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Epidemiological Characteristics of COVID-19 Patients in Kütahya Province in Turkey



Cagla Ozdemir, Adem Durmaz, Nurcan Akbas Gunes

Euras J Fam Med 2021;10(3):135-40. doi:10.33880/ejfm.2021100304

 

Original Article


ABSTRACT

Aim: It is aimed to evaluate the epidemiological features of COVID-19 patients and risk factors affecting hospitalization.

Methods: This cross-sectional study included 883 adult patients whose Polymerase Chain Reaction tests were positive for SARS-CoV-2 in Kütahya province until July 2020. The patients were questioned in terms of their socio-demographic characteristics, drugs, comorbidities, and symptoms. They were divided into two groups according to their hospitalization status and outpatient treatment status.

Results: There were 473 female and 410 male participants in the study. 532 of 883 adult patients were hospitalized. The most common symptoms were fatigue (47.9%), myalgia (44.7%), and loss of smell and taste (32.4%). Hospitalization was associated with advanced age, low income, presence of additional disease, several symptoms, smoking, comorbidities including diabetes mellitus, chronic kidney diseases, cardiovascular and respiratory system. In multivariant analyses, advance age, low income, fever, dyspnea  and chronic lung diseases were associated with increased odds of hospital admission. 

Conclusion: In our study, it was found that independent risk factors for hospitalization were advanced age, low income, fever, shortness of breath, and chronic lung diseases. We think that determining risk factors for hospitalization may be a guide for clinicians in predicting patient prognosis.

Keywords: COVID-19, epidemiology, hospitalization, symptoms, comorbidity


 

Introduction

After the first case occurred in December 2019, in the Hubei province of China, coronavirus disease (COVID-19) continued to spread all over the world with over 17.6 million confirmed cases (1). The first case was detected on March 20, 2020, in Kütahya Province, Turkey. After this date, the cases increased throughout the province.

Due to the government's interventions and control measures (closure of schools, determination of a treatment strategy, age group-specific curfews, reduction of the number of active workers in business life, etc.) and changes in personal behavior (wearing masks and obeying social distance rules), the number of confirmed and suspicious cases in our country has begun to decrease.

Although the first cases in China were found to have contact history with local seafood and wild animal markets in Wuhan, it was found that the virus was transmitted from person to person by droplets or direct contact (2). Typical symptoms in symptomatic patients are fever, cough, dyspnea, weakness, sore throat, and myalgia. It was observed that patients initially had symptoms of upper respiratory tract disease but tended to proceed rapidly to pneumonia (3).

It has been stated that the prognosis is worse in patients with comorbidity (4). This situation carries great importance in the frequency of comorbidity, prognostic importance in age groups, case detection, and establishment of hospital admission protocols. There is a limited number of studies on COVID-19 epidemiology in our country. In this study, disease epidemiology, clinical features, and other risk factors affecting hospitalization were evaluated.

Methods

This cross-sectional study was approved by the Ministry of Health and the Clinical Research Ethics Committee of Kütahya University of Health Sciences (2020/10-03). It was planned to include all Polymerase Chain Reaction (PCR)- positive SARS-CoV-2 cases in Kütahya from 20 March 2020 to 6 July 2020. A total of 1099 cases were followed up between 20 March 2020 and 6 July 2020. In Figure 1, the graph of the date-case number is shown.

Figure 1. The number of cases by time

Between these dates, 1099 cases were followed up in Kütahya province. Ninety-six patients with missing data, 120 patients under 18 years of age, patients under treatment, and patients with symptoms at the time of the study were excluded from the study were excluded. A total of 1003 cases were included in the analysis. 120 of 1003 patients were under 18 years old. Therefore, the study was conducted with 883 patients.   

Patients' information was extracted from the local health database. Moreover, face-to-face interviews with all patients were used to ensure the validity of the data. The patients were questioned in terms of their socio-demographic characteristics, drugs, comorbidi-ties, and symptoms. They were divided into two groups according to their hospitalization status and outpatient treatment status.

In statistical analysis with SPSS 22.0, categorical variables were given as numbers and percentages. For descriptive statistics mean ± standard deviation (SD) and median (min-max value) were used depending on the normal distribution state of the variables. Normal distribution was evaluated with Kolmogorov-Smirnov/ Shapiro-Wilk tests. Chi-Square tests were used for the comparison of categorical variables between groups. Student T-test or Mann-Whitney U test was used for comparison of data sets. Binary logistic regression analysis is used to determine the independent risk factors for hospitalization in patients with COVID-19. Clinically relevant variables and/or variables with p

Results

The study was carried out with 883 patients. The sociodemographic features of the adult patients examined are shown in Table 1. 532 of 883 adult patients were hospitalized. Other patients (n=351) were treated on an outpatient basis. 

