Figure 1
Central figure displaying participating sites and key study findings.
Figure 2
Hospital level resources and ICU admissions by regions. Figure 1 shows that sites in the African region had significantly lower rates of specialist care, advanced care, and ICU admissions compared to non-African sites.
Table 1
Demographic and clinical characteristics of African study participants vs. non-African study participants. The African cohort was significantly younger and had a significantly higher percentage of black participants compared to the non-African cohort. African sites fell into lower and lower-middle income categories, whereas the non-African cohort was comprised of lower-middle- and higher-income sites. African participants had significantly higher heart rates and rates of hypertension with higher baseline systolic and diastolic blood pressures. Covid-19 vaccination rates were significantly lower in the African cohort.
| AFRICA COHORT | NON-AFRICAN COHORT | P-VALUESFOR DIFFERENCE BETWEEN OVERALL AFRICAN AND NON-AFRICAN VALUES | ||||||
|---|---|---|---|---|---|---|---|---|
| OVERALL (N = 948) | SURVIVORS (N = 775) | NON-SURVIVORS (N = 173) | OVERALL (4365) | SURVIVORS (3737) | NON-SURVIVORS (N = 628) | |||
| Age | mean (SD) | 55.0 (16.0) | 53.5 (15.5) | 62.1 (16.1) | 57.5 (16.0) | 56.1 (16.0) | 65.6 (13.4) | <0.001 |
| Sex | Female | 394 (41.6) | 319 (41.2) | 75 (43.3) | 1760 (40.3) | 1551 (41.5) | 209 (33.3) | 0.5 |
| Male | 554 (58.4) | 456 (58.8) | 98 (56.6) | 2605 (59.7) | 2186 (58.5) | 419 (66.7) | ||
| Ethnic Origin | Caucasian | 5 (0.5) | 5 (0.6) | 0 (0.0) | 795 (18.2) | 744 (19.9) | 51 (8.1) | <0.001 |
| Hispanic | 11 (1.2) | 10 (1.3) | 1 (0.6) | 531 (12.1) | 393 (10.5) | 138 (21.9) | ||
| Black | 743 (78.4) | 620 (80.0) | 123 (71.1) | 53 (1.2) | 49 (1.3) | 4 (0.6) | ||
| Middle Eastern | 6 (0.6) | 5 (0.6) | 1 (0.6) | 309 (7.0) | 278 (7.4) | 31 (4.9) | ||
| Asian | 22 (22.3) | 16 (2.1) | 6 (3.5) | 2420 (55.4) | 2030 (54.3) | 390 (62.1) | ||
| Other | 159 (16.8) | 117 (15.1) | 42 (24.3) | 200 (4.5) | 186 (4.9) | 14 (2.2) | ||
| Unknown | 2 (0.2) | 2 (0.3) | 0 (0.0) | 57 (1.3) | 57 (1.5) | 0 | ||
| World Bank Income Groups | LIC | 376 (39.7) | 331 (42.7) | 45 (26.0) | 0 | 0 | 0 | <0.001 |
| LMIC | 383 (40.4) | 303 (39.1) | 80 (46.2) | 2250 (51.5) | 1838 (49.2) | 412 (65.6) | ||
| MIC | 189 (19.9) | 141 (18.2) | 48 (27.7) | 748 (17.1) | 601 (16.1) | 147 (23.4) | ||
| HIC | 0 | 0 | 0 | 1367 (31.3) | 1298 (34.7) | 69(11.0) | ||
| Body Mass Index | (Kg/m2), mean (SD) | 26.9 (7.4) | 26.6 (7.55) | 28.8 (6.3) | 26.8 (5.2) | 26.9 (5.18) | 26.5 (5.09) | <0.001 |
| Underweight (<18) | 38 (4.0) | 29 (3.7) | 10 (5.8) | 45 (1.0) | 38 (1.0) | 7 (1.1) | ||
