key: cord-0746519-qqk578yt
authors: FF, Norman; Crespillo-Andújar, C.; Pérez-Molina, J.A.; B, Comeche; S, Chamorro; Monge-Maillo, B.; Moreno-Guillén, S.; López-Vélez, R.
title: COVID-19 and geographical area of origin
date: 2020-11-25
journal: Clin Microbiol Infect
DOI: 10.1016/j.cmi.2020.11.011
sha: 6a3480326fd4642a7ae2a0822f093c8895aba71e
doc_id: 746519
cord_uid: qqk578yt

OBJECTIVES: To describe and compare the main clinical characteristics and outcome measures in hospitalized patients with confirmed COVID-19 according to geographical area of origin. METHODS: A retrospective analysis of patients hospitalized with confirmed COVID-19 at a referral center in Madrid, Spain, during March-May 2020 was performed. Recorded variables (age, gender, ICU admission, outcome), and geographical area of origin were compared for Europeans and non-Europeans (Latin Americans, Asians and Africans). RESULTS: In total, 2345 patients with confirmed COVID-19 hospitalized during the study period were included in the study. Of these, 1956 (83. 4%) were Europeanand 389 (16. 6%) were non-European (over 90%, 354/389, were Latin American). Non-Europeans were significantly younger than Europeans (mean 54 [SD 13.5] vs 70.4 [SD 15.1] years, p<0.001); the majority of patients were male (1420/2345, 60.6%), with no significant differences in gender between Europeans and non-Europeans (1197/1956, 61.2% males in the European group vs 223/389, 57.3% males in the non-European group, p=0.15). In-hospital mortality overall was higher in Europeans (443/1956, 22.7%, vs 40/389, 10.3% in non-Europeans, p<0.001, but there were no significant differences when adjusted for age/gender (OR: 1.27, 95%CI 0.86-1.88). Non-Europeans were more frequently admitted to ICU (71/389, 18.3%) compared to Europeans (187/1956, 9.6%)(p<0.001) and a difference in ICU admission rate was also found when adjusted for age/gender (OR: 1.43, 95%CI 1.03-1.98). CONCLUSIONS: No significant differences in mortality were observed between Europeans and non-Europeans (mainly Latin Americans), but an increase in ICU admission rate was found in non-Europeans.

The current COVID-19 pandemic ( of COVID-19 were identified from the hospital´s electronic medical records. Recorded 63 variables included age, gender, ICU admission, outcome (discharge or death), and country of Qualitative variables were expressed as relative and absolute frequencies, and quantitative 71 data were expressed as the mean and standard deviation (SD) ( hospital mortality between groups when adjusted for age and gender OR: 1.27 (95%CI 0.86-A descriptive analysis comparing ICU admission and in-hospital mortality rate for different age 120 ranges was performed for Europeans and non-Europeans and these data and the main 121 characteristics of hospitalized patients with confirmed COVID-19 according to geographical 122 area of origin are described in Table 1 . 123

Co-morbidities recorded in the non-European group included hypertension (23.9%), diabetes 124 mellitus (13.4%), chronic pulmonary disease (11.8%), immunosuppression (9.2%; 1.3% HIV-125 associated, 7.9% non-HIV related), cardiovascular disease (8%), chronic renal disease (6.2%), 126 and malignancy (5.1%). When co-morbidities were compared in LA, AFR and AS patients, 127 diabetes and cardiovascular disease were found to be significantly more frequent in the AFR 128 group (p=0.015, p=0.002), and no significant differences were found regarding other co-129 morbidities. 130

The main characteristics in hospitalized non-European patients with confirmed COVID-19 131 according to age range (years) are described in Table 2 . The main co-morbidities in hospitalized 132 non-European patients with confirmed COVID-19 according to geographical area of origin are 133 shown in Table 3.  134   135   136 Discussion 137

The present study analyzed differences in adverse clinical outcomes ( ICU admission and in-138 hospital mortality ) in hospitalized patients with confirmed COVID-19 according to geographic 139 area of origin, with a large representation of patients of Latin American origin. According to 140 official 2020 statistics, around 9.7% of Madrid´s registered population originate from a non-141

European Union country, thus, this series included data on a large proportion of foreign-born 142 patients [5] . In this study, no significant differences in the in-hospital fatality when adjusted for 143 age and gender were observed when Europeans and non-Europeans were compared. 144

However, an increase in ICU admission rate was found in non-Europeans. 145

Around 16% of the study cohort were of non-European origin (over 90% of these were Latin 146 American), and were significantly younger than the European patients (mean age 54 years for 147 non-Europeans vs 70.4 years for Europeans), but with no significant differences in gender 148 distribution (a predominance of males was found, as described in other European series, but 149 this occurred both in the European and non-European groups) [ The overall in-hospital mortality rate (20%) was within the reported 15-28% range for other 172 series in Europe and was significantly higher in Europeans (22.7%) than in non-Europeans 173 (10.3%), however, no significant differences were found between these groups when in-174 hospital fatality rates were adjusted for age and gender [6, 11, 12]. A significantly higher mean 175 age was found in European patients who died compared to non-European patients who died, 176 thus supporting previous findings that advanced age is a risk factor associated with mortality in 177 COVID-19 (rather than geographical area of origin) [11, 14] . The increased risk in mortality 178 associated with male gender found in other studies was not observed in this series (in the 179 overall group, nor when analyzed in Europeans and non-Europeans) [1, 12] . When subgroups 180 were considered, in-hospital fatality was significantly higher in Asian patients (15.8%) 181 compared to Latin Americans (10.2%) and Africans (6.3%), despite a mean age of 52.5 years in 182 the Asian group, much lower than the cohort´s mean age overall. A study examining factors 183 associated with COVID-19 mortality in 17 million patients found both Black and South Asian 184 patients were at higher risk of death compared to people of white ethnicity even after 185 adjustment for other factors [1] . However, as for the findings regarding ICU admission, the 186 data in the current series should be interpreted with caution and investigated further with 187 larger populations. Only diabetes and cardiovascular disease were found to be significantly 188 more frequent in African patients, so presence of recorded co-morbidities did not appear to 189 explain the observed higher rate of ICU admission in Latin American patients or the higher in- 

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