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Who is at Highest Risk for Complications from SARS-CoV-2 and COVID-19?

Updated September 22, 2023


Persons considered most at risk for developing complications from COVID-19 include those with cardiovascular disease, hypertension, cerebrovascular disorders, cystic fibrosis, pulmonary fibrosis, liver disease, Downs Syndrome, dementia and neurological disorders, chronic obstructive pulmonary disease (COPD), type 1 and type 2 diabetes mellitus, chronic kidney disease, cancer, sickle cell disease, thalassemia, and those who are immunocompromised due to solid organ transplant, HIV, immune deficiencies, blood or bone marrow transplant, or those taking medications that suppress the immune system. 

Persons who are obese (body mass index of 30 or higher), pregnant, smokers, including current and former smokers, and persons with substance use disorders are also considered to be at a higher risk of developing severe illness. 

The CDC also states that the risk of hospitalization and death increases with age, and that individuals over the age of 85 are at the greatest risk of developing severe illness. 

Severe Illness Risk Factors for Minorities

In the U.S., African Americans and individuals of Asian, Hispanic and Native American descent have been disproportionally affected by SARS-CoV-2, with higher rates of COVID-19 illness and death reported in comparison to white Americans.      Research has also found that hidden biases exist in health care that prioritizes white Americans over African Americans. 

However, African Americans also have higher rates of underlying chronic illness including diabetes, hypertension, and heart disease, which are known to increase a person’s risk of developing SARS-CoV-2 complications. Many African Americans are also critical front-line workers, which may also increase rates of infection within the African American population.   

Ethnic and racial minorities are known to have less access to health care services and often less likely to have adequate health insurance. As a result, they may not seek prompt treatment for symptoms, which places them at higher risk of hospitalization and death if initial care begins at a later point in the disease process. 

Additionally, higher rates of illness among racial and ethnic minorities in the U.S. has been attributed to lower socioeconomic status among these populations, rather than a predisposition to the illness. Many African Americans, Hispanics, and persons of Native American descent are more likely to reside in crowded conditions, in multigenerational households, be employed in positions that can’t be performed remotely, and use public transportation. As a result, they are more likely to be exposed to the SARS-CoV-2 virus. 

Individuals who are not proficient in English, particularly those who lack an understanding of health literacy, have also been noted to have poorer COVID-19 health outcomes. Experts report that information provided by public health officials is not adequately communicated and distributed to these populations, placing them at higher risk of severe outcomes. 

IMPORTANT NOTE: NVIC encourages you to become fully informed about covid-19 and the covid-19 vaccine by reading all sections in the Table of Contents, which contain many links and resources such as the manufacturer product information inserts, and to speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child. This information is for educational purposes only and is not intended as medical advice.



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