| Normal weight (18–24.99) | 115 (12.1) | 105 (13.5) | 1 (0.6) | 1302 (29.8) | 1140 (30.5) | 162 (25.7) | ||
| Overweight (25–29.99) | 113 (13.8) | 101 (14.8) | 12 (6.9) | 1168 (26.8) | 1032 (27.6) | 136 (21.6) | ||
| Obese (≥ 30) | 131 (13.8) | 115 (14.8) | 16 (9.2) | 697 (16.0) | 615 (16.4) | 82 (13.0) | ||
| Unknown | 551 (58.1) | 425 (54.8) | 134 (77.5) | 1153 (26.4) | 912 (24.4) | 241 (38.3) | ||
| Cough | 609 (64.0) | 494 (63.7) | 115 (66.4) | 3015 (69.1) | 2593 (69.3) | 422 (67.2) | 0.005 | |
| Dyspnoea or Tachypnoea | 580 (61.2) | 435 (56.1) | 145 (83.8) | 2728 (62.5) | 2254 (60.3) | 474 (75.5) | 0.5 | |
| Heart rate (beats/min), mean (SD) | 94.3 (19.8) | 92.6 (18.3) | 102 (24.1) | 91.5 (17.2) | 90.9 (16.7) | 95.3 (19.8) | <0.001 | |
| Systolic BP (mmHg), mean (SD) | 133.7 (22.6) | 134.1 (21.2) | 132 (28.0) | 128.0 (20.3) | 128.0 (19.5) | 129.0 (24.7) | <0.001 | |
| Diastolic BP (mmHg), mean (SD) | 81.4 (14.7) | 82.3 (13.9) | 77.1 (17.1) | 77.5 (12.5) | 77.7 (12.1) | 76.4 (14.8) | <0.001 | |
| Comorbidities (cardiovascular) | Hypertension | 463 (48.8) | 356 (45.9) | 107 (61.8) | 2048 (46.9) | 1704 (45.6) | 344 (54.8) | 0.09 |
| Diabetes | 240 (25.3) | 172 (22.2) | 68 (39.3) | 1460 (33.4) | 1174 (31.4) | 286 (45.5) | <0.001 | |
| Coronary Artery disease | 35 (3.7) | 26 (3.4) | 9 (5.2) | 545 (12.4) | 420 (11.2) | 125 (19.9) | <0.001 | |
| Heart Failure | 37 (3.9) | 32 (4.1) | 5 (2.9) | 253 (5.8) | 206 (5.5) | 47 (7.4) | 0.02 | |
| Stroke | 35 (3.7) | 29 (3.7) | 6 (3.4) | 162 (3.7) | 130 (3.4) | 32 (5.0) | 0.6 | |
| Atrial Fibrillation | 11 (1.2) | 7 (0.9) | 4 (2.3) | 148 (3.4) | 127 (3.4) | 21 (3.3) | <0.001 | |
| Peripheral Vascular Disease | 12 (1.3) | 9 (1.2) | 3 (1.7) | 94 (2.2) | 76 (2.0) | 18 (2.8) | 0.1 | |
| Cardiomyopathies | 13 (1.4) | 10 (1.3) | 3 (1.7) | 47 (1.1) | 43 (1.1) | 4 (0.6) | 0.5 | |
| Rheumatic Heart Disease | 2 (0.2) | 2 (0.3) | 0 | 54 (1.2) | 47 (1.3) | 7 (1.1) | 0.003 | |
| Chagas Disease | 0 | 0 | 0 | 36 (0.8) | 34 (0.9) | 2 (0.3) | <0.001 | |
| Congenital Heart disease | 3 (0.3) | 3 (0.4) | 0 | 179 (4.1) | 163 (4.3) | 16 (2.5) | <0.001 | |
| Valvular Disease | 8 (0.8) | 6 (0.8) | 2 (1.2) | 110 (2.5) | 88 (2.4) | 22 (3.5) | <0.001 | |
| Comorbidities (non-cardiovascular) | Chronic Kidney Disease | 54 (5.7) | 34 (4.4) | 20 (11.5) | 350 (8.0) | 265 (7.1) | 85 (13.5) | <0.001 |
| Chronic Pulmonary disease | 20 (2.1) | 15 (1.9) | 5 (2.9) | 189 (4.3) | 145 (3.8) | 44 (7.0) | 0.002 | |
| Asthma | 38 (4.0) | 33 (4.3) | 5 (2.9) | 181 (4.1) | 167 (4.4) | 14 (2.2) | 0.2 | |
| Chronic Immunosuppression | 24 (2.5) | 18 (2.3) | 6 (3.4) | 112 (2.6) | 92 (2.4) | 20 (3.1) | <0.001 | |
| HIV | 56 (5.9) | 48 (6.2) | 8 (4.6) | 15 (0.3) | 14 (0.4) | 1 (0.1) | <0.001 | |
| Tuberculosis | 34 (3.6) | 31 (4.0) | 3 (3.4) | 22 (0.3) | 18 (0.5) | 4 (0.6) | <0.001 | |
