Adults over 65 and people with certain chronic health conditions are considered high risk for severe COVID-19. More than 81% of COVID-19 deaths have occurred in people over age 65, but younger adults, teens, and even children can also face serious illness if they have underlying medical conditions. “High risk” means you’re more likely to need hospitalization, intensive care, or to develop life-threatening complications if you get infected.
Age Is the Strongest Single Risk Factor
The risk of severe illness and death from COVID-19 rises steeply with age. Compared to adults ages 18 to 29, people in their 50s and early 60s are hospitalized at about 3 times the rate and die at 25 times the rate. By age 65 to 74, the death rate jumps to 60 times higher. For those 85 and older, it’s 360 times higher.
That steep curve is why age 65 has been the most commonly used threshold for “high risk” classification in vaccination schedules and treatment guidelines. But the risk doesn’t suddenly appear at 65. It starts climbing meaningfully in your 40s, when death rates are already 10 times higher than in young adults, and accelerates from there.
Chronic Conditions That Increase Risk
The CDC maintains a list of medical conditions associated with higher risk of severe COVID-19. These apply to people of all ages, including children and teenagers. The conditions fall into several broad categories:
- Lung disease: Chronic obstructive pulmonary disease (COPD), asthma, cystic fibrosis, and other chronic lung conditions reduce the respiratory reserve your body can draw on when fighting a serious lung infection.
- Heart conditions: Heart failure, coronary artery disease, and other cardiovascular problems. These conditions also tend to worsen kidney function over time, compounding the risk.
- Diabetes: Both type 1 and type 2 diabetes are on the list. Diabetes affects immune function and blood vessel health, making it harder for the body to contain a viral infection.
- Chronic kidney disease: At any stage. Even early-stage kidney disease qualifies. People with kidney disease are also more vulnerable to lasting kidney damage after a COVID-19 infection. In one study, nearly 30% of patients with chronic kidney disease who developed acute kidney injury during hospitalization progressed to end-stage kidney disease requiring dialysis within five years.
- Chronic liver disease: Including cirrhosis and other forms of liver damage.
- Cancer: Both active cancer and its treatments can suppress the immune system.
- Cerebrovascular disease: Conditions affecting blood flow to the brain, such as a history of stroke.
- Dementia and other neurological conditions: These may increase risk both biologically and because they can make it harder to recognize or communicate symptoms early.
Weakened Immune Systems
Being immunocompromised is one of the most significant risk factors. This includes people living with HIV, those who have received an organ or bone marrow transplant, and anyone taking medications that suppress immune function, such as treatments for autoimmune diseases, certain cancers, or anti-rejection drugs after a transplant.
People with weakened immune systems often produce a weaker response to vaccines as well, which means they may not get the same level of protection from vaccination that healthy individuals do. This is why immunocompromised people have typically been prioritized for additional vaccine doses and early access to antiviral treatments.
Obesity and BMI Thresholds
Obesity, defined as a BMI of 30 or higher, is a recognized risk factor for severe COVID-19. The risk increases as BMI goes up. A BMI between 30 and 35 (class 1 obesity) carries elevated risk, while a BMI of 40 or above (class 3, sometimes called severe obesity) carries the highest risk in this category.
Even being overweight (BMI 25 to 29.9) has been associated with somewhat increased risk, though not as strongly as obesity itself. Fat tissue produces inflammatory signals that can amplify the body’s response to infection, and excess weight also puts mechanical pressure on the lungs, reducing breathing capacity when it’s needed most.
Pregnancy and Postpartum
Pregnancy raises the risk of severe COVID-19 on its own, and that elevated risk persists for at least a month after giving birth. The risk climbs further if a pregnant person also has obesity, diabetes, high blood pressure, or lung disease.
Pregnant people with severe COVID-19 are more likely to develop complications like heart damage, blood clots, and kidney injury. Moderate to severe symptoms have also been linked to higher rates of preterm birth and preeclampsia, a dangerous form of high blood pressure during pregnancy. Those already managing pregnancy-related high blood pressure or preeclampsia are more likely to need hospital monitoring if they contract COVID-19.
Mental Health, Substance Use, and Physical Inactivity
Some risk factors on the CDC’s list surprise people. Mental health conditions and substance use disorders both appear, likely because they’re associated with chronic inflammation, reduced access to healthcare, and other conditions that compound vulnerability. Smoking, whether current or former, damages lung tissue and impairs immune defenses in the airways.
Physical inactivity is also listed as a risk factor. This isn’t about fitness level in the athletic sense. A sedentary lifestyle is linked to poorer cardiovascular health, higher rates of obesity and diabetes, and weaker immune function overall. These overlapping conditions tend to cluster together, which is part of why so many items on the high-risk list reinforce one another.
Disabilities
Disabilities, including intellectual and developmental disabilities, are recognized as a COVID-19 risk factor. Some disabilities directly affect lung function or immune health, while others increase risk through associated conditions or barriers to healthcare access. People living in group care settings may also face higher exposure risk.
Why High-Risk Status Matters for Treatment
Being classified as high risk has practical consequences beyond general caution. Antiviral treatments like Paxlovid are specifically approved for people who have mild to moderate COVID-19 and at least one risk factor for progressing to severe illness. To be eligible, you need to be at least 18 (or over 12 and weighing at least 88 pounds), not already hospitalized, and without severe kidney or liver problems that would make the drug unsafe.
The decision about whether you qualify is based on your doctor’s assessment of your individual medical history and the CDC’s list of risk factors. If you have any of the conditions described above and test positive for COVID-19, starting treatment early, ideally within the first five days of symptoms, gives you the best chance of staying out of the hospital. Knowing your risk category before you get sick means you can act quickly if you do.