BackgroundUnderlying conditions are risk factors for severe COVID-19 outcomes but evidence is limited about how risks differ with age.AimWe sought to estimate age-specific associations between underlying conditions and hospitalisation, death and in-hospital death among COVID-19 cases.MethodsWe analysed case-based COVID-19 data submitted to The European Surveillance System between 2 June and 13 December 2020 by nine European countries. Eleven underlying conditions among cases with only one condition and the number of underlying conditions among multimorbid cases were used as exposures. Adjusted odds ratios (aOR) were estimated using 39 different age-adjusted and age-interaction multivariable logistic regression models, with marginal means from the latter used to estimate probabilities of severe outcome for each condition-age group combination.ResultsCancer, cardiac disorder, diabetes, immunodeficiency, kidney, liver and lung disease, neurological disorders and obesity were associated with elevated risk (aOR: 1.5-5.6) of hospitalisation and death, after controlling for age, sex, reporting period and country. As age increased, age-specific aOR were lower and predicted probabilities higher. However, for some conditions, predicted probabilities were at least as high in younger individuals with the condition as in older cases without it. In multimorbid patients, the aOR for severe disease increased with number of conditions for all outcomes and in all age groups.ConclusionWhile supporting age-based vaccine roll-out, our findings could inform a more nuanced, age- and condition-specific approach to vaccine prioritisation. This is relevant as countries consider vaccination of younger people, boosters and dosing intervals in response to vaccine escape variants.

Department of Biostatistics National Institute of Public Health Prague Czechia

Department of Infectious Diseases Epidemiology National Institute of Public Health Prague Czechia

Division of Infection Control Norwegian Institute of Public Health Oslo Norway

Epidemiology Unit Regional Health Agency of Tuscany Florence Italy

European Centre for Disease Prevention and Control Stockholm Sweden

European Programme for Intervention Epidemiology Training Stockholm Sweden

European Public Health Microbiology Training Programme Stockholm Sweden

Health Directorate Luxembourg Luxembourg

HSE Health Protection Surveillance Centre Dublin Ireland

Infectious Disease Prevention and Control Unit Superintendence of Public Health Gwardamanġa Malta

Superintendence of Public Health Valletta Malta

World Health Organization Regional Office for Europe Copenhagen Denmark

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