Determinants of Disease Progression in Bangladeshi COVID-19 Patients: A Cross-sectional Survey

Study design & settings

This was a nationwide study of COVID-19 patients who were diagnosed and confirmed by Reverse Transcription-Polymerase Chain Reaction (RT-PCR) from November 2020 to January 2021. The list of available COVID-19 positive patients was obtained, after formal written approval, from Civil Surgeon’s (CS) offices in Bangladesh.

Survey procedures

The target population was the participants aged more than or equal to 18 years. Individuals who were currently being treated for COVID-19, children (<18 years), pregnant women and critically ill were excluded from the study. A structured questionnaire was prepared for the collection of the data. We conducted a pilot survey on 30 post COVID-19 individuals selected randomly from the sampling frame to test the questionnaire. Following, we collected total 384 COVID-19 positive patients from the relevant districts. We found that the response rate was around 60% (due to call drop, call waiting, inactive number, network problem, and refusal to give an interview).

Measures

Outcome variable

The outcome variable “Covid 19 Infection” which was determined by prone to be affected and progression to severity. The disease progression to severity has four categories which were asymptomatic (participants who tested positive for COVID-19 but remained asymptomatic throughout the course of the disease and no hospital admission was required for this group, and they did not receive oxygen support), mild (these group of participants were characterized by the individuals who tested positive for COVID-19 and experienced mild symptoms, such as cough, fever, body ache, loss of smell or taste and they did not require hospital admission or oxygen support), the third category was moderate (the participants with COVID-19 who exhibited more severe symptoms, necessitating clinical consultation, and they had symptoms included shortness of breath (SOB), and some required oxygen support administered via nasal cannula or venturi mask), and the last category were severe (it was indicated the participants who tested positive for COVID-19 with strong and severe symptoms that led to hospital admission and they required mechanical ventilation or high-flow oxygen support during their hospitalization, sometimes they experienced severe health complications as a result of COVID-19, and some individuals in the severe category succumbed to the disease).

Independent variables

All the COVID-19 positive patients in the sample underwent interviews by a structured questionnaire consisting of socio-demographic, lifestyle and behavioral, clinical, and study or work-related factors. The sociodemographic section of the questionnaire obtained information regarding patients age, gender, occupation, family income, education, marital status, living status.

Statistical analysis

Descriptive statistics was applied to describe the characteristics of the study population. Pearson chi-square tests were used to assess the disease progressions of COVID-19 across selected variables. Separate logistic regression model was used to assess the associated factors of Covid 19 Infection for socio-demographic, lifestyle and behavioral, clinical, and study or work-related factors and without adjustment for other explanatory factors. Results were recorded as Odd Ratio (OR) with its 95% Confidence Interval (95% CI). All statistics were performed using the Stata software version 14.0 (Stata corporation, college station, Texas, USA).

Ethical approval

Participation in this study was entirely voluntary. Informed written consent was obtained from study participants following explanation of the study aims and objectives. The study was approved by the Ethics Board of North South University (NSU), Dhaka, Bangladesh (2020/OR-NSU/IRB-No.0801, on 14^th August 2020). All procedures were performed in accordance with relevant guidelines and regulations.

Participant’s background characteristics

Participant’s background characteristics has shown in Table 1. A total of 384 of respondents were involved in the survey. Among the respondents, the largest proportion included within the category of 18 to 35 years (56.8%), while respondents aged 36 to 55 years and those aged more than 55 years constitute 36.7% and 6.5%, respectively. In this study it was also found that 73.2% of the respondents were male, and 26.8% were females. Occupational backgrounds shows that commerce/business and office workers account for the highest percentage at 49.5%, followed by healthcare workers (14.8%), and other occupations (11.7%). Notably, 24.0% of respondents did not specify their occupation. Regarding the family income, the majority (80.0%) earned less than 10,000 BDT, and 19.8% of the respondent’s income was 10,000-25,000 BDT. The educational levels of the respondents had a diverse distribution, with 34.9% completed up to primary education, 28.1% at the secondary level, and 17.5% with a higher secondary and above education. The marital status indicates that 68.7% of respondents were single, while 31.3% were married. Finally, 72.4% of the respondents reported that they were living in urban area, while 27.6% lived in the rural area.

