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Risk Factors for Severe COVID19 Disease

Risk factors for severe disease are older age, ethnicity, male gender, and the following comorbidities:

  • Hypertension
  • Diabetes
  • Coronary artery disease
  • Chronic pulmonary disease
  • Chronic kidney disease
  • Chronic liver disease
  • Cancer
  • Hematologic malignancy
  • Organ transplant
  • Immunosuppression

In New York City the rates of hospitalization were directly proportional to age.

Age Group Rate of Hospitalization
0 to 17 years 1 in 5534
18 to 44 years 1 in 538
45 to 64 years 1 in 136
65 to 74 years 1 in 69
75 years or older 1 in 44


People with heart disease, diabetes and other underlying health conditions are six times more likely to be hospitalized for COVID19 and twelve times more likely to die from the disease compared with COVID19 patients who had no preexisting conditions.

Among hospitalized patients, 33% have been Hispanic, 22% African American and 1.3% Native American or Alaska Native, even though these ethnic groups only account for 18%, 13% and less than 1% of the population, respectively.The reason that Hispanic and African Americans are at higher risk for developing severe COVID19 disease is more likely attributable to socioeconomic than biological factors. Human genomes from people across the world are more than 99.9 percent similar. Observed differences, with very few exceptions, are rarely sufficient to explain differences in diseases or outcomes.

A more likely explanation for differences in COVID19 severity in the United States is discrimination against people by skin color, ethnicity and social class. Examples include being essential workers, working in a job that demands close contact, relying on public transportation, and living in a multigenerational household in a small space because of unaffordable rent.

Hispanics and African Americans are less likely to have adequate health insurance and tend to seek treatment later in the course of an illness. They may also distrust the health care to which they have access. Record levels of incarceration have kept black people out of employment and ineligible for health insurance. Prolonged emotional stress caused by bigotry and racism weakens their immune system and increases the likelihood of the chronic diseases that are risk factors for developing severe COVID19 disease.


Zhou F, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395:1054-62.

Killerby ME, et al. Characteristics Associated with Hospitalization Among Patients with COVID-19 — Metropolitan Atlanta, Georgia, March–April 2020. MMWR Morb Mortal Wkly Rep. ePub: 17 June 2020. DOI: icon

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