Risks of Death and Severe Disease in Patients With Middle East Respiratory Syndrome Coronavirus, 2012–2015

Caitlin M. Rivers; Maimuna S. Majumder; Eric T. Lofgren

Disclosures

Am J Epidemiol. 2016;184(6):460-464. 

In This Article

Results

Demographic Characteristics

The distribution of patient ages for both fatal and nonfatal cases is shown in Figure 1. The distributions of other variables, including the numbers of missing values, are reported in Table 1.

Figure 1.

Gaussian kernel-smoothed age distributions of fatal and nonfatal cases of Middle East respiratory syndrome coronavirus from 2012 to 2015.

Risk Factors for Reported Mortality

The estimated relative risk of death and corresponding 95% confidence intervals for the covariates described in the Methods section are shown in Table 2. As with any emerging infection, both the presence and the absence of associations with putative risk factors warrant reporting. Univariate analysis showed that reported contact with camels or other animals, cases occurring in Saudi Arabia, and case type (a case's being primary vs. secondary) were not associated with reported mortality. Employment as a health-care worker and an increased amount of time between disease onset and hospitalization had minor protective associations with reported mortality. Older age and underlying comorbidity were associated with increased risks of mortality, while female patients and cases with a later time of infection onset (in days since January 1, 2012) had lower risks of mortality. Upon multivariate adjustment, most of the estimated associations were attenuated, and neither female sex nor time between disease onset and hospitalization remained an independent risk factor.

Risk Factors for Reported Severe Disease

The estimated relative risks of severe disease and corresponding 95% confidence intervals are shown in Table 2. Reported contact with camels or other animals, regardless of whether or not the case arose in Saudi Arabia, and longer delays between disease onset and hospitalization were not associated with an increased risk of severe disease. Increased age and the presence of underlying comorbidity were associated with an increased risk of severe disease. Female sex, having a secondary case, having a case arising later in time, and employment as a health-care worker were protective against severe disease.

As with the risk of reported death, the multivariate associations were largely attenuated from the univariate associations, and notably, female sex was no longer protective once other variables had been controlled for. As compared with the risk of death, the estimated associations for severe disease were frequently closer to the null.

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