tetano
Editor, Senior Moderator
Int J Epidemiol
. 2020 Oct 29;dyaa190.
doi: 10.1093/ije/dyaa190. Online ahead of print.
Filling the gaps in the characterization of the clinical management of COVID-19: 30-day hospital admission and fatality rates in a cohort of 118 150 cases diagnosed in outpatient settings in Spain
Daniel Prieto-Alhambra, Elisabet Ball?[SUP] 1 2 3 [/SUP], Ermengol Coma[SUP] 1 2 [/SUP], N?ria Mora[SUP] 1 2 [/SUP], Mar?a Arag?n[SUP] 1 [/SUP], Albert Prats-Uribe[SUP] 4 [/SUP], Francesc Fina[SUP] 1 2 [/SUP], M?ncia Ben?tez[SUP] 2 5 [/SUP], Carolina Guiriguet[SUP] 2 5 [/SUP], Mireia F?bregas[SUP] 2 [/SUP], Manuel Medina-Peralta[SUP] 1 2 [/SUP], Talita Duarte-Salles[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Currently, there is a missing link in the natural history of COVID-19, from first (usually milder) symptoms to hospitalization and/or death. To fill in this gap, we characterized COVID-19 patients at the time at which they were diagnosed in outpatient settings and estimated 30-day hospital admission and fatality rates.
Methods: This was a population-based cohort study.
: Data were obtained from Information System for Research in Primary Care (SIDIAP)-a primary-care records database covering >6 million people (>80% of the population of Catalonia), linked to COVID-19 reverse transcriptase polymerase chain reaction (RT-PCR) tests and hospital emergency, inpatient and mortality registers. We included all patients in the database who were ≥15 years old and diagnosed with COVID-19 in outpatient settings between 15 March and 24 April 2020 (10 April for outcome studies). Baseline characteristics included socio-demographics, co-morbidity and previous drug use at the time of diagnosis, and polymerase chain reaction (PCR) testing and results.
: Study outcomes included 30-day hospitalization for COVID-19 and all-cause fatality.
Results: We identified 118 150 and 95 467 COVID-19 patients for characterization and outcome studies, respectively. Most were women (58.7%) and young-to-middle-aged (e.g. 21.1% were 45-54 years old). Of the 44 575 who were tested with PCR, 32 723 (73.4%) tested positive. In the month after diagnosis, 14.8% (14.6-15.0) were hospitalized, with a greater proportion of men and older people, peaking at age 75-84 years. Thirty-day fatality was 3.5% (95% confidence interval: 3.4% to 3.6%), higher in men, increasing with age and highest in those residing in nursing homes [24.5% (23.4% to 25.6%)].
Conclusion: COVID-19 infections were widespread in the community, including all age-sex strata. However, severe forms of the disease clustered in older men and nursing-home residents. Although initially managed in outpatient settings, 15% of cases required hospitalization and 4% died within a month of first symptoms. These data are instrumental for designing deconfinement strategies and will inform healthcare planning and hospital-bed allocation in current and future COVID-19 outbreaks.
Keywords: COVID-19; coronavirus; epidemiology; fatality; hospital admission.
. 2020 Oct 29;dyaa190.
doi: 10.1093/ije/dyaa190. Online ahead of print.
Filling the gaps in the characterization of the clinical management of COVID-19: 30-day hospital admission and fatality rates in a cohort of 118 150 cases diagnosed in outpatient settings in Spain
Daniel Prieto-Alhambra, Elisabet Ball?[SUP] 1 2 3 [/SUP], Ermengol Coma[SUP] 1 2 [/SUP], N?ria Mora[SUP] 1 2 [/SUP], Mar?a Arag?n[SUP] 1 [/SUP], Albert Prats-Uribe[SUP] 4 [/SUP], Francesc Fina[SUP] 1 2 [/SUP], M?ncia Ben?tez[SUP] 2 5 [/SUP], Carolina Guiriguet[SUP] 2 5 [/SUP], Mireia F?bregas[SUP] 2 [/SUP], Manuel Medina-Peralta[SUP] 1 2 [/SUP], Talita Duarte-Salles[SUP] 1 [/SUP]
Affiliations
- PMID: 33118037
- DOI: 10.1093/ije/dyaa190
Abstract
Background: Currently, there is a missing link in the natural history of COVID-19, from first (usually milder) symptoms to hospitalization and/or death. To fill in this gap, we characterized COVID-19 patients at the time at which they were diagnosed in outpatient settings and estimated 30-day hospital admission and fatality rates.
Methods: This was a population-based cohort study.
: Data were obtained from Information System for Research in Primary Care (SIDIAP)-a primary-care records database covering >6 million people (>80% of the population of Catalonia), linked to COVID-19 reverse transcriptase polymerase chain reaction (RT-PCR) tests and hospital emergency, inpatient and mortality registers. We included all patients in the database who were ≥15 years old and diagnosed with COVID-19 in outpatient settings between 15 March and 24 April 2020 (10 April for outcome studies). Baseline characteristics included socio-demographics, co-morbidity and previous drug use at the time of diagnosis, and polymerase chain reaction (PCR) testing and results.
: Study outcomes included 30-day hospitalization for COVID-19 and all-cause fatality.
Results: We identified 118 150 and 95 467 COVID-19 patients for characterization and outcome studies, respectively. Most were women (58.7%) and young-to-middle-aged (e.g. 21.1% were 45-54 years old). Of the 44 575 who were tested with PCR, 32 723 (73.4%) tested positive. In the month after diagnosis, 14.8% (14.6-15.0) were hospitalized, with a greater proportion of men and older people, peaking at age 75-84 years. Thirty-day fatality was 3.5% (95% confidence interval: 3.4% to 3.6%), higher in men, increasing with age and highest in those residing in nursing homes [24.5% (23.4% to 25.6%)].
Conclusion: COVID-19 infections were widespread in the community, including all age-sex strata. However, severe forms of the disease clustered in older men and nursing-home residents. Although initially managed in outpatient settings, 15% of cases required hospitalization and 4% died within a month of first symptoms. These data are instrumental for designing deconfinement strategies and will inform healthcare planning and hospital-bed allocation in current and future COVID-19 outbreaks.
Keywords: COVID-19; coronavirus; epidemiology; fatality; hospital admission.