The disease severity and death outcomes of COVID-19 outpatient cases in Almaty, Kazakhstan 2021-2022

Abstract Background The global pandemic COVID-19 presented a serious burden on primary health care. We analyzed the association between the age, sex, and comorbidity on the severity and outcomes of COVID-19 in outpatient care in Almaty, Kazakhstan, between 1.1.2021 to 31.12.2022. Methods We assessed Odds ratio and 95% Confidence interval (OR, 95% CI) in a retrospective analysis of data on 174.540 COVID-19 patients on outpatient follow-up collected from an primary care electronic database (108,234 women and 66,306 man). Among outpatients 88.9% (n = 155,127) had mild disease, 8.3% (n = 14,537) asymptomatic; and moderate/severe disease was observed in 2.8% of cases. Results Among the COVID-19 outpatients, the incidence of diabetes mellitus was significantly higher in women (3.1%) then man (2.4%) (p < 0.001), obesity was more common in women (0.6%) than in men (0.4) (p < 0.05), and arterial hypertension was more common in men (10%) versus women (6.2%) (p < 0.001). The probability of developing moderate/severe disease increased significantly with age, especially in those 60 years and older, where it was 9 times higher (p < 0.001, OR = 9.01, 95% CI: 7.7-10.5), and where the probability of lethal outcome was very high (OR = 61.8, 95% CI: 8.5-446.2, p < 0.001) too. The odds of developing moderate/severe COVID-19 were 1.4 times higher in patients with diabetes mellitus (p < 0.001, OR = 1.43, 95% CI: 1.27-1.6), 2.5 times higher in obese patients (p < 0.001, OR = 2.51, 95% CI: 1.9-3.15), and in patients with chronic obstructive pulmonary disease (p < 0.001, OR = 2.5, 95% CI: 2.13-3.02), and the presence of arterial hypertension increased the risk 1.2-fold (p < 0.001, OR = 1.16, 95% CI: 1.07-1.26). Conclusions In Almaty outpatients, an association between the moderate and severe COVID-19 and age and comorbidity (diabetes mellitus, obesity, arterial hypertension, and COPD) was found, which underscores the necessity of more research on primary care organization and delivery in health emergencies. Key messages • An increase of severe COVID-19 in elder outpatients and with comorbidity emphasizes the need for their effective protection. • The research on the impact of various factors on the disease severity and outcomes in outpatients can assist in optimizing primary care.