| Cancer on Chemotherapy | 6 (0.6) | 3 (0.4) | 3 (3.4) | 108 (2.5) | 87 (2.3) | 21 (3.3) | 0.003 | |
| Renal Replacement Therapy | 6 (0.6) | 3 (0.4) | 3 (3.4) | 56 (1.3) | 42 (1.1) | 14 (2.2) | <0.001 | |
| Previous Organ Transplant | 2 (0.2) | 1 (0.1) | 1 (0.5) | 43 (1.0) | 37 (0.9) | 6 (0.9) | <0.001 | |
| Covid Vaccine | 6 (0.6) | 5 (0.6) | 1 (0.5) | 325 (7.4) | 323 (8.6) | 2 (0.3) | <0.001 | |
Table 2
In-hospital findings of participants with Covid-19. African participants had a higher WCC and a significantly higher CRP compared to non-African participants. African non-survivors had higher pro-BNP levels, higher total cholesterol levels, and LDL cholesterol levels compared to non-African non-survivors. T wave changes were more common and QTc longer in the African participants on their admission ECGs. ICU admissions rates were lower in the African cohort, but with higher rates of cardiac arrest. Other major adverse events were comparable between the two groups. Rates of pneumonia and ARDS also showed no statistically significant differences. Acute renal injury was more common in African participants.
| AFRICA COHORT | NON-AFRICAN COHORT | P-VALUES FOR DIFFERENCE BETWEEN OVERALL AFRICAN AND NON-AFRICAN VALUES | ||||||
|---|---|---|---|---|---|---|---|---|
| OVERALL (N = 948) | SURVIVORS (N = 775) | NON-SURVIVORS (N = 173) | OVERALL (N = 4365) | SURVIVORS (3737) | NON-SURVIVORS (N = 628) | |||
| Laboratory findings (median; IQR) | WCC, ×10^9/L | 2.0 (0.00, 8.8) | 2.6 (0.0, 8.5) | 0.03 (0.01, 9.3) | 4.8 (0.0, 8.3) | 5.2 (0.0, 8.5) | 0.02 (0.0, 6.9) | 0.3 |
| Hb, mml/L | 7.9 (6.9, 8.7) | 8.0 (7.1; 8.8) | 7.6 (6.4; 8.6) | 8.0 (7.1; 8.8) | 8.0 (7.2; 8.8) | 7.8 (6.6; 8.7) | 0.02 | |
| Platelets, 10^3/uL | 238 (180; 315) | 239 (182; 317) | 230 (174; 308) | 230 (166; 343) | 231 (168; 347) | 216 (152; 318) | <0.001 | |
| CRP, mg/L | 75.7 (24.5; 142.5) | 68.1 (20.9; 133) | 105.4 (52.3; 197.8) | 51 (16.6; 103.6) | 46.3 (15.1; 99.3) | 91 (34.3; 163.4) | <0.001 | |
| Creatinine, umol/L | 84.4 (69; 114.9) | 82 (67.9; 106.3) | 104.4 (74.3; 144.8) | 88.0 (70.7; 113.2) | 85.8 (69.8; 107) | 99.5 (76.3; 155.7) | 0.2 | |
| D-Dimer, mg/FEU/L | 1.0 (0.4; 5.9) | 0.8 (0.3; 6.1) | 1.9 (0.5: 5.2) | 1.0 (0.5; 4:0) | 0.9 (0.4; 3.3) | 2.0 (0.8; 5.4) | 0.7 | |
| NT-Pro-BNP, pmol/L | 60.5 (15; 257.1) | 19.6 (7.1; 85.2) | 163.7 (37.6; 480.7) | 60.1 (12; 254.0) | 47.4 (10.3; 226.1) | 130.4 (41.4; 454.0) | 0.2 | |
| HbA1c | 6.8 (6.1; 8.6) | 6.8 (6.1; 8.7) | 6.9 (6.3; 8.6) | 6.9 (6.1, 8.4) | 6.9 (6.1; 8.5) | 6.9 (6.2; 8.4) | 0.3 | |
| IL-6, pg/ml | - | - | - | 25.2 (8.7; 64.7) | 21.6 (7.0; 52.0) | 64.5 (21.3; 125.0) | - | |
| Total cholesterol. mmol/L | 4.2 (3.3; 5.1) | 4.2 (3.3; 5.2) | 4.3 (2.9; 4.9) | 4.0 (3.1; 5.0) | 4.2 (3.4; 5.2) | 3.4 (2.7; 4.3) | 0.6 | |
