Links To And Excerpts From The CDC’s “Underlying Medical Conditions Associated with High Risk for Severe COVID-19: Information for Healthcare Providers”

Posted on April 13, 2021 by Tom Wade MD

In this post I link to and excerpt from the Centers For Disease Control and Prevention (CDC) web page, Underlying Medical Conditions Associated with High Risk for Severe COVID-19: Information for Healthcare Providers, updated Mar. 29, 2021.

Here are direct links to the sections on the above CDC web page:

On This Page

Here are excerpts:

Purpose

This webpage provides an evidence-based resource for healthcare providers caring for patients with underlying medical conditions who are at higher risk of developing severe outcomes of COVID-19. Severe outcomes are defined as hospitalization, admission to the intensive care unit (ICU), intubation or mechanical ventilation, or death. This page summarizes data from preprinted and published studies that were included in a literature review conducted by subject-matter experts. The summary of information reflects current evidence regarding underlying medical conditions and is intended to help healthcare providers make informed decisions about patient care and increasing the awareness of risk among their patients.

This page is distinct from the People with Certain Medical Conditions webpage which is intended for the general public.

Background

We are learning more about the risk factors for severe COVID-19 outcomes every day. Age is the strongest risk factor for severe COVID-19 outcomes. Approximately 54.1 million people aged 65 years or older reside in the United States; this age group accounts for more than 80% of U.S. COVID-19 related deaths.(1, 2) Residents of long-term care facilities make up less than 1% of the U.S. population but account for more than 35% of all COVID-19 deaths.(3-7) Additionally, adults of any age with certain underlying medical conditions are at increased risk for severe illness from COVID-19.(8)

Studies have shown that COVID-19 does not affect all population groups equally. The risk of severe COVID-19 increases as the number of underlying medical conditions increases in an individual.(9,10,11) Some chronic medical conditions occur more frequently or at a younger age in racial or ethnic minority populations. Moreover, data has also shown that compared to non-Hispanic White persons, members of certain racial/ethnic groups are dying from COVID-19 at younger ages.(12) Based on mortality data from CDC’s National Vital Statistics System (NVSS), an estimated 299,028 excess deaths occurred from late January through October 3, 2020 in the United States, with 198,081 (66%) excess deaths attributed directly and indirectly to COVID-19. The largest percentage increases in mortality occurred among adults aged 25–44 years and among Hispanic or Latino persons.(13) Additionally, we are still learning about how conditions that affect the environments where people live, learn and work (i.e., social determinants of health, such as neighborhood and physical environment, housing, occupation, education, food security, access to healthcare, and economic stability) can influence the risk for infection and severe COVID-19 outcomes.

This page lists high-risk underlying medical conditions based on available evidence. The list of underlying medical conditions is not exhaustive and includes only conditions with sufficient evidence to draw conclusions. This document will be updated as the science evolves.

Actions Providers Can Take

  • Educate and encourage everyone, especially older people and those with underlying medical conditions, to be fully vaccinated against COVID-19 as soon as a vaccine becomes available to them. For additional information, including a link to your state or territorial health department’s website on eligibility for and locations for COVID-19 vaccination, check here.
  • Encourage patients to keep appointments for routine care and adhere to treatment regimens.
  • Consider use of telehealth in coordination with community-based organizations, family members, or other providers, when appropriate, although some patients may not have knowledge of or access to appropriate technology or internet service.
  • Encourage patients with underlying medical conditions to continue practicing preventive measures, such as wearing a mask and physical distancing, to avoid infection with the virus that causes COVID-19. This becomes even more important with increasing age and number and severity of underlying conditions.
  • Carefully consider potential additional risks of COVID-19 illness for patients who are members of racial and ethnic minority groups, and how to facilitate access to culturally and linguistically appropriate resources. These patients are often younger when they develop chronic medical conditions, might be at higher risk of having more than one underlying medical condition, and at higher risk for acquisition of COVID-19. Studies have shown that people in ethnic and racial minority groups are dying from COVID-19 at younger ages.
  • Based on their clinical judgement, healthcare providers might recommend that people with underlying conditions that are not included on this list receive vaccination as soon as it becomes available.

Key Findings from Two Large Cohort Studies

Summary of Evidence

An updated list of high-risk underlying conditions, based on what has been reported in the literature, and the level of evidence for risk of severe COVID-19 outcomes are provided below. Updates to the list of high-risk underlying medical conditions that put adults of any age at increased risk for severe COVID-19 illness were based on evidence from published reports, scientific articles in press, unreviewed preprints, and internal data. This list of conditions was categorized into four groups primarily based on the study method used in the analyses at the time of review. Some of the conditions listed represent a larger category (e.g., heart conditions) and some are listed as one specific health condition (e.g., sickle cell disease). This reflects how conditions were defined in studies. For example, ICD-10-CM codes were used in some studies and others used lab codes.

1. Co-morbidities that are supported by meta-analysis/systematic review: Defined as having a significant association with risk of severe COVID-19 illness in at least one meta-analysis or systematic review.

  • Cancer
  • Cerebrovascular disease
  • Chronic kidney disease
  • COPD (chronic obstructive pulmonary disease)
  • Diabetes mellitus, type 1 and type 2
  • Heart conditions (such as heart failure, coronary artery disease, or cardiomyopathies)
  • Obesity (BMI ≥30 kg/m2)
  • Pregnancy
  • Smoking, current and former

2. Co-morbidities that are supported by mostly observational (e.g., cohort, case-control, or cross-sectional) studies: These might include systematic review or meta-analysis that represents one condition in a larger group of conditions (for example, kidney transplant under the category of solid organ or blood stem cell transplantation).

  • Children with certain underlying conditions
  • Down syndrome
  • HIV (human immunodeficiency virus)
  • Neurologic conditions, including dementia
  • Overweight (BMI ≥25 kg/m2, but <30 kg/m2)
  • Other lung disease (including interstitial lung disease, pulmonary fibrosis, pulmonary hypertension)
  • Sickle cell disease
  • Solid organ or blood stem cell transplantation
  • Substance use disorders
  • Use of corticosteroids or other immunosuppressive medications

3. Co-morbidities that are supported by mostly case series, case reports, or, if other study design, the sample size is small (and no systematic review or meta-analysis available was available to review): Defined as having an association in one or more case series studies. If there are cohort or case-control studies, the sample size was small. Conditions included might be less common.

  • Cystic fibrosis
  • Thalassemia

4.Co-morbidities that are supported by mixed evidence: Defined as having an association in at least one meta-analysis or systematic review and additional studies or reviews that reached different conclusions about risk associated with a condition.

  • Asthma
  • Hypertension
  • Immune deficiencies
  • Liver disease

Find Evidence used to update the list of underlying medical conditions that increase a person’s risk of severe illness from COVID-19

Additional Resources

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