A total of 3072 patients, meeting the inclusion and exclusion criteria and confirmed positive for Covid19 by the reverse-transcriptase polymerase chain reaction (RT-PCR) constituted the study population. More than half (1630/3072, 53%) of the patients were in the age group between 31–50 years (Table 1), followed by older patients above 51 years of age (966/3072, 31.5%). Less than one-fifth of the total Covid19 patients were females (659/3072, 21.5%), the majority being male patients (table). Covid19 was widespread among the Asian population (2187/3072, 71.2%), followed by Middle Eastern Arabs (716/3072, 23.3%). Patients with social habits, irrespective of the social habit were more likely for Covid19 infection (1712/3072, 85.8%), compared to those without any social habit (Table 1).
Table 1
Demographics of Adult Covid19 Patients Admitted to the Public Hospitals in Al Ain, the Eastern Region of the United Arab Emirates
Characteristics
|
Category
|
n
|
%
|
Age (Years)
|
18–30
|
476
|
15.5
|
31–50
|
1630
|
53.1
|
51–65
|
770
|
25.1
|
> 66
|
196
|
6.4
|
Gender
|
Male
|
2413
|
78.5
|
Female
|
659
|
21.5
|
Nationality
|
Asian
|
2187
|
71.2
|
Middle East
|
716
|
23.3
|
Others
|
167
|
5.4
|
Social Habit
|
Some Habit
|
1712
|
85.8
|
No Habit
|
283
|
14.2
|
Diabetes Mellitus was the most predominant comorbidity observed among adult Covid19 patients, more than one quarter of the patients presented with Diabetes Mellitus (792/3072, 26.8%) (Fig. 1). Hypertension (759/3072, 25.7%) was the second most common comorbidity among Covid19 patients, followed by heart disease including patients with dyslipidemia (283/3072, 9.6%). Respiratory (130/3072, 4.4%) Kidney (112/3072, 3.8%), Obesity (102/3072, 3.4%), Immunocompromised (80/3072, 2.7%), diseases were below five percent for Covid19 patients. Hematological and Liver diseases were not common, less than one percent of the patients (Fig. 1).
Subgroup analysis of the data indicated a statistically significant (p < 0.001) positive association between age and survival. Higher age enhanced mortality rate. The mortality rate was less than 0.5% for the Covid19 patients in the age group of 18–30 Years. Between 31–50 years, the death rate was less than 2% and escalated to 5.7% and 13.5%, for the older age group of 51–65 years and 66 + years, respectively (Table 2). Statistically significant association was not observed for the disease outcomes either for the gender differences and for patients with some social habits (Table 2). In contrast, despite the large number of Asian patients who contracted Covid19 infection (2080/3072, 97.4%), the mortality rate was low at 2.6%, compared to statistically significant (P < 0.005) higher mortality in the Middle Eastern Arab (4.6%) and other’s (immigrants from the America’s, Europe and Africa, 6.3%, Table 2).
Table 2
Association between Patient Characteristics and Survival of Adult Covid19 Patients Admitted to the Public Hospitals in Al Ain, the Eastern Region of the United Arab Emirates
Characteristics
|
Category
|
Outcome
|
P
|
Survival
|
Deceased
|
n
|
%
|
n
|
%
|
Age (Years)
|
18–30
|
462
|
99.6
|
2
|
0.4
|
< 0.001
|
31–50
|
1566
|
98.4
|
25
|
1.6
|
51–65
|
706
|
94.3
|
43
|
5.7
|
> 66
|
160
|
86.5
|
25
|
13.5
|
Gender
|
Male
|
2273
|
96.7
|
77
|
3.3
|
Not Significant
|
Female
|
621
|
97.2
|
18
|
2.8
|
Nationality
|
Asian
|
2080
|
97.4
|
55
|
2.6
|
< 0.005
|
Middle East Arab
|
665
|
95.7
|
30
|
4.3
|
Others
|
149
|
93.7
|
10
|
6.3
|
Social Habit
|
Some Habit
|
1638
|
97.4
|
44
|
2.6
|
Not Significant
|
No Habit
|
249
|
97.6
|
6
|
2.4
|
Further, subgroup analysis of the association between the patient comorbidities and disease outcome yielded interesting results. Kidney disease as a comorbidity for adult Covid19 patients was found to be detrimental for survival. The mortality rate was almost eight-fold high (19.4%) and statistically significant (p < 0.001), as compared to other Covid19 infected patients without kidney disease (2.4%) (Table 3). Comorbidities such as heart disease (p < 0.01), hypertension (p < 0.001), and diabetes mellitus (p < 0.001), escalated mortality significantly by 2–3 fold, as compared to the patients without these comorbidities (Table 3). Other associated comorbidities such as respiratory, hematological, liver diseases, and immunocompromising disease and obesity did not significantly impact Covid19 adult patients survived when compared with other Covid19 patients without these comorbidities (Table 3).