| HDL | 1.0 (0.8; 1.2) | 1.0 (0.8; 1.2) | 1.0 (0.8; 1.1) | 0.9 (0.8; 1.1) | 1.0 (0.8; 1.1) | 0.8 (0.6; 1.1) | 0.4 | |
| LDL | 2.5 (1.6, 3.5) | 2.5 (1.8; 3.6) | 3.3 (1.1; 3.3) | 2.2 (1.6; 2.9) | 2.3 (1.8; 3.0) | 1.6 (1.2; 2.2) | 0.8 | |
| Triglycerides | 1.5 (1.0; 2.1) | 1.5 (1.1; 2.2) | 1.1 (1.0; 1.5) | 1.6 (1.2; 2.1) | 1.6 (1.2; 2.1) | 1.6 (1.3; 2.3) | 0.2 | |
| ECG Findings | T wave changes (%) | 170 (17.9) | 131 (16.9) | 39 (22.5) | 605 (13.8) | 463 (12.3) | 142 (22.6) | 0.005 |
| AF (%) | 21 (2.2) | 13 (1.7) | 8 (4.6) | 110 (2.5) | 84 (2.2) | 26 (4.1) | <0.001 | |
| QTc (median, IQR) | 437 (406; 460) | 433 (403; 459) | 447 (420; 472) | 413 (1; 443) | 410 (1; 440) | 424 (352; 456) | <0.001 | |
| Median Length of Hospital Stay in days (IQR) | 9 (6, 13) | 9 (6, 13) | 10 (5.25, 11.50) | 10 (6,15) | 10 (6,15) | 11 (6, 17) | 0.3 | |
| ICU admission (%) | 184 (19.4) | 110 (14.2) | 74 (42.7) | 1484 (34.0) | 1063 (28.4) | 421 (67.0) | <0.001 | |
| Major Adverse Cardiovascular Events (%) | Cardiac Arrest | 71 (7.5) | 0 | 71 (41.0) | 223 (5.1) | 56 (1.4) | 167 (26.6) | 0.003 |
| Acute heart Failure | 35 (3.7) | 23 (3.0) | 12 (6.9) | 166 (3.8) | 78 (2.1) | 88 (14.0) | 0.2 | |
| Atrial Fibrillation | 15 (1.6) | 1 (0.1) | 9 (5.2) | 111 (2.5) | 80 (2.1) | 31 (4.9) | 0.1 | |
| Myocardial Infarction | 8 (0.8) | 4 (0.5) | 4 (2.3) | 76 (1.7) | 59 (1.5) | 17 (2.7) | 0.003 | |
| Myocarditis | 9 (0.9) | 5 (0.6) | 4 (2.3) | 38 (0.8) | 17 (0.4) | 21 (3.3) | 0.03 | |
| Ventricular Arrythmia | 8 (0.8) | 3 (0.4) | 5 (2.8) | 52 (1.1) | 35 (0.9) | 17 (2.7) | 0.4 | |
| Pericarditis | 13 (1.4) | 12 (1.5) | 1 (0.5) | 17 (0.3) | 15 (0.4) | 2 (0.3) | <0.001 | |
| Endocarditis | 1 (0.1) | 1 (0.1) | 0 (0.0) | 8 (0.1) | 5 (0.1) | 3 (0.4) | 0.5 | |
| Heart Blocks | 9 (0.9) | 7 (0.9) | 2 (1.2) | 68 (1.5) | 51 (1.3) | 17 (2.7) | 0.3 | |
| Haemorrhagic Stroke | 0 (0.0) | 0 (0.0) | 0 (0.0 | 21 (0.4) | 14 (0.3) | 7 (0.1) | 0.07 | |
| Ischaemic Stroke | 6 (0.6) | 3 (0.4) | 3 (1.7) | 50 (1.1) | 35 (0.9) | 15 (2.3) | 0.3 | |
| Pulmonary Embolus | 11 (1.2) | 8 (1.0) | 3 (1.7) | 105 (2.4) | 79 (1.9) | 26 (4.1) | <0.001 | |
| Respiratory Outcomes | Pneumonia | 338 (35.7) | 252 (32.5) | 86 (49.7) | 1654 (37.8) | 1324 (35.4) | 330 (52.5) | 0.2 |
| Acute Respiratory Distress Syndrome | 116 (12.2) | 58 (7.5) | 58 (33.5) | 607 (13.9) | 363 (9.7) | 244 (38.9) | <0.001 | |
| Acute Renal Injury | 120 (12.7) | 63 (8.1) | 57 (32.9) | 316 (7.2) | 144 (3.8) | 172 (27.3) | <0.001 | |
| Other | Anaemia | 87 (9.2) | 58 (7.5) | 29 (16.7) | 359 (8.2) | 253 (6.7) | 106 (16.8) | 0.4 |
| Shock | 37 (3.9) | 4 (0.5) | 33 (19.0) | 251 (5.7) | 48 (1.2) | 203 (32.3) | 0.05 | |
