1/ THREAD: Important study just out from @CDCgov shows certain characteristics may increase risk of hospitalization: age, black race, diabetes, lack of insurance, male sex, smoking, and obesity. Although there are limitations, these are important findings. bit.ly/MMWR61720 
2/ Interesting figure. Note the differences between adjusted and unadjusted odds ratios, especially for hypertension, age 45-64, and insurance status. Adjusting (i.e. correcting for likely bias or confounding) makes the elevated risk for hypertension disappear.
3/ Increased risk among black people is consistent with multiple studies, and may be due to more exposure to Covid, more underlying illness, less access to health care, and possibly other issues as well. We must do better to protect and care for those most at risk.
4/ It's clear in this study that smoking increases Covid risk. Tobacco industry pseudo-science to the contrary, tobacco increases the risk of lung disease. Period. Poor quality studies on this have muddied the waters.
5/ Alone, hypertension may not increase risk. Lower blood pressure reduces risk of heart attack, stroke, and kidney failure, but hypertension in the US increases linearly with age, which may explain the correlation with severe Covid.
6/ Age 45-64 is not a risk factor in this study, but there are problems with that, including the sample size being too small to look at more detailed age groups (linear regression on age would have been a reasonable approach).
7/ The 60-64 age group also needs more attention. We use 65 as the cut-off in the US, but other research has shown that risk increases at 60.
8/ Interesting that lacking insurance is only shown to be a risk on adjusted analysis. Always important to adjust findings to clarify what’s real and what isn’t.
9/ As mentioned, there are big limitations in this study, as the authors note, including small sample size, possible statistical biases from design, and no tracking of objective outcomes (such as ICU admission, mechanical ventilation, deaths).
10/ Bottom line: to reduce deaths and dislocation from Covid, we must improve protection, detection, and care of the elderly, black people, people with diabetes, those who smoke or are obese, and males. Knowing who is at most risk can help us reduce that risk.
11/ And: we must address health insurance coverage. Getting people the care they need is crucial and makes us all safer. Even more important now with patients and providers adjusting to Covid reality. Telemedicine. Team based care. Outcomes-focused accountability. Access for all.
