Cancer and the risk of COVID-19 diagnosis, hospitalisation, and death: a population-based multi-state cohort study including 4,618,377 adults in Catalonia, Spain.
Roel E., Pistillo A., Recalde M., Fernández-Bertolín S., Aragón M., Soerjomataram I., Jenab M., Puente D., Prieto-Alhambra D., Burn E., Duarte-Salles T.
The relationship between cancer and COVID-19 infection and severity remains poorly understood. We conducted a population-based cohort study between 1 March and 6 May 2020 describing the associations between cancer and risk of COVID-19 diagnosis, hospitalisation, and COVID-19-related death. Data was obtained from the SIDIAP database, including primary care electronic health records from ~80% of the population in Catalonia, Spain. Cancer was defined as any primary invasive malignancy excluding non-melanoma skin cancer. We estimated adjusted hazard ratios (aHRs) for the risk of COVID-19 (outpatient) clinical diagnosis, hospitalisation (with or without a prior COVID-19 diagnosis) and COVID-19-related death using Cox proportional hazard regressions. Models were estimated for the overall cancer population and by years since cancer diagnosis (<1-year, 1-5-years, ≥5-years), sex, age, and cancer type; and adjusted for age, sex, smoking status, deprivation, and comorbidities. We included 4,618,377 adults, of which 260,667 (5.6%) had a history of cancer. A total of 98,951 individuals (5.5% with cancer) were diagnosed and 6,355 (16.4% with cancer) were directly hospitalised with COVID-19. Of those diagnosed, 6,851 were subsequently hospitalised (10.7% with cancer) and 3,227 died without being hospitalised (18.5% with cancer). Among those hospitalised, 1,963 (22.5% with cancer) died. Cancer was associated with an increased risk of COVID-19 diagnosis (aHR: 1.08; 95% CI [1.05-1.11]); direct COVID-19 hospitalisation (1.33 [1.24-1.43]); and death following hospitalisation (1.12 [1.01-1.25]). These associations were stronger for patients recently diagnosed with cancer, aged <70 years, and with haematological cancers. These patients should be prioritised in COVID-19 vaccination campaigns and continued non-pharmaceutical interventions. This article is protected by copyright. All rights reserved.