Trends in Patient Characteristics and COVID-19 In-Hospital Mortality in the United States During the COVID-19 Pandemic
| Autor: | Simon I. Hay, Gregory A. Roth, Joseph H. Williams, Tracy Y. Wang, David A. Morrow, Saate S Shakil, Sophia Emmons-Bell, Jason G. Walchok, James A. de Lemos, Sandeep R Das, Fatima Rodriguez, Emmanuela Gakidou, Mitchell S.V. Elkind, Reed J D Sorensen, Heather M. Alger, Laura M. Stevens, Christopher J L Murray, Jennifer L. Hall, Steven M. Bradley, Catherine O. Johnson, Christine Rutan |
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| Rok vydání: | 2021 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty Time Factors Pneumonia Viral Severity of Illness Index Cohort Studies Sex Factors Disease registry Risk Factors Severity of illness Humans Medicine Medical history Hospital Mortality Registries Original Investigation SARS-CoV-2 Vital Signs business.industry Research Mortality rate Age Factors COVID-19 Retrospective cohort study General Medicine Odds ratio Middle Aged United States Hospitalization Patient Outcome Assessment Intensive Care Units Online Only Female Public Health business Body mass index Cohort study |
| Zdroj: | JAMA Network Open |
| ISSN: | 2574-3805 |
| Popis: | Key Points Question What factors are associated with observed trends in the in-hospital mortality rates in the United States during the first 9 months of the COVID-19 pandemic? Findings In this cohort study of 20 736 patients, in-hospital mortality rates decreased in the US between March and November 2020, even after accounting for the changing mix in patient age, sex, comorbidities, and disease severity at the time of admission. Hospital and intensive care unit length of stay and use of mechanical ventilation decreased over time, whereas the use of glucocorticoids and remdesivir increased. Meaning Changes in age, sex, comorbidities, and disease severity among patients with COVID-19 do not fully explain the decrease in the in-hospital mortality rates observed during the first 9 months of the COVID-19 pandemic. Importance In-hospital mortality rates from COVID-19 are high but appear to be decreasing for selected locations in the United States. It is not known whether this is because of changes in the characteristics of patients being admitted. Objective To describe changing in-hospital mortality rates over time after accounting for individual patient characteristics. Design, Setting, and Participants This was a retrospective cohort study of 20 736 adults with a diagnosis of COVID-19 who were included in the US American Heart Association COVID-19 Cardiovascular Disease Registry and admitted to 107 acute care hospitals in 31 states from March through November 2020. A multiple mixed-effects logistic regression was then used to estimate the odds of in-hospital death adjusted for patient age, sex, body mass index, and medical history as well as vital signs, use of supplemental oxygen, presence of pulmonary infiltrates at admission, and hospital site. Main Outcomes and Measures In-hospital death adjusted for exposures for 4 periods in 2020. Results The registry included 20 736 patients hospitalized with COVID-19 from March through November 2020 (9524 women [45.9%]; mean [SD] age, 61.2 [17.9] years); 3271 patients (15.8%) died in the hospital. Mortality rates were 19.1% in March and April, 11.9% in May and June, 11.0% in July and August, and 10.8% in September through November. Compared with March and April, the adjusted odds ratios for in-hospital death were significantly lower in May and June (odds ratio, 0.66; 95% CI, 0.58-0.76; P This cohort study of patients included in the US American Heart Association COVID-19 Cardiovascular Disease Registry evaluates whether any changes in the in-hospital COVID-19 mortality rates during the first 9 months of the pandemic are associated with individual characteristics of patients with COVID-19. |
| Databáze: | OpenAIRE |
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