TY - JOUR
T1 - Trends in Patient Characteristics and COVID-19 In-Hospital Mortality in the United States During the COVID-19 Pandemic
AU - Roth, Gregory A.
AU - Emmons-Bell, Sophia
AU - Alger, Heather M.
AU - Bradley, Steven M.
AU - Das, Sandeep R.
AU - de Lemos, James A.
AU - Gakidou, Emmanuela
AU - Elkind, Mitchell S.V.
AU - Hay, Simon
AU - Hall, Jennifer L.
AU - Johnson, Catherine O.
AU - Morrow, David A.
AU - Rodriguez, Fatima
AU - Rutan, Christine
AU - Shakil, Saate
AU - Sorensen, Reed
AU - Stevens, Laura
AU - Wang, Tracy Y.
AU - Walchok, Jason
AU - Williams, Joseph
AU - Murray, Christopher
N1 - Publisher Copyright:
© 2021 American Medical Association. All rights reserved.
PY - 2021/5/3
Y1 - 2021/5/3
N2 - 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 < .001), July and August (odds ratio, 0.58; 95% CI, 0.49-0.69; P < .001), and September through November (odds ratio, 0.59; 95% CI, 0.47-0.73). CONCLUSIONS AND RELEVANCE In this cohort study, high rates of in-hospital COVID-19 mortality among registry patients in March and April 2020 decreased by more than one-third by June and remained near that rate through November. This difference in mortality rates between the months of March and April and later months persisted even after adjusting for age, sex, medical history, and COVID-19 disease severity and did not appear to be associated with changes in the characteristics of patients being admitted.
AB - 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 < .001), July and August (odds ratio, 0.58; 95% CI, 0.49-0.69; P < .001), and September through November (odds ratio, 0.59; 95% CI, 0.47-0.73). CONCLUSIONS AND RELEVANCE In this cohort study, high rates of in-hospital COVID-19 mortality among registry patients in March and April 2020 decreased by more than one-third by June and remained near that rate through November. This difference in mortality rates between the months of March and April and later months persisted even after adjusting for age, sex, medical history, and COVID-19 disease severity and did not appear to be associated with changes in the characteristics of patients being admitted.
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U2 - 10.1001/jamanetworkopen.2021.8828
DO - 10.1001/jamanetworkopen.2021.8828
M3 - Article
C2 - 33938933
AN - SCOPUS:85105215617
SN - 2574-3805
VL - 4
SP - E218828
JO - JAMA Network Open
JF - JAMA Network Open
IS - 5
ER -