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Adeel Aslam
Fahad Asim
Aamna Habib
Sadia Rafique
Wajiha Tahir
Rafia Anjum
Adiya Afzal
Tayyeba Mirza
Hamna Zaheer
Abdul Qader
Muhammad Sarfraz
Kanwal Asif


SARS-CoV-2, Comorbidities, and mortality



The ongoing COVID-19 pandemic, caused by a novel coronavirus, has resulted in significant morbidity and mortality worldwide. Pre-existing health conditions, such as hypertension, cardiovascular diseases, obesity, asthma, immunodeficiency, chronic kidney disease, neurodegenerative disorders, and diabetes, have been shown to enhance the risk of infection and exacerbate prognostic outcomes. Countries that have observed this correlation between COVID-19 mortality and comorbidities include Italy, the United States, and the United Kingdom. Objective: So, the objective of the current study is to analyze how comorbidities affect clinical patterns and outcomes, emphasizing the importance of understanding their role in the severity of COVID-19.


The methodology of the study involves conducting research in low- and middle-income countries while utilizing the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines for data extraction and screening.


The results of this review analysis revealed that COVID-19 patients with comorbidities, specifically hypertension, diabetes, cardiovascular illnesses, respiratory disorders, and smoking, experienced higher mortality rates. It was observed that younger individuals had a greater infection rate, while older individuals faced a higher risk of death due to complications. Notably, the age group between 18 to 59 years, representing the economically active population, exhibited the highest rate of COVID-19 infection. Conversely, individuals aged 60 years and above had a higher fatality rate attributed to disease-related complications.


Comorbidities such as cardiovascular diseases and diabetes were found to drastically increase the likelihood of severe outcomes among affected patients. So, the current systematic review findings confirm the close association between pre-existing health conditions and COVID-19-related fatalities.

