JMIR Publications

ABSTRACT

Background:

Spain is one of the countries which has been most affected by COVID-19, with more than 700,000 cases as of the end of September 2020. Initially the burden of care fell on hospitals, but this situation has progressively changed, with primary care increasingly taking a leading role. Patients with a history of chronic conditions, obesity and cancer are at greater risk from COVID-19 and concerns surrounding the use of angiotensin-converting enzyme inhibitors and angiotensin-converting enzyme 2 and its relation to COVID-19 susceptibility and severity have increased since the beginning of the pandemic.

Objective:

The objectives of the study were: first, to compare the characteristics of patients diagnosed with COVID-19 disease to patients without COVID-19 in primary care, second, to analyse the features of patients with COVID-19 in primary care to determine the risk factors associated with the mortality outcome, and third, to determine the potential influence of certain medications such as ACEi and ARB on the mortality of patients with COVID-19.

Methods:

An observational retrospective study of patients diagnosed with COVID-19 in Spain, specifically in the Catalan Central Region, between 1 March and 17 August 2020 was conducted. The data was obtained from the Primary Care Services Information Technologies System (SISAP in Catalan) belonging to the Catalan Institute of Health, in Barcelona, Spain.

Results:

The study population included 348,596 adult patients (aged over 15) registered in the Primary Care Services IT System of the Catalan Central Region. The mean age was 49.53 years (SD 19.42) and 31.17% were 60 years old or older. 175,484 (50.34%) patients were women. A total of 23,844 (6.84%) patients in the population studied were diagnosed with COVID-19 during the study period and the most common clinical conditions among them, were hypertension (5,267 (22.1%) of patients), obesity (5,181 (21.7%) of patients) and dyslipidemia (4,749 (19.9%) of patients). Overall, 2,680 (0.77%) patients died during the study period from the study population as a whole. The number of deaths among patients without COVID-19 was 1,825 (0.57%, mean age 80.6 years old, SD=13.3), while among patients diagnosed with COVID-19 the number of deaths was 855 (3.72%, mean age 83.0 years old, SD= 10.80) with an OR of 6.58 (95%-CI 6.06-7.15).

Conclusions:

Unlike the majority of studies focused on patients admitted to hospitals, we describe the characteristics of patients diagnosed with COVID-19 in primary care. We have seen that women were more likely to catch COVID-19, unlike the majority of studies which reported that men were more frequently infected. In addition, our study did not show that hypertension and obesity, two of the major risk factors often associated with COVID-19 patients, were linked to an increase in mortality. Clinical Trial: n/a