Children with multiple long-term conditions face nearly three times the mortality from COVID-19

People with multiple long-term conditions are two and a half times more likely to die after contracting COVID-19 than others. When children were assessed separately, the risk of mortality among those with multiple long-term conditions increased to almost three times (2.8) the risk of those without. The mortality rates are 22% and 8% respectively.

That’s according to an authoritative systematic review and meta-analysis of more than four million COVID-19 patients published today (Thursday 17 October) in Journal of the Royal Society of Medicine.

The authors call for patients with multiple long-term conditions to be prioritized in health care policies.

This systematic review is believed to have looked at the largest ever cohort of patients with COVID-19 in a study investigating the impact of multiple long-term conditions. The review synthesized data from 111 observational studies of patients with confirmed COVID-19 published between January 2020 and May 2023. These studies were conducted in 51 countries and most involved cohorts of high-risk or hospitalized patients with COVID-19, which could account for the high mortality rates found in the study.

This important study thus provides an updated picture of the impact of COVID-19 on people with multiple long-term conditions.

While previous research has identified risk factors for severe COVID-19 disease — such as older age, male gender, socioeconomic deprivation, being from an ethnic minority and having a pre-existing condition — there has been limited research or reporting on outcomes for patients with multiple long-term conditions. The authors say this should be a matter of increasing concern as a third of adults worldwide – and over a quarter in England – have two or more long-term health conditions.

This major review found that after infection with COVID-19 and relative to people with one or no long-term conditions, patients with multiple long-term conditions have:

• 4 times more likely to be hospitalized in all ages and specifically 3.5 times more likely in children
• 8 times more likely to require mechanical ventilation at all ages and 4.3 times more likely in children, specifically
• 2 times more likely to be admitted to the Intensive Care Unit in all ages and 2.9 times more likely in children.

Dr. Shukrat Salisu-Olatunji, a PhD student at the University of Leicester and funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) East Midlands, was the lead author of the study. He said:

“Our systematic review and meta-analysis showed that there is a significantly higher risk of adverse COVID-19 outcomes for people living with multiple long-term conditions, compared to those without. Furthermore, relative to those without pre-existing long-term conditions, children and youth with multiple long-term conditions experienced more adverse COVID-19 outcomes. age, as was previously mentioned.

“We hope that health policies will prioritize people with multiple long-term conditions, especially during times of public health emergencies such as the COVID-19 pandemic.”

This study highlights the high risk of poorer outcomes for people with multiple long-term conditions. This systematic review is timely as the publication of the recent NHS Darzi review highlights the biggest challenge facing the nation as an aging population, who are more often living in poor health with multiple long-term conditions.”

Professor Kamlesh Khunti, Director of the NIHR ARC East Midlands and senior author of the paper