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1. Bornstein SR, Rubino F, Khunti K, et al. Practical recommendations for the management of diabetes in patients with COVID-19. The Lancet Diabetes & Endocrinology. 2020;8(6):546-550. doi: 10.1016/s2213-8587(20)30152-2
2. WHO. WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020 available on
3. Wang H, Paulson KR, Pease SA, et al. Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020–21. Vaccines. 2022;399(10334):1513-1536. doi: 10.1787/cf265a42-en
4. Cao J, Hu X, Cheng W, Yu L, Tu W-J, Liu QJIcm. Clinical features and short-term outcomes of 18 patients with corona virus disease 2019 in intensive care unit. Intensive Care Medicine. 2020;46:851-853. doi: 10.1007/s00134-020-05987-7
5. Amatriain-Fernández S, Gronwald T, Murillo-Rodríguez E, et al. Physical Exercise Potentials Against Viral Diseases Like COVID-19 in the Elderly. Frontiers in medicine. 2020;7:379. doi: 10.3389/fmed.2020.00379
6. Mehraeen E, Karimi A, Barzegary A, et al. Predictors of mortality in patients with COVID-19-a systematic review. European Journal of Integrative Medicine. 2020;40:101226. doi:10.1016/j.eujim.2020.101226
7. Verity R, Okell LC, Dorigatti I, et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. The Lancet Infectious Diseases. 2020;20(6):669-677. doi: 10.1016/s1473-3099(20)30243-7
8. SeyedAlinaghi S, Mirzapour P, Dadras O, et al. Characterization of SARS-CoV-2 different variants and related morbidity and mortality: a systematic review. European Journal of Medical Research. 2021;26(1):51. doi: 10.1186/s40001-021-00524-8
9. Mehta A, Vasudevan S, Parkash A, Sharma A, Vashist T, Krishna VJP. COVID-19 mortality in cancer patients: a report from a tertiary cancer centre in India. PeerJ2021;9:e10599. doi:10.7717/peerj.10599
10. Jarahzadeh MH, Asadian F, Farbod M, et al. Cancer and coronavirus disease (COVID-19): Comorbidity, mechanical ventilation, and death risk. Journal of Gastrointestinal Cancer. 2021;52:80-84. doi: 10.1007/s12029-020-00529-2
11. Escobedo-de la Peña J, Rascón-Pacheco RA, de Jesús Ascencio-Montiel I, et al. Hypertension, diabetes and obesity, major risk factors for death in patients with COVID-19 in Mexico. Archives of Medical Research. 2021;52(4):443-449. doi: 10.1016/j.arcmed.2020.12.002
12. Teixeira-Vaz A, Rocha JA, Costa A, et al. What is the impact of previous cerebrovascular disease on critical COVID-19 patients' mortality? A prospective cohort study. Journal of the neurological sciences. 2022;442:120382. doi: 10.1016/j.jns.2022.120382
13. Dave JA, Tamuhla T, Tiffin N, et al. Risk factors for COVID-19 hospitalisation and death in people living with diabetes: A virtual cohort study from the Western Cape Province, South Africa. Diabetes Research and Clinical Practice. 2021;177:108925. doi: 10.1016/j.diabres.2021.108925
14. Hernández-Galdamez DR, González-Block MÁ, Romo-Dueñas DK, et al. Increased risk of hospitalization and death in patients with COVID-19 and pre-existing non-communicable diseases and modifiable risk factors in Mexico. Archives of Medical Research. 2020;51(7):683-689. doi: 10.1016/j.arcmed.2020.07.003
15. Martinez EZ, Aragon DC, Pontes CM, et al. Comorbidities and the risk of death among individuals infected by COVID-19 in Espírito Santo, Brazil. Revista da Sociedade Brasileira de Medicina Tropical. 2021;54. doi: 10.1590/0037-8682-0138-2021
16. Cheng Y, Luo R, Wang K, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney International. 2020;97(5):829-838. doi: 10.1016/j.kint.2020.03.005
17. Harbuwono DS, Handayani DO, Wahyuningsih ES, et al. Impact of diabetes mellitus on COVID-19 clinical symptoms and mortality: Jakarta's COVID-19 epidemiological registry. Primary Care Diabetes. 2022;16(1):65-68. doi: 10.1016/j.pcd.2021.11.002
18. Orioli L, Servais T, Belkhir L, et al. Clinical characteristics and short-term prognosis of in-patients with diabetes and COVID-19: a retrospective study from an academic center in Belgium. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2021;15(1):149-157. doi: 10.1016/j.dsx.2020.12.020
19. UlHaq Z, Shahzad M, Khattak MI, et al. Clinical Characteristics, Mortality and Associated risk factors in COVID-19 patients reported in ten major hospitals of Khyber Pakhtunkhwa. AEA Randomized Controlled Trials. 2020;32(4 Suppl 1):633-639. doi: 10.1257/rct.6307-1.0
20. Karasneh RA, Khassawneh BY, Al-Azzam S, et al. Risk Factors Associated with Mortality in COVID-19 Hospitalized Patients: Data from the Middle East. International Journal of Clinical Practice. 2022;2022. doi: 10.1155/2022/9617319
21. Gustani-Buss EG, Buss CE, Cavalli LR, et al. Cross-sectional study for COVID-19-related mortality predictors in a Brazilian state-wide landscape: the role of demographic factors, symptoms and comorbidities. BMJ open. 2022;12(10):e056801. doi: 10.1136/bmjopen-2021-056801
