The coronavirus is killing about 1 in 10 hospitalized middle-aged patients and 4 in 10 older than 85 in the United States, and is particularly lethal to men even when taking into account common chronic diseases that exacerbate risk, according to previously unpublished data from a company that aggregates real-time patient data from 1,000 hospitals and 180,000 health-care providers.
Allscripts, through its subsidiary CarePort Health, released the data collected from multiple electronic health record companies across the nation. It does not identify patients by name.
Allscripts said it was repurposing the data to help hospitals better understand the nature of covid-19 and the needs of patients who are discharged but will need follow-up care.
“Never in the history of the world has there been something that operated at this scale, and never have we had the ability to track it electronically the way we can today,” Allscripts CEO Paul Black said Saturday.
“We couldn’t have done this five years ago,” he said.
The new data do not cover everyone infected by the virus, only patients who have been hospitalized. The CarePort data come from facilities in 43 states. The high death rates in the data reflect the fact that hospitals typically admit only patients with severe symptoms, CarePort CEO Lissy Hu said.
Most cases of covid-19, the disease caused by the coronavirus, are mild to moderate, and people generally can recover at home.
The first batch of data covers 6,479 hospitalized patients, roughly four times the number of patients analyzed by the Centers for Disease Control and Prevention in a surveillance report released Wednesday.
“We have data from all these different sources, in terms of hospitals large and small, different geographies, different electronic health records,” Hu said. Most hospitals have information only from within their own electronic records, she said. Instead of the data being used for analysis after the fact, the release of the information now can help hospitals respond while the pandemic is ongoing, she said.
This broader swath of data largely echoes the CDC findings. One difference: CarePort found that, after adjusting the estimated mortality rate to take age into account, chronic kidney disease appears to correspond to a 2.5 times greater risk of death among hospitalized patients.
According to CarePort, an 85-year-old who has no chronic diseases and is hospitalized faces a mortality risk between 22 and 27 percent. But if the person has what is known as existing acute kidney injury, the mortality rate spikes to 39 to 49 percent.
“The strongest signal for us based on our data seems to be kidney disease,” Hu said.
These numbers reinforce what has been known about covid-19 since it first flared in China: This is a disease that is far more severe in the elderly, people with underlying chronic diseases and particularly older people with multiple chronic conditions.
Among the common diseases associated with higher levels of mortality from covid-19 are diabetes, lung disease and heart disease. These are common conditions in the United States, and the medical community is still trying to understand how these conditions affect the progression of covid-19.
Covid-19 can sicken a person at any age. The Allscripts data show that 57 percent of people hospitalized were under the age of 65, which is consistent with CDC data.
The new data show that, even when controlling for age and the most common chronic diseases, men are 1.3 times as likely as women to die in the hospital from covid-19. This is consistent with observations in China and Italy, and it remains unexplained.
“Those common conditions don’t seem to explain why men do worse,” Hu said. She said there might be some uncommon conditions that are skewing the results, and so the gender difference in disease outcomes remains a preliminary finding. But being male, she said, “seems to increase risk even when you take into account very common underlying conditions.”
The average age of a patient hospitalized with covid-19, the company said, is 59.6 years old. Mortality rises sharply with age: It is just 1 percent for hospitalized patients under the age of 20, 4 percent for ages 20 to 44, 9 percent for 45 to 54, 13 percent for 55 to 64, 23 percent for 65 to 74, 31 percent for 75 to 84, and 40 percent for 85 and up.
The data compiled by CarePort found that a 65-year-old with multiple chronic conditions — hypertension, diabetes, kidney disease and obesity — has the same mortality rate as a 75-year-old with no such chronic conditions.
Allscripts and CarePort plan further dissemination of data in the days ahead.
“There’s information in the data, about cohorts, about populations, about hot spots, about race, ethnicity, about sex, male-female, and that’s information that we want to get out so that other people use it and make better clinical decisions,” Black said.
This is preliminary data, and Allscripts cautions that the numbers could change as more patient records are compiled. There are built-in limitations: The numbers reflected patients whose disease outcome is known, which is to say, they recovered or died. That doesn’t capture the cases of people still hospitalized and for whom there is not yet a statistically recorded outcome.