tetano
Editor, Senior Moderator
Open Forum Infect Dis
. 2022 Aug 25;9(9)
fac436.
doi: 10.1093/ofid/ofac436. eCollection 2022 Sep.
Reduction in Risk of Death Among Patients Admitted With COVID-19 Between the First and Second Epidemic Waves in New York City
Anthony Bowen[SUP] 1 [/SUP], Jason Zucker[SUP] 1 [/SUP], Yanhan Shen[SUP] 2 [/SUP], Simian Huang[SUP] 1 [/SUP], Qiheng Yan[SUP] 2 [/SUP], Medini K Annavajhala[SUP] 1 [/SUP], Anne-Catrin Uhlemann[SUP] 1 [/SUP], Louise Kuhn[SUP] 2 [/SUP], Magdalena Sobieszczyk[SUP] 1 [/SUP], Delivette Castor[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Many regions have experienced successive epidemic waves of coronavirus disease 2019 (COVID-19) since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with heterogeneous differences in mortality. Elucidating factors differentially associated with mortality between epidemic waves may inform clinical and public health strategies.
Methods: We examined clinical and demographic data among patients admitted with COVID-19 during the first (March-August 2020) and second (August 2020-March 2021) epidemic waves at an academic medical center in New York City.
Results: Hospitalized patients (n = 4631) had lower overall and 30-day in-hospital mortality, defined as death or discharge to hospice, during the second wave (14% and 11%) than the first (22% and 21%). The wave 2 in-hospital mortality decrease persisted after adjusting for several potential confounders. Adjusting for the volume of COVID-19 admissions, a measure of health system strain, accounted for the mortality difference between waves. Several demographic and clinical patient factors were associated with an increased risk of mortality independent of wave: SARS-CoV-2 cycle threshold, do-not-intubate status, oxygen requirement, and intensive care unit admission.
Conclusions: This work suggests that the increased in-hospital mortality rates observed during the first epidemic wave were partly due to strain on hospital resources. Preparations for future epidemics should prioritize evidence-based patient risks, treatment paradigms, and approaches to augment hospital capacity.
Keywords: COVID-19; Cox regression; epidemics; mortality.
. 2022 Aug 25;9(9)
fac436.doi: 10.1093/ofid/ofac436. eCollection 2022 Sep.
Reduction in Risk of Death Among Patients Admitted With COVID-19 Between the First and Second Epidemic Waves in New York City
Anthony Bowen[SUP] 1 [/SUP], Jason Zucker[SUP] 1 [/SUP], Yanhan Shen[SUP] 2 [/SUP], Simian Huang[SUP] 1 [/SUP], Qiheng Yan[SUP] 2 [/SUP], Medini K Annavajhala[SUP] 1 [/SUP], Anne-Catrin Uhlemann[SUP] 1 [/SUP], Louise Kuhn[SUP] 2 [/SUP], Magdalena Sobieszczyk[SUP] 1 [/SUP], Delivette Castor[SUP] 1 [/SUP]
Affiliations
- PMID: 36131846
- PMCID: PMC9452151
- DOI: 10.1093/ofid/ofac436
Abstract
Background: Many regions have experienced successive epidemic waves of coronavirus disease 2019 (COVID-19) since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with heterogeneous differences in mortality. Elucidating factors differentially associated with mortality between epidemic waves may inform clinical and public health strategies.
Methods: We examined clinical and demographic data among patients admitted with COVID-19 during the first (March-August 2020) and second (August 2020-March 2021) epidemic waves at an academic medical center in New York City.
Results: Hospitalized patients (n = 4631) had lower overall and 30-day in-hospital mortality, defined as death or discharge to hospice, during the second wave (14% and 11%) than the first (22% and 21%). The wave 2 in-hospital mortality decrease persisted after adjusting for several potential confounders. Adjusting for the volume of COVID-19 admissions, a measure of health system strain, accounted for the mortality difference between waves. Several demographic and clinical patient factors were associated with an increased risk of mortality independent of wave: SARS-CoV-2 cycle threshold, do-not-intubate status, oxygen requirement, and intensive care unit admission.
Conclusions: This work suggests that the increased in-hospital mortality rates observed during the first epidemic wave were partly due to strain on hospital resources. Preparations for future epidemics should prioritize evidence-based patient risks, treatment paradigms, and approaches to augment hospital capacity.
Keywords: COVID-19; Cox regression; epidemics; mortality.