22. Cordero-Franco HF, De La Garza-Salinas LH, Gomez-Garcia S, Moreno-Cuevas JE, Vargas-Villarreal J, González-Salazar FJFiPH. Risk factors for SARS-CoV-2 infection, pneumonia, intubation, and death in northeast mexico. Frontiers in Public Health. 2021;9:645739. doi: 10.3389/fpubh.2021.645739
23. Jassat W, Cohen C, Tempia S, et al. A national cohort study of COVID-19 in-hospital mortality in South Africa: the intersection of communicable and non-communicable chronic diseases in a high HIV prevalence setting. MedRxiv. 2020:2020.2012. 2021.20248409. doi: 10.1101/2020.12.21.20248409
24. Rohith M, Monika N, Rajanna AH, Ravi KJAJoIM. Study of impact of comorbidities on patients with COVID-19 infection. APIK Journal of Internal Medicine. 2021;9(4):233-238. doi: 10.4103/ajim.ajim_69_21
25. Huang S, Wang J, Liu F, et al. COVID-19 patients with hypertension have more severe disease: a multicenter retrospective observational study. 2020;43(8):824-831.
26. Tamura RE, Said SM, de Freitas LM, Rubio IGSJD, syndrome m. Outcome and death risk of diabetes patients with Covid-19 receiving pre-hospital and in-hospital metformin therapies. Diabetology & Metabolic Syndrome. 2021;13(1):1-13. doi: 10.1186/s13098-021-00695-8
27. Martínez-Martínez OA, Valenzuela-Moreno KA, Coutiño BJIJfEiH. Effect of comorbidities and risk conditions on death from COVID-19 in migrants in Mexico. International Journal for Equity in Health. 2021;20:1-11. doi: 10.1186/s12939-021-01599-9
28. Jha M, Tak M, Gupta R, et al. Relationship of anemia with COVID-19 deaths: A retrospective cross-sectional study. 2022;38(Suppl 1):S115. doi: 10.4103/joacp.joacp_63_22
29. Hartantri Y, Debora J, Widyatmoko L, et al. Clinical and treatment factors associated with the mortality of COVID-19 patients admitted to a referral hospital in Indonesia. The Lancet Regional Health - Southeast Asia. 2023;11. doi: 10.1016/j.lansea.2023.100167
30. Vecino-Ortiz AI, Villanueva Congote J, Zapata Bedoya S, Cucunuba ZMJPO. Impact of contact tracing on COVID-19 mortality: An impact evaluation using surveillance data from Colombia. PLOS ONE. 2021;16(3):e0246987. doi: 10.1371/journal.pone.0246987
31. Sifuentes-Osornio J, Angulo-Guerrero O, De Anda-Jáuregui G, et al. Probability of hospitalisation and death among COVID-19 patients with comorbidity during outbreaks occurring in Mexico City. Journal of Global Health. 2022;12. doi: 10.7189/jogh.12.05038
32. Koya SF, Ebrahim SH, Bhat LD, et al. COVID-19 and comorbidities: Audit of 2,000 COVID-19 deaths in India. Journal of Epidemiology and Global Health. 2021;11(2):230. doi: 10.2991/jegh.k.210303.001
33. Dimova R, Stoyanova R, Blagoeva V, Mavrov M, Doykov M. COVID-19 mortality and related comorbidities in hospitalized patients in Bulgaria. Healthcare. 2022. 10:8:1525. doi: 10.3390/healthcare10081535
34. Jassat W, Cohen C, Tempia S, et al. COVID-19 in-hospital mortality in South Africa: The intersection of communicable and non-communicable chronic diseases in a high HIV prevalence setting. Medrixv. 2020. doi: 10.1101/2020.12.21.20248409
35. Jud P, Gressenberger P, Muster V, et al. Evaluation of endothelial dysfunction and inflammatory vasculopathy after SARS-CoV-2 infection—a cross-sectional study. Frontiers in Cardiovascular Medicine. 2021;8:750887. doi: 10.3389/fcvm.2021.750887
36. Bae S, Kim SR, Kim M-N, Shim WJ, Park S-M. Impact of cardiovascular disease and risk factors on fatal outcomes in patients with COVID-19 according to age: a systematic review and meta-analysis. Heart. 2021;107(5):373-380. doi: 10.1136/heartjnl-2020-317901
37. Nishijima Y, Hader SN, Hanson AJ, et al. Prolonged endothelial-dysfunction in human arterioles following infection with SARS-CoV-2. Cardiovascular Research. 2022;118(1):18-19. doi: 10.1093/cvr/cvab339
38. Carnevale S, Beretta P, Morbini P. Direct endothelial damage and vasculitis due to SARS-CoV-2 in small bowel submucosa of COVID-19 patient with diarrhea. Journal of Medical Virology. 2021;93(1):61-63. doi: 10.1002/jmv.26119
39. Degauque N, Haziot A, Brouard S, Mooney N. Endothelial cell, myeloid, and adaptive immune responses in SARS-CoV-2 infection. The FASEB Journal. 2021;35(5):e21577.
40. Liu F, Han K, Blair R, et al. SARS-CoV-2 Infects Endothelial Cells In Vivo and In Vitro. Frontiers in cellular and infection microbiology. 2021;11:701278. doi: 10.1096/fj.202100024r
41. Ahmetaj-Shala B, Vaja R, Atanur SS, George PM, Kirkby NS, Mitchell JA. Cardiorenal Tissues Express SARS-CoV-2 Entry Genes and Basigin (BSG/CD147) Increases With Age in Endothelial Cells. JACC Basic to translational science. 2020;5(11):1111-1123. doi: 10.1016/j.jacbts.2020.09.010
42. Bojkova D, Wagner JUG, Shumliakivska M, et al. SARS-CoV-2 infects and induces cytotoxic effects in human cardiomyocytes. Cardiovascular Research. 2020;116(14):2207-2215. doi: 10.1093/cvr/cvaa267
