A higher number of concurrent comorbidities cumulatively increases the risk of severe disease. The people most at risk are older adults, people who are severely immunocompromised, and people who have multiple comorbidities, including young children. 15-17 This applies to both unvaccinated as well as vaccinated individuals. Certain medical conditions are associated with an increased risk of severe illness from COVID-19. The evidence around medical conditions which increase the risk of severe COVID-19 has been reviewed and updated in March 2023. Compared to a person aged 45 to 49 years, the risk was 4.8 times higher for 65 to 69 year olds and 16.6 times higher for those aged 80 years and over. The risk of severe disease (hospitalisation, oxygen or ventilation requirement, or death) versus non-severe disease rises with age. In the Omicron era, a study of people who have received both primary and booster vaccine doses found that the risk of death due to COVID-19 was 31.3 times higher for an 80-year-old compared with a 50-year-old. 14,15 The risk of death from COVID-19 increases throughout each decade of age over 50 years. ![]() 11-13 This continues to be true even in individuals who have received a primary course of vaccination, with or without booster doses. ![]() Older age is by far the strongest risk factor associated with morbidity and mortality from COVID-19. ![]() 10 Risk factors for severe disease Older age A nationwide Danish study estimated the infection fatality rate in the Omicron era at 1.6 per 100,000 infections in 17 to 35 year olds, through to 15.1 per 100,000 infections in 61 to 72 year olds. Estimates of severe disease vary widely due to varying levels of vaccination and hybrid immunity by country or region. High rates of hybrid immunity, which is thought to provide better protection than either infection or vaccination alone, have also greatly reduced the likelihood of severe disease and death. Severe disease is less common since the Omicron strain and its subvariants have emerged and become dominant after November 2021.
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