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Original research
History of coronary heart disease increased the mortality rate of patients with COVID-19: a nested case–control study
  1. Tian Gu1,
  2. Qiao Chu2,
  3. Zhangsheng Yu3,
  4. Botao Fa3,
  5. Anqi Li4,
  6. Lei Xu5,
  7. Ruijun Wu4,
  8. Yaping He2,6
  1. 1Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
  2. 2School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  3. 3Department of Bioinformatics and Biostatistics, Shanghai Jiao Tong University, Shanghai, China
  4. 4School of Social Development, East China Normal University, Shanghai, China
  5. 5Department of Cardiology, Shanghai Chest Hospital, Shanghai, China
  6. 6Center for Health Technology Assessment, Shanghai Jiao Tong University, Shanghai, China
  1. Correspondence to Dr. Yaping He; hypcyr{at}; Dr. Ruijun Wu; rjwu{at}


Objective Evaluate the risk of pre-existing comorbidities on COVID-19 mortality, and provide clinical suggestions accordingly.

Setting A nested case–control design using confirmed case reports released from the news or the national/provincial/municipal health commissions of China between 18 December 2019 and 8 March 2020.

Participants Patients with confirmed SARS-CoV-2 infection, excluding asymptomatic patients, in mainland China outside of Hubei Province.

Outcome measures Patient demographics, survival time and status, and history of comorbidities.

Method A total of 94 publicly reported deaths in locations outside of Hubei Province, mainland China, were included as cases. Each case was matched with up to three controls, based on gender and age ±1 year old (94 cases and 181 controls). The inverse probability-weighted Cox proportional hazard model was performed, controlling for age, gender and the early period of the outbreak.

Results Of the 94 cases, the median age was 72.5 years old (IQR=16), and 59.6% were men, while in the control group the median age was 67 years old (IQR=22), and 64.6% were men. Adjusting for age, gender and the early period of the outbreak, poor health conditions were associated with a higher risk of COVID-19 mortality (HR of comorbidity score, 1.31 [95% CI 1.11 to 1.54]; p=0.001). The estimated mortality risk in patients with pre-existing coronary heart disease (CHD) was three times that of those without CHD (p<0.001). The estimated 30-day survival probability for a profile patient with pre-existing CHD (65-year-old woman with no other comorbidities) was 0.53 (95% CI 0.34 to 0.82), while it was 0.85 (95% CI 0.79 to 0.91) for those without CHD. Older age was also associated with increased mortality risk: every 1-year increase in age was associated with a 4% increased risk of mortality (p<0.001).

Conclusion Extra care and early medical interventions are needed for patients with pre-existing comorbidities, especially CHD.

  • epidemiology
  • coronary heart disease
  • survival analysis

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  • Contributors TG conducted the analysis, interpreted the data, drafted the article and rechecked the transcribed manuscript. QC conducted the literature review and drafted the article. ZY guided and supervised the statistical analysis. BF helped with data analysis. AL helped with literature review, data collection, management and the data quality check, and was responsible for reference organization. LX provided clinical support and interpretation of the results. RW collected, preprocessed and managed data, and conducted preliminary data analysis. YH guided and supervised the research process. RW and YH provided funding support. All authors critically revised the manuscript for intellectual content, approved the final draft and agreed to accountability for all aspects of the work.

  • Funding This project was funded by the National Natural Science Foundation of China (No. 71874111), China Ministry of Education Key Research Institute of Humanities and Social Sciences at Universities (No. 17JJD790008), Shanghai Municipal Health Bureau Foundation (No. 201740116), and Shanghai Jiao Tong University Scientific and Technological Innovation Funds (YG2020YQ01, YG2020YQ06).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting, or dissemination plans of this research.

  • Patient consent for publication Exempt.

  • Ethics approval The data published in news reports and websites were open to the public and free of identifiers.The study was approved by Shanghai Jiao Tong University Public Health and Nursing Medical Research Ethics Committee (SJUPN-202001).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. Raw data are available at