Associations of comorbidities and medications with COVID-19 outcome: A retrospective analysis of real-world evidence data

Background: Hundreds of thousands of deaths have already been recorded for patients with the severe acute respiratory syndrome coronavirus (SARS-CoV-2; aka COVID-19). Understanding whether there is a relationship between comorbidities and COVID-19 positivity will not only impact clinical decisions, it will also allow an understanding of how better to define the long-term complications in the groups at risk. In turn informing national policy on who may benefit from more stringent social distancing and shielding strategies. Furthermore, understanding the associations between medications and certain outcomes may also further our understanding of indicators of vulnerability in people with COVID-19 and co-morbidities. Methods: Electronic healthcare records (EHR) from two London hospitals were analysed between 1st January and 27th May 2020. 5294 patients presented to the hospitals in whom COVID status was formally assessed; 1253 were positive for COVID-19 and 4041 were negative. This dataset was analysed to identify associations between comorbidities and medications, separately and two outcomes: (1) presentation with a COVID-19 positive diagnosis, and (2) inpatient death following COVID-19 positive diagnosis. Medications were analysed in different time windows of prescription to differentiate between short-term and long-term medications. All analyses were done with controls (without co-morbidity) matched for age, sex, and number of admissions, and a robustness approach was conducted to only accept results that consistently appear when the analysis is repeated with different proportions of the data. Results: We observed higher COVID-19 positive presentation for patients with hypertension (1.7 [1.3-2.1]) and diabetes (1.6 [1.2-2.1]). We observed higher inpatient COVID-19 mortality for patients with hypertension (odds ratio 2.7 [95% CI 1.9-3.9]), diabetes (2.2 [1.4-3.5]), congestive heart failure (3.1 [1.5-6.4]), and renal disease (2.6 [1.4-5.1]). We also observed an association with reduced COVID-19 mortality for diabetic patients for whom anticoagulants (0.11 [0.03-0.50]), lipid-regulating drugs (0.15 [0.04-0.58]), penicillins (0.20 [0.06-0.63]), or biguanides (0.19 [0.05-0.70]) were administered within 21 days after their positive COVID-19 test with no evidence that they were on them before, and for hypertensive patients for whom anticoagulants (0.08 [0.02-0.35]), antiplatelet drugs (0.10 [0.02-0.59]), lipid-regulating drugs (0.15 [0.05-0.46]), penicillins (0.14 [0.05-0.45]), or angiotensin-converting enzyme inhibitors (ARBs) (0.06 [0.01-0.53]) were administered within 21 days post-COVID-19-positive testing with no evidence that they were on them before. Moreover, long-term antidiabetic drugs were associated with reduced COVID-19 mortality in diabetic patients (0.26 [0.10-0.67]). Conclusions: We provided real-world evidence for observed associations between COVID-19 outcomes and a number of comorbidities and medications. These results require further investigation and replication in other data sets.