COVID-19 Severity and Mortality in Veterans with Chronic Lung Disease.

INTRODUCTION: Chronic lung disease (CLD) has been associated with risk for more severe manifestations and death with COVID-19. However, few studies have evaluated the risk overall and by type of CLD for severity of COVID-19 outcomes in a US national cohort.

METHODS: Using data from the Veterans Health Administration, we determined the risk associated with CLDs including COPD (mild/severe), asthma (mild/active/severe), idiopathic pulmonary fibrosis (IPF), sarcoidosis and other interstitial lung diseases (ILDs) for outcomes among veterans with SARS-CoV-2 positive tests between 3/1/2020-4/30/2021. We used multinomial regression to estimate risk of four mutually exclusive COVID-19 outcomes within 30-days: outpatient management, hospitalization, hospitalization with indicators of critical illness, or death. We calculated the overall proportion with each outcome, the absolute risk difference and risk ratios for each outcome between those with and without CLD. We also describe clinical and laboratory abnormalities by CLD in those hospitalized.

RESULTS: We included 208,283 veterans with COVID-19; 35,587 (17%) had CLD. Compared to no CLD, veterans with CLD were older and had more comorbidities. Hospitalized veterans with CLD were more likely to have low temperature, mean arterial pressure, oxygen saturation, leukopenia and thrombocytopenia, and more likely to receive oxygen, mechanical ventilation and vasopressors. Veterans with CLD were significantly less likely to have mild COVID-19 (-4.5%, adjusted risk ratio [aRR] 0.94, 95% confidence interval [CI] 0.94-0.95), and more likely to have a moderate (+2.5%, aRR 1.21, 95% CI 1.18-1.24), critical (+1.4%, aRR 1.38, 95% CI 1.32-1.45) or fatal (+0.7%, aRR 1.15, 95% CI 1.10-1.20) outcome. IPF was most strongly associated with COVID-19 severity, especially mortality (+3.2%, aRR 1.69, 95% CI 1.46-1.96), followed by other ILDs and COPD, whereas asthma was less likely to be associated with severity of COVID-19. In veterans under age 65, worse COVID-19 outcomes were generally more likely with IPF, sarcoidosis, and other ILDs.

CONCLUSIONS: Veterans who had CLD, particularly IPF, other ILDs and COPD, had an increased probability of more severe 30-day outcomes with COVID-19. These results provide insight into the absolute and relative risk of different CLDs with severity of COVID-19 outcomes and can help inform considerations of healthcare utilization and prognosis.