COVID-19 Hospitalization is More Frequent and Severe in Down Syndrome and Affects Patients a Decade Younger.
Abstract
Background
Individuals with rare disorders, like Down syndrome (DS) are historically understudied. Currently, it is not known how COVID-19 pandemic affects individuals with DS. Herein, we report an analysis of individuals with DS who were hospitalized with COVID-19 in the Mount Sinai Health System in New York City, USA.
Methods
In this retrospective, single-center study of 4,615 patients hospitalized with COVID-19, we analyzed all patients with DS admitted in the Mount Sinai Health System. Hospitalization rates, clinical and outcomes were assessed.
Findings
Contrary to an expected number of one, we identified six patients with DS. We found that patients with DS are at an 8.9-fold higher risk of hospitalization with COVID-19 when compared to non-DS patients. Hospitalized DS individuals are on average 10 years younger than non-DS patients with COVID-19. Moreover, type 2 diabetes mellitus appears to be an important driver of this susceptibility to COVID-19. Finally, patients with DS have more severe outcomes than controls, and are more likely to progress to sepsis in particular.
Interpretation
We demonstrate that individuals with DS represent a higher risk population for COVID-19 compared to the general population and conclude that particular care should be taken for both the prevention and treatment of COVID-19 in these patients.
Funding
National Institute of Allergy and Infectious Diseases.
Research in context
Evidence before this study
We searched PubMed and Google Scholar on May 26, 2020, for articles describing the features of patients in Down syndrome infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), using the search terms “SARS-CoV-2” or “COVID-19” and “Down syndrome” or “Trisomy 21.” We found only one case report describing a cluster of 4 cases of COVID-19 in a healthcare facility for patients with mental retardation.
Added value of this study
We compared the hospitalization rates of DS patients to over 4,500 individuals without DS, and we assessed comorbidities and outcomes of individuals with DS compared to age, race, and sex-matched controls hospitalized with COVID-19. To the best of our knowledge, we provide the first evidence that patients with DS with are at higher risk of hospitalization with COVID-19 and more severe disease progression than non-DS patients.
Implications of all the available evidence
We demonstrate that individuals with DS are a high-risk population for COVID-19 and suggest appropriate measures should be taken for both the prevention and treatment of COVID-19 in these patients.
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