Table 1. Sociodemographic and clinical features of patients

Characteristics

All patients

(N=883)

Outpatient (N=351)

Hospitalized

 (N=532) 

p value

Age, Med (min-max)

46 (18-96)

38 (18-87)

52 (18-96)

<0.001

Sex, N (%)

 

 

 

0.579

   Female

473 (53.6)

184 (52.4)

289 (54.3)

 

   Male

410 (46.4)

167 (47.6)

243 (45.7)

 

Marital status, N (%)

 

 

<0.001

   Married

714 (80.9)

262 (74.6)

452 (85.0)

 

   Single

169 (19.1)

89 (25.4)

80 (15.0)

 

Education time (year), Med (min-max)

5 (0-22)

8 (0-22)

5 (0-22)

<0.001

Monthly income, N (%)

 

 

 

<0.001

    ≤ 2500 TL

518 (58.7)

164 (46.7)

354 (66.5)

 

    > 2500 TL

365 (41.3)

187 (53.3)

178 (33.5)

 

Smoking (+), N (%)

330 (37.4)

147 (41.9)

183 (34.4)

0.025

Comorbidity (+), N (%)

343 (39.1)

90 (26.3)

252 (73.7)

<0.001

    Hypertension

156 (17.8)

29 (8.3)

127 (24.1)

<0.001

    Diabetes mellitus

126 (14.4)

32 (9.2)

94 (17.8)

<0.001

    Chronic lung diseases

66 (7.5)

10 (2.9)

56 (10.6)

<0.001

    Cardiovascular diseases

59 (6.7)

11 (3.2)

48 (9,1)

0.001

    Neurological diseases

41 (4.7)

22 (6.3)

19 (3.6)

0.062

    Psychiatric diseases

27 (3.1)

9 (2.6)

18 (3.4)

0.489

    Nephrological diseases

13 (1.5)

1 (0.3)

12 (2.3)

0.017

    Others *

63 (7.1)

20 (5.7)

43 (8.1

0.178

Pharmacological therapy (+), N (%)

 

 

 

    Oral antidiabetic 

86 (10.4)

23 (6.8)

63 (13)

0.005

    Anticoagulant

69 (8.4)

11 (3.3)

57 (12,0)

<0.001

    Alpha-beta blocker

59 (7.2)

11 (3.3)

48 (10)

<0.001

    ACEI

56 (6.8)

5 (1.5)

51 (10.6)

<0.001

    Diuretic 

56 (6.3)

9 (2.7)

47 (9.8)

<0.001

    İnhaler

44 (5.3)

6 (1.8)

38 (7.8)

<0.001

    ARB

44 (5.0)

12 (3.6)

32 (6.6)

0.053

    CCB

35 (4.3)

4 (1.2)

31 (6.4)

<0.001

    Anti-lipidemic

28 (3.4)

3 (0.9)

25 (5.1)

0.001

    Others **

103 (12.5)

47 (13,9)

56 (11.5)

0.301

Symptoms, N (%)

 

 

 

    Fatigue 

423 (47.9)

161 (45.9)

262 (49.2)

0.325

    Myalgia 

395 (44.7)

162 (46.2)

233 (43.8)

0.491

    Loss of smell and taste 

286 (32.4) 

102 (29.1)

184 (34.6)

0.086

    Cough  

256 (29.0)

70 (19.9)

186 (35)

<0.001

    Fever 

253 (28.7)

83 (23.6)

170 (32)

0.008

    Headache 

153 (17.3)

56 (16)

97 (18.2)

0.381

    Diarrhea 

127 (14.4)

54 (15.4)

73 (13.7)

0.491

    Anorexia 

127 (14.4)

35 (10)

92 (17.3)

0.002

    Dyspnea 

120 (13.6)

21 (6)

99 (18.6)

<0.001

    Sore throat

107 (12.1)

56 (16)

51 (9.6)

0.005

    Nausea and vomiting

69 (7.8)

21 (6)

48 (9)

0.100

    Runny nose

48 (5.4)

15 (4.3)

33 (6.2)

0.216

    Nazal stuffiness

39 (4.4)

16 (4.6)

23 (4.3)

0.868

    Sputum 

39 (4.4)

11 (3.1)

28 (5.3)

0.132

    Dizziness 

22 (2.5)

4 (1.1)

18 (3.4)

0.036

* Dyslipidemia, rheumatological, thyroid, gastrointestinal diseases and malignancy; **Proton pump inhibitor, thyroid, insulin, dialysis, immunosuppressant, cardiac and neurological therapy

Hospitalized patients were older, more frequently married, and less educated (p<0.05) and had significantly more comorbidities than outpatients (p<0.05). Among symptoms, fever, cough, anorexia, dyspnea, throat ache, and dizziness were higher in hospitalized patients (p<0.05) (Table 1). 

In multivariant analyses, advanced age, low income, fever, dyspnea, and chronic lung diseases were independent determinants of hospitalization. However, patients with sore throats were less likely to be hospitalized (Table 2).

Table 2. The determinants of hospitalization in patients 

 

B

OR

Cl %95

P

Socio-demographic

 

 

 

 

    Age

0.029

1.03

1.01-1.04

<0.001

    Gender (male)

0.037

1.04

0.76-1.41

0.815

    Marital status (married)

0.328

1.38

0.93-2.07

0.108

    Monthly income (low income)

0.590

1.80

1.32-2.45

<0.001

    Smoking

-0.095

0.90

0.66-1.24

0.550

Symptoms

 

 

 

 

    Fever 

0.458

1.58

1.11-2.23

0.010

    Dyspnea 

0.981

2.66

1.55-4.58

<0.001

    Sore throat

-0.567

0.56

0.36-0.90

0.016

Comorbidities

 

 

 

 

    Hypertension

0.364

1.44

0.86-2.40

0.165

    Diabetes mellitus

-0.085

0.91

0.55-1.50

0.736

    Chronic lung diseases

0.833

2.30

1.08-4.87

0.030

    Nephrological diseases

1.463

4.31

0.53-34.9

0.170

Discussion

COVID-19 virus is more contagious in the early phase, and therefore diagnosing people with specific symptoms is essential for the management of the disease (5). In this study, the most common symptoms were fatigue (47.9%), myalgia (44.7%), loss of smell and taste (32.4%). A systematic review and meta-analysis of 148 studies from 9 countries reported that the most prevalent symptoms were fever (78%), cough (57%), and fatigue (31%) (6). 

In multivariate analysis, older age, low income, presence of fever or dyspnea and chronic lung disease is a risk factor for hospitalization in our study. Several studies have reported similar results (7-9). In most studies, factors affecting disease severity rather than hospitalization were evaluated (10,11). However, hospitalization of patients indicates the high severity of the disease. Hospitalization rates were high in our study. In the early phase of the pandemic, patients with COVID-19 were hospitalized more often, as the course of the disease is not known exactly, and practices of local health committees recommended that patients be hospitalized for isolation.

Studies have shown that age is the most important predictor of death or severe stage in patients (12-16). Older age affects the immune system, which prevents virus reproduction (17).

We determined that specific symptoms such as fever and dyspnea were more common in patients who were hospitalized than those who were not hospitalized. Under the literature, we found that the presence of high fever and dyspnea symptoms increased hospital admissions. (18-22). 

Wiemers et al. (23) showed that socioeconomic status is associated with COVID-19 adverse events. Clouston et al. (24) reported that higher socioeconomic status was associated with the earlier incidence of index cases. Sese et al. (25) stated that low socioeconomic status may contribute to the excess mortality observed in hospitalized patients. Therefore, particular attention should be paid to patients with low socioeconomic status to fight against health disparities in the context of the COVID-19 epidemic. 

The presence of underlying chronic lung disease has been identified as an increased risk factor for COVID-19 infection (26,27). In the present study, it was found that people with comorbid diseases had more severe diseases. 

The results of this study may contribute to the training of clinicians during this disease. This study can be a guide in the development of preventive interventions for hospitalization and the evaluation of risk factors within the scope of clinical applications.

Interestingly, we found that the hospitalization rate was less in patients with sore throat in our study. Sore throat is a common symptom of COVID-19. A sore throat could lead to an early diagnosis of COVID-19. Sore throat is often associated with the upper respiratory tract rather than the lower respiratory tract.

Conclusion

Older age, low income, presence of fever, dyspnea, or chronic lung disease are determinants in hospitalization in patients with COVID-19. During COVID-19 disease, it is important to determine the risk factors in the transition to the severe disease stage to ensure more appropriate and efficient management of the disease. 

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How to cite: Ozdemir C, Durmaz A, Akbas Gunes N. Epidemiological characteristics of COVID-19 patients in Kütahya province in Turkey. Euras J Fam Med 2021;10(3):135-40. doi:10.33880/ejfm.2021100304.


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