This study applies an umbrella review approach to summarise the global evidence on the risk of severe COVID-19 outcomes in patients with pre-existing health conditions. Systematic reviews (SRs) were identified in PubMed, Embase/Medline and seven pre-print servers until December 11, 2020. Due to the absence of age-adjusted risk effects stratified by geographical regions, a re-analysis of the evidence was conducted. Primary studies were extracted from SRs and evaluated for inclusion in the re-analysis. Studies were included if they reported risk estimates (odds ratio (OR), hazard ratio (HR), relative risk (RR)) for hospitalisation, intensive care unit admission, intubation or death. Estimated associations were extracted from the primary studies for reported pre-existing conditions. Meta-analyses were performed stratified for each outcome by regions of the World Health Organization. The evidence certainty was assessed using GRADE. Registration number CRD42020215846. In total, 160 primary studies from 120 SRs contributed 464 estimates for 42 pre-existing conditions. Most studies were conducted in North America, European, and Western Pacific regions. Evidence from Africa, South/Latin America, and the Eastern Mediterranean region was scarce. No evidence was available from the South-East Asia region. Diabetes (HR range 1.2–2.0 (CI range 1.1–2.8)), obesity (OR range 1.5–1.75 (CI range 1.1–2.3)), heart failure (HR range 1.3–3.3 (CI range 0.9–8.2)), COPD (HR range 1.12–2.2 (CI range 1.1–3.2)) and dementia (HR range 1.4–7.7 (CI range 1.2–39.6)) were associated with fatal COVID-19 in different regions, although the estimates varied. Evidence from Europe and North America showed that liver cirrhosis (OR range 3.2–5.9 (CI range 0.9–27.7)) and active cancer (OR range 1.6–4.7 (CI range 0.5–14.9)) were also associated with increased risk of death. Association between HIV and undesirable COVID-19 outcomes showed regional heterogeneity, with an increased risk of death in Africa (HR 1.7 (CI 1.3–2.2)). GRADE certainty was moderate to high for most associations. Risk of undesirable COVID-19 health outcomes is consistently increased in certain patient subgroups across geographical regions, showing high variability in others. The results can be used to inform COVID-19 vaccine prioritisation or other intervention strategies.

中文翻译：

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既往健康状况和严重的 COVID-19 结果：总体审查方法和全球证据的荟萃分析

本研究采用伞式审查方法来总结有关已有健康状况的患者出现严重 COVID-19 结局风险的全球证据。截至 2020 年 12 月 11 日，在 PubMed、Embase/Medline 和七个预印本服务器中确定了系统评价 (SR)。由于缺乏按地理区域分层的年龄调整风险影响，因此对证据进行了重新分析。初步研究从 SR 中提取，并进行评估以纳入重新分析。如果研究报告了住院、重症监护室入住、插管或死亡的风险估计（比值比 (OR)、风险比 (HR)、相对风险 (RR)），则研究被纳入。估计的关联是从报告的既往病史的初步研究中提取的。世界卫生组织按地区对每个结果进行了分层荟萃分析。使用 GRADE 评估证据的确定性。注册号 CRD42020215846。总共，来自 120 个 SR 的 160 项初步研究为 42 种既往病史提供了 464 项估计值。大多数研究是在北美、欧洲和西太平洋地区进行的。来自非洲、南美/拉丁美洲和东地中海地区的证据很少。东南亚地区没有提供任何证据。糖尿病（HR 范围 1.2–2.0（CI 范围 1.1–2.8））、肥胖（OR 范围 1.5–1.75（CI 范围 1.1–2.3））、心力衰竭（HR 范围 1.3–3.3（CI 范围 0.9–8.2））、COPD （HR 范围 1.12-2.2（CI 范围 1.1-3.2））和痴呆（HR 范围 1.4-7.7（CI 范围 1.2-39.6））在不同地区与致命的 COVID-19 相关，尽管估计值有所不同。来自欧洲和北美的证据表明，肝硬化（OR范围3.2-5.9（CI范围0.9-27.7））和活动性癌症（OR范围1.6-4.7（CI范围0.5-14.9））也与死亡风险增加相关。HIV 与 COVID-19 不良结果之间的关联显示出区域异质性，非洲的死亡风险增加（HR 1.7（CI 1.3-2.2））。大多数协会的等级确定性为中等到高。在不同地理区域的某些患者亚组中，出现不良 COVID-19 健康结果的风险持续增加，而在其他亚组中则表现出较高的变异性。结果可用于为 COVID-19 疫苗优先顺序或其他干预策略提供信息。