Health risk assessment for severe COVID-19 in Taiwan: a multi-centre electronic health record study

Background As the global battle against COVID-19 continues, understanding the factors contributing to severe outcomes remains critical for public health strategies. We aim to identify the determinants significantly influencing severe COVID-19 infection and mortality among the general population in Taiwan. Methods We conducted a retrospective cohort study using data extracted from the Taipei Medical University Clinical Research Database from 1 January 2022 to 31 December 2022. We defined the primary outcomes as severe COVID-19 infection, including hospitalisation, ventilator use, intubation, and mortality. We performed logistic regression analyses to explore the association of various factors, including demographic characteristics, body mass index (BMI), Charlson Comorbidity Index score, and multiple comorbidities. Results Among 96 489 confirmed COVID-19 cases, 44 996 (46.6%) were classified as high-risk patients. Compared to females, male patients had significantly higher risks of ventilator use (odds ratio (OR) = 1.245; 95% confidence interval (CI) = 1.147–1.352, P< 0.0001), intubation (OR = 1.115; 95% CI = 1.011–1.230, P= 0.03), and mortality (OR = 1.510; 95% CI = 1.332–1.713, P< 0.0001). Patients with lower BMI had significantly increased risks of ventilator use (OR = 0.972; 95% CI = 0.964–0.981, P< 0.0001) and mortality (OR = 0.92; 95% CI = 0.908–0.935, P< 0.0001), compared to patients with higher BMI. Patients with chronic comorbidities such as heart disease, moderate to severe kidney disease, diabetes, cancer, hypertension, anaemia, and Parkinson disease had significantly higher risks of severe COVID-19 or mortality compared to those without these conditions. Conversely, patients with peptic ulcer disease or hyperlipidaemia seem to have lower risks of severity and mortality compared to those without these conditions. Conclusions We found that being male, having a lower BMI, and having certain chronic conditions increased the risk of severe COVID-19 outcomes, while peptic ulcer disease and hyperlipidaemia were linked to reduced risks. These findings highlight the need for targeted public health strategies for high-risk groups. © 2025 The Author(s)