The association between frailty risk and COVID-19-associated all-mortality in hospitalised older people: a national cohort study

Introduction Frailty has emerged as an important construct to support clinical decision-making during the COVID-19 pandemic. However, doubts remain related to methodological limitations of published studies. Methods Retrospective cohort study of all people aged 75 + admitted to hospital in England between 1 March 2020 and 31 July 2021. COVID-19 and frailty risk were captured using International Classification of Disease-10 (ICD-10) diagnostic codes. We used the generalised gamma model to estimate accelerated failure time, reporting unadjusted and adjusted results. Results The cohort comprised 103,561 individuals, mean age 84.1, around half female, 82% were White British with a median of two comorbidities. Frailty risk was distributed approximately 20% low risk and 40% each at intermediate or high risk. In the unadjusted survival plots, 28-day mortality was almost 50% for those with an ICD-10 code of U071 (COVID-19 virus identified), and 25-35% for those with U072 (COVID-19 virus not identified). In the adjusted analysis, the accelerated failure time estimates for those with intermediate and high frailty risk were 0.63 (95% CI 0.58-0.68) and 0.67 (95% CI 0.62-0.72) fewer days alive respectively compared to those with low frailty risk with an ICD-10 diagnosis of U072 (reference category). Conclusion In older people with confirmed COVID-19, both intermediate and high frailty risk were associated with reduced survival compared to those with low frailty risk. Key summary pointsAim Frailty appears to be an important risk factor for COVID-19-related deaths, but studies to data have important limitations. The aim of this study was to describe the relationship between COVID-19, frailty risk and mortality in older people. Findings This study examined outcomes for all older people hospitalised with COVID-19 between March 2020 and July 2021 and showed that mortality risk was increased with higher Hospital Frailty Risk Scores. Message Any level of elevated frailty risk should be considered an important prognostic marker for older people hospitalised with COVID-19.