| Liver Dysfunction | 43 (4.5) | 30 (3.9) | 13 (7.5) | 192 (4.3) | 142 (3.7) | 50 (0.8) | <0.001 | |
Table 3
In-hospital outcomes, outcomes at 30 days, and overall causes of death in African and non-African participants. In-hospital death was more common in hospitalised African participants compared to non-African participants. Although 30-day mortality was lower in the African cohort, overall mortality was significantly higher in the African cohort.
| AFRICAN (N = 948) | NON-AFRICAN (N = 4365) | P-VALUE FOR DIFFERENCE | |
|---|---|---|---|
| In-hospital outcomes (%) | 0.03 | ||
| Discharged | 682 (71.9) | 3391 (77.7) | |
| Alive, and still an inpatient | 7 (0.7) | 157 (3.6) | |
| Transfer to another facility | 73 (7.7) | 155 (3.6) | |
| Death | 162 (17.0) | 521 (11.9) | |
| Palliative discharge | 0 (0.0) | 3 (0.1) | |
| Unknown | 24 (2.5) | 138 (3.2) | |
| Outcomes at 30 days (%) | <0.001 | ||
| Alive | 659 (69.5) | 2968 (68.0) | |
| Re-hospitalized | 5 (0.5) | 67 (1.5) | |
| Death | 11 (1.2) | 107 (2.5) | |
| Unknown/loss-to-follow-up | 79 (8.3) | 589 ((13.5) | |
| CAUSE OF DEATH (IN-HOSPITAL + 30-DAY MORTALITY) | (N = 173) | (N = 628) | <0.001 |
| Sudden Cardiac Death | 30 (17.3) | 124 (19.7) | |
| Presumed Cardiovascular | 21 (12.1) | 20 (3.2) | |
| Death due to MI | 3 (1.7) | 5 (0.8) | |
| Respiratory Failure | 69 (39.9) | 249 (39.6) | |
| Death due to Heart Failure | 3 (1.7) | 46 (7.3) | |
| Pulmonary embolus | 2 (1.2) | 8 (1.3) | |
| Death due to Stroke | 0 (0.0) | 31 (4.9) | |
| Other | 41 (23.7) | 134 (21.3) | |
| Unknown | 4 (2.3) | 11 (1.8) | |
| Overall mortality | 173 (18.2) | 628 (14.2) | 0.003 |
Table 4a
Logistic regression analyses for factors associated with in-hospital death in COVID-19 hospitalized patients – Adjusted for age, sex, BMI, smoking, vaccine status, diabetes, hypertension, COPD, asthma, HIV, and acute renal injury. Both the African and non-African cohorts showed significantly increased odds of death in participants aged 60 or older. The non-African cohort had higher odds of overall mortality in participants aged 45–60, compared to individuals 45 or younger. Being female was associated with lower odds of overall mortality in the non-African cohort compared to being male. This sex difference was not observed in the African cohort in overall mortality. In the African cohort, smoking status did not significantly change the odds of in-hospital death, whereas in the non-African cohort, smoking was protective. Vaccination status was associated with a strong protective status in the non-African cohort. Diabetes showed a significantly higher risk for in-hospital deaths both in the African and non-African cohorts. Acute renal injury showed the highest increase in odds for in-hospital death, especially in the African cohort.
| AFRICAN COHORT | NON-AFRICAN COHORT | ||||
|---|---|---|---|---|---|
| UNADJUSTED ODDS OR (95% CI) | ADJUSTED ODDS* OR (95% CI) | UNADJUSTED ODDS OR (95% CI) | ADJUSTED ODDS* OR (95% CI) | ||
| Demographic | |||||
| Age | <45 (Ref) | 1.0 | 1,0 | 1.0 | 1.0 |
| 45–60 | 1.09 (0.64, 1.87) | 0.63 (0.14, 2.81) | 2.63 (1.85, 3.80) | 1.91 (1.25, 3.00) | |
| >60 | 3.28 (2.11, 5,23) | 2.95 (0.86, 11.33) | 4.90 (3.56, 6.90) | 3.73 (2.52, 5.67) | |
| Sex | Male | 1.0 | 1,0 | 1.0 | 1.0 |
| Female | 1.12 (0.79, 1.57) | 1.81 (0.67, 5.08) | 0.76 (0.63, 0.92) | 0.76 (0.58, 1.00) | |
| History | |||||
| Smoking status | Never (Ref) | 1.0 | 1.0 | 1.0 | 1.0 |
| Current | 1.96 (0.71, 4.67) | 10.57 (0.46, 101.00) | 0.36 (0.21, 0.59) | 0.44 (0.24, 0.76) | |
| Former | 2.15 (1.04, 4.18) | 1.54 (0.22, 8.33) | 0.92 (0.70, 1.19) | 0.64 (0.45, 0.90) | |
| BMI | 18–24 | 1.0 | 1,0 | 1.0 | 1.0 |
| <18 | 0.32 (0.02, 1.78) | 0.27 (0.01, 1.92) | 1.05 (0.36, 2.48) | 0.88 (0.27, 2.31) | |
| 25–29 | 1.27 (0.50, 3.27) | 0.78 (0.23, 2.54) | 1.01 (0.78, 1.31) | 0.94 (0.71, 1.25) | |
| >30 | 1.52 (0.65, 3.76) | 1.03 (0.32, 3.33) | 0.99 (0.73, 1.33) | 0.85 (0.60, 1.19) | |
| COVID vaccine status | Unvaccinated | 1.0 | 1,0 | 1.0 | 1.0 |
| Vaccinated | 0.39 (0.02, 2.49) | – | 0.02 (0.00, 0.08) | 0.09 (0.00, 0.40) | |
| Clinical | |||||
| Comorbidities | DM | 2.47 (1.72, 3.52) | 3.51 (1.31, 9.62) | 1.82 (1.51, 2.19) | 1.43 (1.10, 1.85) |
| COPD | 1.22 (0.35, 3.37) | – | 2.06 (1.42, 2.93) | 2.03 (1.19, 3,36) | |
| Asthma | 0.72 (0.24, 1.72) | 1.69 (0.08, 11.47) | 0.56 (0.30, 0.95) | 0.55 (0.26, 1.07) | |
| Hypertension | 1.98 (1.40, 2.83) | 1.96 (0.68, 5.96) | 1.49 (1.4, 1.79) | 0.89 (0.68, 1.16) | |
| HIV | 0.57 (0.22, 1.25) | 0.74 (0.06, 4.45) | – | – | |
| In-hospital complications | Acute renal injury | 5.69 (3.75, 8.62) | 48.12 (13.44, 197.50) | 10.36 (8.10, 13.25) | 8.27 (6.07, 11.27) |
Table 4b
Logistic Regression analysis for factors associated with overall mortality in Covid-19 hospitalised patients. *Adjusted for demographic variables age, sex, BMI, smoking, vaccine status, diabetes, hypertension, COPD, asthma, HIV, and acute renal injury. In the non-African cohort, both participants aged >60 and between 45–60 had higher odds of overall mortality. In the African cohort, only those above the age of 60 were at higher risk of mortality. There was no sex difference in the African participants associated with mortality, but in the non-African cohort, being of female sex was protective. Current smoking status appeared protective only in the non-African cohort. Diabetes was associated with a significantly higher mortality in both groups. AKI showed increased mortality in both groups in adjusted models, but showed a much higher risk of death in the African cohort.
