COVID-19: Who is Most at Risk?

6 min read  |  September 09, 2020  | 

Older adults are more at risk for developing life-threatening complications from COVID-19 infection. But a new study reveals that 40.7% of Americans age 18 and older have underlying health conditions (comorbidities) that put them at risk for severe disease caused by the novel coronavirus.

What are comorbidities?

The Centers for Disease Control and Prevention identified the following five comorbidities as having “strong and consistent evidence of increased risk.” They determine severe coronavirus disease-associated illness as those requiring hospitalization, intensive care unit admission, mechanical ventilation, or resulting in death.

Americans with any of these conditions are six times more likely to end up in the hospital due to COVID-19 infection. They are admitted to intensive care units for coronavirus complications at five times the rate of those without these underlying health issues. And their mortality rates from severe COVID-19 disease are 12 times higher than adults without these comorbidities. Adults with any of these conditions – without COVID-19 infection – are still at a higher risk than the rest of the population for serious health problems and premature death.

Type 2 Diabetes

This condition affects 11.4% of all U.S. adults.

“There is clearly a relationship between these two illnesses,” said Rajesh Garg, M.D., endocrinologist at the University of Miami Health System’s Comprehensive Diabetes Center. “Whether you look at the data from Wuhan, New York, or Italy, you see that about 20% to 25% of the patients who wound up in the hospital with COVID-19 had diabetes. They become much sicker than other COVID-19 patients, they have more complications, and they die a lot more often. About one-third of the people who die from COVID-19 have Type 2 diabetes. People who have Type 2 diabetes and who normally take oral medication may require insulin injections during treatment for COVID-19.”

Do diabetics have an increased risk of contracting the virus in the first place? At this point, there is no evidence of this. But, as more cases develop and more research is done, the findings may change. Click here to learn more from Dr. Garg about the relationship between diabetes and COVID-19.

Cardiorespiratory Conditions

This includes chronic obstructive pulmonary disease, emphysema, and chronic bronchitis.

COPD alone affects 6.9% of all U.S. adults. Patients with COPD have a significantly higher risk of mortality. “Up to 90% of those with COPD currently smoke or have been smokers,” said Mehdi Mirsaeidi, M.D., a pulmonary and critical care specialist with UHealth. “The chronic damage in the lungs caused by COPD may be another reason smoking increases the risk for COVID-19 disease and, ultimately, death. This is just another reason every smoker should quit, particularly in the COVID-19 era.”

Cardiovascular Disease

This includes angina, coronary heart disease, heart attack, or myocardial infarction. Heart disease alone affects 6.8% of all U.S. adults. A diseased heart has to work harder to pump oxygenated blood through the body. When the lungs (COVID-19’s main target) are compromised, the heart has to work double-time.

“When blood is not oxygenated properly, it affects the entire body and all the other organs. It can ultimately lead to multi-organ system failure,” said Mauricio Cohen, M.D., interventional cardiologist, and director of UHealth’s Cardiac Catheterization Lab. “People with underlying heart issues, he adds, also have a lower functional reserve, which complicates the body’s response to any viral or bacterial agent that enters the body.”

As a result, “Having a heart condition, or other serious underlying condition, can result in a worse outcome for [COVID-19] patients,” Dr. Mauricio said. “You’re simply more vulnerable.” Click here to learn more from Dr. Mauricio about the dangerous mix of cardiovascular disease and COVID-19.

UHealth’s unique COVID-19 Heart Program addresses the cardiac needs of COVID-19 patients post-infection. The program also helps those who experienced significant cardiac symptoms during the pandemic but did not seek treatment because of concerns about contracting COVID-19.

Chronic Kidney Disease

This affects 3.1% of all U.S. adults. “Americans have a high prevalence of diabetes and hypertension, which are the most common causes of Chronic Kidney Disease (CKD),” said Jair Munoz Mendoza, M.D., a nephrologist.

“Patients with CKD have high rates of malnutrition and inflammation and weaker immune systems,” he said, which makes them more vulnerable to severe disease from coronavirus infection. “In addition, these patients tend to have multiple other underlying comorbidities such as diabetes, obesity, and cardiovascular disease.”


This serious health risk affects 30.9% of all U.S. adults. The CDC defines obesity as a body mass index of 30 or higher.

If you fall into this category, you can help support your overall health and immune system by taking your medicines for any underlying health conditions exactly as prescribed. Losing weight through positive lifestyle changes can help lower your BMI and your risk for severe complications from COVID-19 infection.

Follow your doctor or dietitian’s recommendations for your daily caloric intake, improving your diet’s nutritional value, lowering the amount of sugar, alcohol, and refined foods in your diet; and increasing your physical activity.

Who is most affected?

Based on census data and self-reporting, the study’s findings show that these health conditions are most commonly found in rural communities, with the highest concentrations in Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Tennessee, West Virginia, Oklahoma, South Dakota, Texas, and Michigan.

Even before the pandemic, people of color were more likely to have preexisting health conditions. With the addition of this virus, the prevalence of underlying risk factors makes these populations even more vulnerable to severe illness and death.

“We have always known about the issue of diabetes and hypertension within poor communities and among people of color, for instance. We are now seeing these chronic health conditions escalate to a negative impact within weeks of coronavirus infection,” said Roderick King, M.D., director of the Miller School of Medicine’s M.D./M.P.H. Program in Public Health Sciences, who serves as senior associate dean of Diversity, Inclusion, and Community Engagement.

“What COVID has done is amplify all the issues for underserved populations and accelerated poor outcomes.”

What can you do to stay healthy?

This list of five common comorbidities does not include all of the underlying medical conditions that can increase your risk for severe COVID-19 illness. These include cancer, sickle cell disease, organ transplant, cardiomyopathies, and heart failure.

If you have or are at risk for any of these comorbidities, this is a great reminder that you can make lifestyle changes to help manage these conditions and lower your risk for severe COVID-19 complications. Avoid smoking, unhealthy eating, and alcohol; and get more physical activity.

To protect yourself and anyone else with comorbidity from COVID-19 infection, everyone must maintain social distancing, wear a mask in public, and wash your hands. To save lives, this is not an option.

Dana Kantrowitz is a contributing writer for UMiami Health News.

Tags: cardiology, cardiovascular, chronic kidney disease, covid-19 in Miami, diabetic, obesity

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