforces that this highly significant information.
“It’s certainly as big a study as has been undertaken in Ireland related to this Covid pandemic period. This is a national database.
“This was able to tell us that whilst many people contracted Covid, younger people didn’t have the same seriousness on average as older people did.
“The mean age was 42 for incidents of Covid, but the age for being admitted to hospital was 59, and the age of those who died was 75, so that really shows strongly that age is a very important driver of morbidity and mortality in Covid – it reinforces what we knew.”
The first case of Covid-19 in the Republic was reported on February 29, 2020. Severity varied from little or no symptoms to life-threatening pneumonia and death.
Of all the 1,408,249 Covid-19 patients in the study, 31,037 (2.2%) individuals required hospital admission, 4,432 individuals (0.31%) were admitted to an intensive care unit, and 10,855 (0.8%) people died due to Covid-19.
Overall, just over 8% had an underlying health condition, which included long-term illnesses such as asthma, cardiovascular disease, epilepsy, arthritis, and cancer.
The study found increasing age was a key factor associated with Covid death.
People with two or more metabolic diseases – such as high blood pressure, diabetes mellitus, and obesity – were about six times more likely to die, and 14 times more likely to be admitted to the ICU.
Published in the BMC Public Health journal, the study also stated: “Odds of death were also significantly increased in presence of an underlying condition but not when age was taken into account as an interaction term.”
Prof Kelleher said the findings on the 1.4 million cases show doctors were correct in their warnings during the pandemic. She added: “It’s very comprehensive that the messaging around age and underlying disease comorbidities was borne out in what we saw in this analysis, whether it was deaths overall or serious complications of being admitted to intensive care.
“From the point of view of what we learned about managing Covid-19 and what we need to do for the future, it is very clear that where you have a population of older people and those who are vulnerable, those must be protected from developing a condition like Covid-19. The most important thing about Covid was the development of the vaccination programme. Then, when you take into account that those older people were either in hospital or in long-stay care, that was a risky environment for contracting Covid. That, again, is a very important public health message.
“What I would take out of that is number one, we need to be very vigilant to ensure that older people are protected from risk. We need to particularly be sure that those who have significant medical conditions are protected.”
Prof Kelleher also pointed to lessons for public health, including the importance of supporting people to quit smoking and reducing obesity in the population. But she warned a future epidemic could have very different effects.
Prof Kelleher added: “I think the main take-home message for this was that Covid-19 was a very significant epidemic strongly associated with age and underlying disease.
“For a future epidemic, it might be a completely different virus, a completely different set of circumstances. So I don’t think it would be generalisable to a future scenario.”
She pointed out Covid remains a serious condition to contract, especially for those with risk factors for severe outcomes.
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