Distribution of progression of disease among the COVID-19 patients

Figure 1 shows the prevalence of disease progression among COVID-19 patients. We found that 40.36% of patients were in asymptotic condition, 43.49% were in mild condition, 9.11% were moderate condition and 7.03% were in severe condition.

Figure 1. COVID-19 disease progression among the respondents.

Association among demographic and lifestyle variables with the disease progressions of COVID-19

Table 2 shows the association between various socio-demographic and lifestyle factors with COVID-19 symptom severity. The respondents whose age was 18-35 years, showing mild symptoms at 39.73%, while those over 55 years, experienced moderate symptoms at 34.00% and severe symptoms at 49.38%. Gender disparities were also evident, with males reporting higher percentages of mild (65.64%), moderate (71.88%), and severe symptoms (52.00%) than females. On the other hand, the healthcare workers facing 18.46% mild symptoms but only 1.00% severe, while commerce/business and office workers exhibit 46.67% mild and 48.03% severe symptoms. Marital status significantly influences symptom severity, with 98.00% of married individuals experiencing severe symptoms compared to 2.00% of singles. Urban residents generally face more severe symptoms (78.97%) compared to rural dwellers (21.03%). Additionally, lifestyle factors like smoking (95.0%) and physical exercise (48.0%) present percentages of association with more severe symptoms.

Association among Clinical Factors (Comorbidity) with the disease progressions of COVID-19

Table 3 shows that among the comorbidity participants specially the participants having diabetics from earlier have faced covid-19 disease. About 98 percent participants have faced covid-19 disease with severe stage who had diabetics from earlier. The association between cancer and asthma with the disease progressions of COVID-19 has found significant. Diabetes prevalence has been found significant disease progression in all categories- from asymptomatic to severe conditions. Similar findings were found for CLD-Asthma/COPD. The prevalence is around 88-98% considering all respect. The association between cancer with the disease progressions of COVID-19 has found significant. It was found that among the patients who was reached to the severe stage of the disease, 60 percent of them have faced the disease cancer while this percentage is 93.97 for the patients who has reached to mild stage.

Association among study or Work-Related Factors with the disease progressions of COVID-19

It is portrayed that workplace condition, public transport use, long exposure in public facilities, sedentary work is significantly associated with Covid-19 disease progression. Among the patients with using public transport have faced 68.07 percent in asymptomatic condition while 38.02 percent people with exposed to public facilities for long time faced covid-19 with severe condition (Table 4).

Determinants of COVID-19 disease progression

Logistic regression estimates shows that age, gender, smoking status, diabetics, working conditions significantly affect Covid 19 disease progression among people (Table 5). It was found that female has 70% lower risk of Covid 19 asymptomatic condition than the male (OR=0.30, p≤0.05). It was also found that people with not habituate with smoking have lower risk of affecting in Covid 19 (OR=.065, p≤0.05). It was also found that people with not having diabetics have 89 percent lower risk of affecting in Covid 19 (OR=0.11, p≤0.05). It was also found that people aged more than 55 has 9 times higher chance of having Covid-19 in comparison to people aged 18-35; (OR=9.33, p≤0.05). It has also found that people with income 10000 to 25000 had 63% of lower chance of having covid-infection in comparison to people with income less than 10000 (OR=0.34, p≤0.05).

Limitations

This study has several limitations. First, due to COVID-19 situations, number of sample size was limited. Data from the hotspot areas or geographically dispersed area cannot be considered for time limits. Second, disease progression into severity was measured through response not from hospital records or clinical database. Third, the study did not a large area therefor, the results do not present the whole situation.