Children with multiple long-term conditions hospitalized with COVID are almost three times more likely to die

Individuals with multiple long-term conditions are two and a half times more likely to die following COVID-19 infection than others. When children were assessed separately, the risk for 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 is according to an authoritative systematic review and meta-analysis of over four million patients with COVID-19 published 17 October in the Journal of the Royal Society of Medicine. The review is titled “COVID-19-related morbidity and mortality in people with multiple long-term conditions: a systematic review and meta-analysis of over 4 million people.”

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

This systematic review is believed to have considered the largest ever cohort of patients with COVID-19 in a study investigating the impact of multiple long-term conditions. The review synthesized evidence from 111 observational studies of patients with confirmed COVID-19 published between January 2020 and May 2023.

These studies were conducted across 51 countries and most involved high risk or hospitalized patient cohorts with COVID-19, which could account for the high rates of mortality found in the study.

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

While previous research has identified risk factors for severe COVID-19 disease—such as older age, male sex, socioeconomic deprivation, being from an ethnic minority background and having a pre-existing condition—there has been limited research into, or reporting of, the outcomes for patients with multiple long-term conditions.

The authors say this should be a matter of growing concern as a third of adults globally—and more than a quarter in England—have two or more long-term health conditions.

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

• 2.4 times higher chance of hospitalization in all ages and specifically 3.5 times higher in children
• 1.8 times greater chance of needing mechanical ventilation in all ages and 4.3 times higher in children, specifically
• 1.2 times higher chance of admission to Intensive Care Unit for all ages and 2.9 times greater in children.

Dr. Shukrat Salisu-Olatunji, a Ph.D. student at the University of Leiceste was the lead author of the study. She said, “Our systematic review and meta-analysis demonstrated that there is a significantly higher risk of adverse COVID-19 outcomes for people living with multiple long-term conditions, compared with those without.

“Furthermore, relative to those without pre-existing long-term conditions, children and young people with multiple long-term conditions experienced more adverse COVID-19 outcomes. This may suggest that increased vulnerabilities could be associated more with the extremes of age rather than simply older age, as has been previously reported.

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

Professor Kamlesh Khunti, Director of NIHR ARC East Midlands and a senior author of the paper added, “This study puts into the spotlight 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 the aging population, who are living longer, often in ill-health with multiple long-term conditions.”