| AFRICAN COHORT | NON-AFRICAN COHORT | ||||
|---|---|---|---|---|---|
| UNADJUSTED ODDS OR (95% CI) | ADJUSTED ODDS* OR (95% CI) | UNADJUSTED ODDS OR (95% CI) | ADJUSTED ODDS* OR (95% CI) | ||
| Demographic | |||||
| Age | <45 (Ref) | 1.0 | 1,0 | 1.0 | 1.0 |
| 45–60 | 1.01 (0.60, 1.71) | 0.66 (0.15, 2.76) | 2.76 (2.00, 3.89) | 2.14 (1.42, 3.29) | |
| >60 | 3.42 (2.23, 5.38) | 4.03 (1.26, 14.73) | 5.27 (3.92, 7.24) | 4.18 (2.86, 6.26) | |
| Sex | Male | 1.0 | 1,0 | 1.0 | 1.0 |
| Female | 1.09 (0.78, 1.52) | 1.95 (0.76, 5.17) | 0.70 (0.59, 0.84) | 0.71 (0.55, 0.91) | |
| History | |||||
| Smoking status | Never (Ref) | 1.0 | 1,0 | 1.0 | 1.0 |
| Current | 2.00 (0.78, 4.57) | 8.04 (0.36, 72.45) | 0.43 (0.27, 0.66) | 0.53 (0.31, 0.86) | |
| Former | 1.82 (0.88, 3.50) | 1.15 (0.17, 5.86) | 0.98 (0.76, 1.25) | 0.70 (0.50, 0.97) | |
| BMI | 18–24 | 1.0 | 1,0 | 1.0 | 1.0 |
| <18 | 0.28 (0.02, 1.56) | 0.24 (0.01, 1.64) | 1.30 (0.52, 2.78) | 1.19 (0.43, 2.85) | |
| 25–29 | 1.25 (0.52, 3.08) | 0.77 (0.25, 2,36) | 0.93 (0.73,1.18) | 0.85 (0.65, 1.11) | |
| >30 | 1.46 (0.64, 3.47) | 0.98 (0.33, 2.96) | 0.94 (0.70, 1.24) | 0.81 (0.59, 1.11) | |
| COVID vaccine status | Unvaccinated | 1.0 | 1,0 | 1.0 | 1.0 |
| Vaccinated | 0.37 (0.02, 2.33) | – | 0.03 (0.0, 0.09) | – | |
| Clinical | |||||
| Comorbidities | DM | 2.31 (1.62, 3.28) | 3.07 (1.20, 7.92) | 1.81 (1.52, 2.14) | 1.43 (1.11, 1.83) |
| COPD | 1.51 (0.48, 3.95) | – | 1.86 (1.30, 2.61) | 2.05 (1.24, 3.31) | |
| Asthma | 0.67 (0.23, 1.59) | 1.11 (0.06, 7.29) | 0.49 (0.27, 0.81) | 0.47 (0.22, 0.90) | |
| Hypertension | 1.94 (1.39, 2.74) | 1.82 (0.67, 5.17) | 1.39 (1.17, 1.65) | 0.91 (0.70, 1.17) | |
| HIV | 0.74 (0.32, 1.50) | 0.63 (0.06, 3.43) | 0.42 (0.02, 2.11) | – | |
| In-hospital complications | AKI | 5.82 (3.85, 8.79) | 41.74 (12.02, 164.04) | 9.16 (7.19, 11.68) | 8.02 (5.91, 10.90) |
Table 4c
Logistic Regression analysis for factors associated with MACE. Adjusted for demographic variables age, sex, BMI, smoking, vaccine status, diabetes, hypertension, COPD, asthma, HIV, and acute renal injury. In adjusted models, age >60 was associated with MACE only in the non-African cohort. Among African participants, being female was significantly associated with occurrence of MACE, whereas in the non-African cohort, being female was protective. Covid vaccination status appeared to have no impact on MACE. Diabetes was associated with a higher odds of MACE occurrence in the non-African cohort, but not in the African one. Again, acute renal injury appeared to be one of the strongest predictors of adverse cardiac outcomes in both cohorts.
