Evidence used to update the list of underlying medical conditions that increase a person’s risk of severe illness from COVID-19

Evidence used to update the list of underlying medical conditions that increase a person’s risk of severe illness from COVID-19
Updated Nov. 2, 2020
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Updates to the list of underlying medical conditions that put adults of any age at increased risk for severe illness from the virus that causes COVID-19 were based on published reports, articles in press, unreviewed pre-prints, and internal data available between December 1, 2019 and October 16, 2020*. This list is a living document that will be periodically updated by CDC, and it could rapidly change as the science evolves. Severe illness from COVID-19 is defined as hospitalization, admission to the ICU, intubation or mechanical ventilation, or death.

The level of evidence for each condition was determined by CDC reviewers based on available information about COVID-19. Conditions were added to the list (if not already on the previous underlying medical conditions list [originally released in March 2020]) if evidence for an association with severe illness from COVID-19 met any of the following criteria:

  • Strongest and most consistent evidence: Defined as consistent evidence from multiple small studies or a strong association from a large study,
  • Mixed evidence: Defined as multiple studies that reached different conclusions about risk associated with a condition, or
  • Limited evidence: Defined as consistent evidence from a small number of studies.

Qualifiers to previously listed conditions were added or removed if there was strong evidence to support that the condition be expanded. Conditions previously listed were to be removed if there was strong and consistent evidence demonstrating no association with severe outcomes. Based on this criterion, no conditions were removed from the previous underlying medical conditions list dated March 2020; however, in this most recent update in November 2020, pregnancy was moved from “mixed evidence” to “strong evidence.”

*Updates to smoking were based on evidence available between December 1, 2019 and July 20, 2020.

Evidence used to update the list of underlying medical conditions that increase a person’s risk of severe illness from COVID-19
Level of Evidence Condition Evidence of Impact on COVID-19 Severity
Strongest and Most Consistent Evidence Cancer Systematic Review [6]
Cohort Study [7,8]
Case Series [9]
Chronic kidney disease Case Series [10, 11, 12]
Cohort Studies [13, 14, 15]
COPD Meta Analyses [4, 16]
Case Series [17]
Cohort Study [14]
Heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies Cohort Study [1, 2]
Meta Analyses [3, 4]
Case Series [5]
Obesity (BMI> 30 kg/m2) Cohort Studies [18, 19, 20, 21, 22]
Cross-sectional [23]
Severe Obesity (BMI ≥ 40 kg/m2) Cohort Study [98, 99]
Cross-Sectional Study [95]
Meta Analysis [107]
Pregnancy Systematic Review [54, 116]
Case Control Study [55]
Case Series [56, 57, 58, 59]
Cohort Study [60, 61, 62, 117]
Sickle cell disease Case Series [24, 25, 26, 27, 28]
Smoking Meta Analyses [3, 16*, 63, 64, 65, 66, 101, 102, 104, 105]
Solid organ transplantation Case Series [12, 29, 30, 31, 32, 33, 34]
Meta Analysis [100]
Type 2 diabetes mellitus Case Series [11]
Longitudinal Study [35]
Cohort Study [36, 37]
Meta Analysis [38]
Cross-Sectional Study [114]
Mixed Evidence Asthma Cohort Study [14, 39, 40, 41]
Case Series [17]
Cerebrovascular disease Meta Analysis [42, 43, 44, 45]
Synthesis of Evidence [46]
Cohort Study [1, 2, 47, 48, 49]
Hypertension Cohort Study [1, 2, 49, 50, 51, 91, 93]
Case Series [92]
Systematic Review [52]
Meta Analyses [3, 4, 53, 94]
Use of corticosteroids or other immunosuppressive medications Case Series [67, 68, 69]
Cohort Study [70, 71]
Limited Evidence Bone marrow transplantation Review [72]
HIV Case Series [73, 74]
Cohort Study [109, 110, 111, 112]
Immune deficiencies Case Series [75]
Systematic Review [76]
Inherited metabolic disorders Cohort Study [47, 77]
Liver disease Meta-Analysis [78]
Cohort  Study [79, 80, 118, 119]
Literature Review [81]
Case Control Study [120]
Neurologic conditions Cross-Sectional Study [82]
Cohort Study [41, 49, 77]
Other chronic lung diseases Meta-Analysis [4]
Case Series [17]
Cohort Study [14, 83]
Overweight (BMI > 25 kg/m2, but < 30 kg/m2) Cohort Study [96, 106]
Case Series [97]
Meta Analysis [115]
Pediatrics Systematic Review [84, 85]
Cross-Sectional Study [82, 86, 107]
Cohort Study [77, 87, 88, 103, 108, 113,121, 122, 125]
Case Series [123, 124]
Thalassemia Case Series [89]
Cross-Sectional Study [90]
Type 1 diabetes mellitus Case Series [11]
Cohort Study [36, 37]
Meta-Analysis [38]
Cross-Sectional Study [114]

*Methodological issues found by other authors; re-analyzed by Guo [64] and an association finding risk factor for greater severity was found.

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Last Updated Nov. 2, 2020
Content source: National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases