Changes

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HEART FAILURE

Heart failure has been described, either under this term or as a cardiovascular disease, as the most prevalent risk factor in the population diagnosed with COVID-19 (up to 30%) and is present in more than 50% of COVID-19 patients admitted to the ICU in Spain, according to several studies. Its mechanism of action is the same as for diabetes and hypertension.

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CHRONIC KIDNEY DISEASE

Chronic Kidney Disease (CKD) is included in the range of comorbidities that are associated with worse COVID-19 outcomes. Kidneys have ACE-2 receptors and are primarily involved in the renin-angiotensin-aldosterone system that regulates blood pressure. These are usually patients with added comorbidities, such as diabetes and hypertension, who have a weakened immune system.

Although studies linking CKD and COVID-19 are limited, increased mortality has been observed in these patients, especially in advanced stages of CKD. Other researches have not found an increased admission to the ICU of CKD patients infected by SARS-CoV-2.

The regions of Catalonia (Catalunya/Cataluña), Valencia, Murcia, the Canary Islands (Canarias) and the town of Ceuta have higher adjusted rates than the other regions. Conversely, the lowest rates are recorded in Cantabria and Castile and León (Castilla y León). When rates are analysed by sex, men are clearly seen to have higher rates than women in all regions, except in the Balearic Islands (Illes Balears), Ceuta and Melilla, being almost twice as high in several regions.

The Spanish Registry of Kidney Diseases was founded in 2006 as a result of merging the data provided by all regional registries. These consolidated data show a real difference in the prevalence of this pathology.

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HIV-AIDS

HIV infection and AIDS diagnosis is not usually listed as a risk factor in most studies as such; immunodeficiency is. However, this term is very broad and difficult to define. So a pathology like VIH-AIDS, with a well-established information system and a clear impact on the immune system, especially cell-mediated immunity, was opted for in this study.

How the vulnerability of an immunocompromised patient fits in with immune hyperactivation is not fully understood. There is no strong evidence to support an increased risk in immunocompromised patients. In the case of HIV/AIDS, studies suggest not so much an association with increased susceptibility to infection, but some association with rising fatalities. In the SEMI-COVID-19 registry, COVID-19 cases with HIV infection represent 0.7%. It is not possible to draw conclusions on its possible implication for the clinical severity of COVID-19 with such a low number of cases.

HIV/AIDS prevalence in Spain is low in general, yet it shows significant differences between regions. It mainly affects males. There is an increasing number of cases in the Balearic Islands (Illes Baleares), the Canary Islands (Canarias) and the Region of Valencia (Comunitat Valenciana) that are linked to tourism, which could be a reason for relaxing protection/prevention measures. The Region of Madrid (Comunidad de Madrid) also follows this pattern of prevalence. On the other hand, Catalonia (Catalunya/Cataluña) shows a very low prevalence even though it is also a region where tourism plays an important role.

Although the data are unadjusted for age and sex, it is very likely that these differences between regions are real, as the age group of people affected is more limited (young, young adults and adults) and the demographic differences between regions are somewhat smaller in these age groups than in the case of the elderly.

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