43. Tucker NR, Chaffin M, Bedi KC, Jr., et al. Myocyte-Specific Upregulation of ACE2 in Cardiovascular Disease: Implications for SARS-CoV-2-Mediated Myocarditis. Circulation. 2020;142(7):708-710. doi: 10.1161/circulationaha.120.047911
44. Fagyas M, Bánhegyi V, Úri K, et al. Changes in the SARS-CoV-2 cellular receptor ACE2 levels in cardiovascular patients: a potential biomarker for the stratification of COVID-19 patients. GeroScience. 2021;43(5):2289-2304. doi: 10.1007/s11357-021-00467-2
45. Fagyas M, Kertész A, Siket IM, et al. Level of the SARS-CoV-2 receptor ACE2 activity is highly elevated in old-aged patients with aortic stenosis: implications for ACE2 as a biomarker for the severity of COVID-19. GeroScience. 2021;43(1):19-29. doi: 10.1007/s11357-020-00300-2
46. Lecarpentier Y, Vallée A. The key role of the level of ACE2 gene expression in SARS-CoV-2 infection. Aging. 2021;13(11):14552-14556. doi: 10.18632/aging.203181
47. Bajaj V, Gadi N, Spihlman AP, Wu SC, Choi CH, Moulton VR. Aging, Immunity, and COVID-19: How Age Influences the Host Immune Response to Coronavirus Infections? Front Physiology. 2020;11:571416. doi: 10.3389/fphys.2020.571416
48. Nikolich-Zugich J, Knox KS, Rios CT, Natt B, Bhattacharya D, Fain MJ. SARS-CoV-2 and COVID-19 in older adults: what we may expect regarding pathogenesis, immune responses, and outcomes. GeroScience. 2020;42(2):505-514. doi: 10.1007/s11357-020-00186-0
49. Bartleson JM, Radenkovic D, Covarrubias AJ, Furman D, Winer DA, Verdin E. SARS-CoV-2, COVID-19 and the Ageing Immune System. Nature aging. 2021;1(9):769-782. doi: 10.1007/s11357-020-00186-0
50. Nicoli F, Solis-Soto MT, Paudel D, et al. Age-related decline of de novo T cell responsiveness as a cause of COVID-19 severity. GeroScience. 2020;42(4):1015-1019. doi: 10.1007/s11357-020-00217-w
51. Pence BD. Severe COVID-19 and aging: are monocytes the key? GeroScience. 2020;42(4):1051-1061. doi: 10.1007/s11357-020-00213-0
52. Campana P, Palaia ME, Conte M, et al. The elderly at risk: aldosterone as modulator of the immune response to SARS-CoV-2 infection. GeroScience. 2022;44(2):567-572. doi: 10.1007/s11357-021-00481-4
53. Justice JN, Gubbi S, Kulkarni AS, Bartley JM, Kuchel GA, Barzilai N. A geroscience perspective on immune resilience and infectious diseases: a potential case for metformin. GeroScience. 2021;43(3):1093-1112. doi: 10.1007/s11357-020-00261-6
54. Budamagunta V, Foster TC, Zhou D. Cellular senescence in lymphoid organs and immunosenescence. Aging. 2021;13(15):19920-19941. doi: 10.18632/aging.203405
55. Zhou C, Zhang T, Ren H, et al. Impact of age on duration of viral RNA shedding in patients with COVID-19. Aging. 2020;12(22):22399-22404. doi: 10.18632/aging.104114
56. Connors J, Bell MR, Marcy J, Kutzler M, Haddad EK. The impact of immuno-aging on SARS-CoV-2 vaccine development. GeroScience. 2021;43(1):31-51. doi: 10.1007/s11357-021-00323-3
57. Tripathi U, Nchioua R, Prata L, et al. SARS-CoV-2 causes senescence in human cells and exacerbates the senescence-associated secretory phenotype through TLR-3. Aging. 2021;13(18):21838-21854. doi: 10.18632/aging.203560
58. Salimi S, Hamlyn JM. COVID-19 and Crosstalk With the Hallmarks of Aging. J Gerontol A Biol Sci Med Sci. 2020;75(9):e34-e41. doi: 10.1093/gerona/glaa149
59. Khattab MH, Prodan CI, Vincent AS, et al. Increased procoagulant platelet levels are predictive of death in COVID-19. GeroScience. 2021;43(4):2055-2065. doi: 10.1007/s11357-021-00385-3
60. Danics K, Pesti A, Törő K, et al. A COVID-19-association-dependent categorization of death causes in 100 autopsy cases. GeroScience. 2021;43(5):2265-2287. doi: 10.1007/s11357-021-00451-w
61. WHO. Statement – Older people are at highest risk from COVID-19, but all must act to prevent community spread. 2020;
62. Saleem, A., Davis, M., Rafique, S., Meer, S., Qader, A., & Aslam, M. N. (2023). A Critical Glance to Non-Pharmacological Management of Novel COVID-19 Infection: Non-Pharmacological Management of COVID-19 Infection. Pakistan Journal of Health Sciences, 02-13.
63. Shabbir, I., Qader, A., Ahmad, Z., Tariq, H., Davis, M., Rafique, S., & Zia, A. (2023). Monkeypox Virus a Rising Concern in Current age: A Mini Review on Epidemiology, Clinical Manifestations and Therapeutic interventions. The Journal of Medical Research, 9(3), 58-62.
64. Hayat, A. Q., & Akash, M. S. H. (2020). Effect of Novel COVID-19 Infection on Different Organs of Human Body: A Narrative Review. Journal of Islamabad Medical & Dental College, 9(4), 303-306.
65 Qader, A., Tariq, H., & Hayat, M. K. (2024). Risk of Zoonotic Transmission of COVID-19 during Eid-Ul-Fitr in Pakistan. Health Dynamics, 1(4), 108-110.

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