| AFRICAN COHORT | NON-AFRICAN COHORT | ||||
|---|---|---|---|---|---|
| UNADJUSTED ODDS OR (95% CI) | ADJUSTED ODDS* OR (95% CI) | UNADJUSTED ODDS OR (95% CI) | ADJUSTED ODDS* OR (95% CI) | ||
| Demographic | |||||
| Age | <45 (Ref) | 1.0 | 1,0 | 1.0 | 1.0 |
| 45–60 | 0.87 (0.50, 1.51) | 0.28 (0.01, 5.22) | 2.75 (2.06, 3.70) | 2.06 (1.48, 2.89) | |
| >60 | 2.10 (1.34, 3.37) | 1.95 (0.18, 30.89) | 3.94 (3.02, 5.22) | 2.82 (2.06, 3.90) | |
| Sex | Male | 1.0 | 1,0 | 1.0 | 1.0 |
| Female | 1.22 (0.84, 1.77) | 19.95 (2.65, 440.97) | 0.77 (0.65, 0.92) | 0.68 (0.54, 0.84) | |
| History | |||||
| Smoking status | Never (Ref) | 1.0 | 1,0 | 1.0 | 1.0 |
| Current | 2.90 (1.23, 6.28) | – | 0.51 (0.34, 0.74) | 0.48 (0.30, 0.73) | |
| Former | 2.09 (1.03, 3.98) | 2.48 (0.11, 53.07) | 1.31 (1.05, 1.61) | 0.95 (0.73, 1.24) | |
| BMI | 18–24 | 1.0 | 1,0 | 1.0 | 1.0 |
| < 18 | – | – | 0.92 (0.37, 1.97) | 1.04 (0.40, 2.38) | |
| 25–29 | 1.37 (0.30, 7.09) | 0.95 (0.06, 16.17) | 0.93 (0.75, 1.16) | 0.84 (0.66, 1.05) | |
| >30 | 3.42 (1.04, 15.42) | 1.01 (0.09, 14.47) | 1.09 (0.86, 1.39) | 0.94 (0.72, 1.23) | |
| COVID vaccine status | Unvaccinated | 1.0 | 1,0 | 1.0 | 1.0 |
| Vaccinated | 1.16 (0.06, 7.53) | – | 0.20 (0.11, 0.35) | 0.51 (0.22, 1.02) | |
| Clinical | |||||
| Comorbidities | DM | 1.90 (1.28, 2.81) | 1.35 (0.15, 10.61) | 1.65 (1.40, 1.95) | 1.32 (1.06, 1.64) |
| COPD | 5.42 (2.14, 13.36) | 1.47 (0.00, 401.57) | 1.57 (1.09, 2.21) | 1.13 (0.69, 1.78) | |
| Asthma | 0.73 (0.21, 1.87) | – | 1.12 (0.74, 1.64) | 0.96 (0.58, 1.52) | |
| Hypertension | 1.49 (1.03, 2.18) | 1.54 (0.22, 12.14) | 1.97 (1.67, 2.34) | 1.30 (1.04, 1.63) | |
| HIV | 0.60 (0.21, 1.39) | 0.08 (0.00, 6.12) | 0.38 (0.02, 1.90) | – | |
| In-hospital complications | AKI | 16.62 (10.65, 26.20) | 660.55 (75.13, 18871.12) | 5.94 (4.68, 7.54) | 4.92 (3.67, 6.58) |