Table 3
Assessment of Association between Patient Comorbidities and Survival for Adult Covid19 Patients Admitted to the Public Hospitals in Al Ain, the Eastern Region of the United Arab Emirates
Comorbidity
|
Category
|
Outcome
|
P Value
|
Survived
|
Deceased
|
n
|
%
|
n
|
%
|
Kidney disease
|
No
|
2716
|
97.6
|
68
|
2.4
|
< 0.001
|
Yes
|
83
|
80.6
|
20
|
19.4
|
Heart disease/Dyslipidemia
|
No
|
2546
|
97.2
|
73
|
2.8
|
< 0.01
|
|
Yes
|
253
|
94.4
|
15
|
5.6
|
|
Diabetes Mellitus
|
No
|
2069
|
97.9
|
45
|
2.1
|
< 0.001
|
|
Yes
|
730
|
94.4
|
43
|
5.6
|
|
Hypertension
|
No
|
2100
|
97.6
|
52
|
2.4
|
< 0.001
|
Yes
|
699
|
95.1
|
36
|
4.9
|
Respiratory disease
|
No
|
2681
|
97.1
|
81
|
2.9
|
Not Significant
|
Yes
|
118
|
94.4
|
7
|
5.6
|
Hematology
|
No
|
2781
|
97
|
87
|
3
|
Not Significant
|
Yes
|
18
|
94.7
|
1
|
5.3
|
Immunocompromised
|
No
|
2727
|
97
|
83
|
3
|
Not Significant
|
Yes
|
72
|
93.5
|
5
|
6.5
|
Liver Disease
|
No
|
2792
|
97
|
87
|
3
|
Not Significant
|
Yes
|
7
|
87.5
|
1
|
12.5
|
Obesity
|
No
|
2706
|
97
|
83
|
3
|
Not Significant
|
Yes
|
93
|
94.9
|
5
|
5.1
|
In order to predict the association between critical patient characteristics and comorbidity, against mortality, the Odds Ratio was estimated. Patient age and nationality were chosen for patient characteristics and, the comorbidities identified included heart disease/dyslipidemia, hypertension, kidney disease, and patients with diabetes mellitus. Higher age of Covid19 patients between 51 and 65 years, significantly decreased the odds for survival (Crude OR 14.1, Confidence Interval 3.4–58.4, p < 0.001) and (Adjusted OR 12.3, Confidence Interval 2.9–52.4, p < 0.001), and patient age beyond 66 years, further significantly decreased the odds for survival (Crude OR 36.1, Confidence Interval 8.5-154.1, P,0.001) and (Adjusted OR 26.6, Confidence Interval 5.7-123.8, p < 0.001) (Table 4). Kidney disease as comorbidity significantly diminished the survival rates for Covid19 patients (Crude OR 9.6, Confidence Interval 5.6–16.6, p < 0.001) and (Adjusted OR 5.7, Confidence Interval 3.0-10.8, p < 0.001, Table 4), as compared to those without kidney dysfunction. Patient nationality and other comorbidity related risk factors such as heart disease, hypertension, and diabetes did not significantly alter the odds (adjusted OR) for the survival of Covid19 patients in our study. Additionally, the majority of patients were not treated with antibiotics (70%, 2154/3072), those severely ill received Augmentin, Tazocin, Amoxicillin and Doxycycline. Less than 10% (7.2%, 224/3072) of the patients did not receive any antiviral therapy, others received hydroxyquinoline and Favipiravir as monotherapy, or in combination (data not shown).
Table 4
Odds ratio (crude and adjusted) for predicting the association between critical patient characteristics and comorbidities against mortality for Covid19 infection
Characteristics
|
Group
|
Crude
|
Adjusted
|
OR
|
CI
|
P
|
OR
|
CI
|
P
|
Age (Years)
|
18–30
|
1
|
--
|
--
|
1
|
--
|
--
|
31–50
|
3.7
|
0.9–15.6
|
Not Significant
|
3.3
|
0.8–14.2
|
Not Significant
|
51–65
|
14.1
|
3.4–58.4
|
< 0.001
|
12.3
|
2.9–52.4
|
< 0.001
|
> 65
|
36.1
|
8.5-154.1
|
< 0.001
|
26.6
|
5.7-123.8
|
< 0.001
|
Nationality
|
Asia
|
1
|
--
|
--
|
1
|
--
|
--
|
Middle East Arab
|
1.7
|
1.1–2.7
|
< 0.05
|
0.9
|
0.5–1.5
|
Not Significant
|
Others
|
2.5
|
1.3–5.1
|
< 0.01
|
2.1
|
1.0-4.5
|
Not Significant
|
Heart disease/Dyslipidemia
|
No
|
1
|
--
|
--
|
1
|
--
|
--
|
Yes
|
2.1
|
1.2–3.7
|
< 0.05
|
0.6
|
0.3–1.3
|
Not Significant
|
Hypertension
|
No
|
1
|
--
|
--
|
1
|
--
|
--
|
Yes
|
2.1
|
1.4–3.2
|
< 0.001
|
0.8
|
0.5–1.3
|
Not Significant
|
Kidney disease
|
No
|
1
|
--
|
--
|
1
|
--
|
--
|
Yes
|
9.6
|
5.6–16.6
|
< 0.001
|
5.7
|
3.0-10.8
|
< 0.001
|
Diabetes Mellitus
|
No
|
1
|
--
|
--
|
1
|
--
|
--
|
Yes
|
2.7
|
1.8–4.1
|
< 0.001
|
1.3
|
0.8–2.1
|
Not Significant
|