COVID-19 can infect anyone, but it hits certain groups far harder than others. Adults over 65 account for 70% of all COVID-19 hospitalizations in the United States, and people with chronic health conditions, weakened immune systems, or lower incomes face significantly worse outcomes. Understanding who carries the greatest risk helps explain why the virus continues to cause serious illness even years into the pandemic.
Older Adults Face the Steepest Risk
Age is the single strongest predictor of severe COVID-19. During the October 2023 to April 2024 surveillance season, adults 75 and older were hospitalized at 24 times the rate of adults 18 to 49. Their cumulative hospitalization rate approached one for every 100 people in that age group. Adults 65 to 74 were hospitalized at more than seven times the rate of younger adults, and those 50 to 64 at nearly three times the rate.
Death follows a similar pattern. Among all in-hospital COVID-19 deaths during that same period, 45% occurred in people 75 and older. The overall in-hospital death rate was about 7%, but it climbed to roughly 11% for hospitalized patients between 65 and 74.
Chronic Health Conditions That Raise Risk
A long list of underlying conditions increases the chance of ending up in the hospital, in intensive care, on a ventilator, or dying from COVID-19. The CDC maintains a list based on systematic reviews and meta-analyses, and it includes many of the most common chronic diseases in the U.S.:
- Diabetes (type 1, type 2, and gestational)
- Heart conditions such as heart failure, coronary artery disease, and cardiomyopathies
- Chronic kidney disease
- Chronic lung diseases including COPD, interstitial lung disease, and bronchiectasis
- Obesity (BMI over 30, or above the 95th percentile in children)
- Cancer, including blood cancers
- Chronic liver disease, including cirrhosis and fatty liver disease
- Mental health conditions, specifically mood disorders like depression and schizophrenia spectrum disorders
- Neurologic conditions like dementia and Parkinson’s disease
- HIV
Smoking, both current and former, physical inactivity, and the use of immunosuppressive medications also independently raise risk. Even conditions that might seem unrelated to respiratory illness, like cerebrovascular disease (stroke history) and Down syndrome, appear on the list because of their documented association with worse outcomes.
Immunocompromised People Are Disproportionately Affected
People with weakened immune systems, whether from organ transplants, blood stem cell transplants, primary immune deficiencies, or immunosuppressive medications, face an outsized share of severe illness. A 2023 observational study found that immunocompromised individuals made up just 4% of the population studied but accounted for nearly 22% of COVID-19 hospitalizations and deaths. That five-fold overrepresentation persists even in the vaccine era, partly because vaccines generate a weaker immune response in these individuals.
Updated vaccine data reflects this gap. Among adults 65 and older without immune-compromising conditions, the 2024-2025 COVID-19 vaccine reduced hospitalization risk by about 45% within the first four months. For those in the same age group with compromised immune systems, the reduction was 40%, a meaningful but smaller benefit that still leaves considerable residual risk.
Pregnant People and Their Babies
Pregnancy places people at higher risk for severe COVID-19 compared to non-pregnant peers of the same age. A large meta-analysis found that COVID-19 during pregnancy was associated with nearly five times the odds of ICU admission, close to twice the odds of preterm birth, and roughly double the odds of stillbirth compared to pregnant individuals without the infection. Babies born to infected mothers were also more likely to have low birth weight and to need neonatal intensive care.
When the infection was severe rather than mild, these risks escalated dramatically. Severe COVID-19 in pregnancy was linked to more than 15 times the odds of ICU admission and 19 times the odds of needing mechanical ventilation, compared to mild cases. The risk of preeclampsia jumped fourfold.
Children Generally Do Better, but Are Not Immune
Children consistently experience milder illness than adults. In one comparative study, no children were categorized as having severe disease, and only about 6% had moderate illness, compared to nearly 30% of adults with moderate or severe infection. The biological reasons for this are still being explored, but the pattern has held across multiple waves of the virus.
That said, children are not risk-free. Certain pediatric conditions, including obesity, diabetes, and developmental disabilities, raise the odds of a more serious course. Multisystem inflammatory syndrome in children (MIS-C), a rare but serious inflammatory reaction that can occur weeks after infection, emerged as a unique pediatric concern, though cases have declined substantially since the early pandemic years.
Racial and Ethnic Disparities
COVID-19 has not affected all racial and ethnic groups equally. Multiple studies have documented that racial and ethnic minority groups in the U.S. experience disproportionately higher rates of hospitalization and in-hospital death. Research in Hawaii found that Asian and Pacific Islander subgroups had higher rates of in-hospital death, with Filipino, Pacific Islander, and other Asian subgroups showing the highest test positivity and hospitalization rates.
These disparities are driven by overlapping factors: higher rates of underlying health conditions, greater occupational exposure, more crowded housing, and less access to healthcare. A UK Biobank study found that non-white essential workers had more than eight times the risk of severe COVID-19 compared to white non-essential workers, illustrating how race, occupation, and socioeconomic status compound one another.
Income and Housing Shape Exposure Risk
Lower-income communities bore a dramatically heavier burden during the pandemic’s early waves. In a study of 81 communities in Los Angeles, the lowest-income neighborhoods had 6.6 times the COVID-19 incidence rate of the wealthiest neighborhoods during the July 2020 surge, and 4.3 times the rate during the January 2021 surge. People in these communities were more likely to work in service industries where remote work was not an option, more likely to rely on public transportation, and more likely to live in higher-density housing.
Vaccination helped narrow this gap. By September 2021, after vaccines became widely available, the income-based disparity in infection rates had effectively disappeared. But vaccination coverage itself tracked with income: the wealthiest communities reached median coverage of about 72%, while the lowest-income communities reached about 59%. The virus exploited inequality at every turn, from who got exposed to who got vaccinated.
Certain Jobs Carry Greater Risk
Occupation plays a significant role in who gets infected and how severely. Healthcare workers had roughly seven times the risk of severe COVID-19 compared to non-essential workers in a large UK prospective study. Medical support staff faced the highest risk of any specific occupation, at nearly nine times the baseline. Social care workers had about 2.5 times the risk, and transport workers about twice the risk, though some of the elevated risk among transport workers was explained by socioeconomic factors rather than the job itself.
Social and education workers also had elevated risk, at about 1.8 times that of non-essential workers. The common thread across high-risk occupations is sustained close contact with other people in indoor settings, combined with limited ability to work remotely.
Long COVID Affects a Different Profile
The people most likely to develop long-lasting symptoms after infection don’t perfectly overlap with those most likely to be hospitalized. Long COVID peaks in middle age, with the highest prevalence (23.5%) among adults 45 to 54. Risk rises from about 18% in the 18 to 24 age group through middle age, then declines after 65, meaning the oldest adults who face the worst acute illness are not the ones most likely to develop persistent symptoms.
Women are 40% more likely than men to develop long COVID, with a prevalence of about 25% compared to 16% in men. Lower socioeconomic status, including lower education, lack of insurance, and lower household income, is also associated with higher long COVID rates. These patterns suggest that long COVID involves immune and biological mechanisms distinct from those driving acute severity, and that being young and otherwise healthy does not protect against it.