Variation in US Hospital Mortality Rates for Patients Admitted With COVID-19 During the First 6 Months of the Pandemic

Abstract

IMPORTANCEIt is unknown how much the mortality of patients with coronavirus disease 2019 (COVID-19) depends on the hospital that cares for them, and whether COVID-19 hospital mortality rates are improving.OBJECTIVE To identify variation in COVID-19 mortality rates and how those rates have changed over the first months of the pandemic. DESIGN, SETTING, AND PARTICIPANTSThis cohort study assessed 38 517 adults who were admitted with COVID-19 to 955 US hospitals from January 1, 2020, to June 30, 2020, and a subset of 27 801 adults (72.2%) who were admitted to 398 of these hospitals that treated at least 10 patients with COVID-19 during 2 periods (January 1 to April 30, 2020, and May 1 to June 30, 2020).EXPOSURES Hospital characteristics, including size, the number of intensive care unit beds, academic and profit status, hospital setting, and regional characteristics, including COVID-19 case burden. MAIN OUTCOMES AND MEASURESThe primary outcome was the hospital's risk-standardized event rate (RSER) of 30-day in-hospital mortality or referral to hospice adjusted for patient-level characteristics, including demographic data, comorbidities, community or nursing facility admission source, and time since January 1, 2020. We examined whether hospital characteristics were associated with RSERs or their change over time. RESULTSThe mean (SD) age among participants (18 888 men [49.0%]) was 70.2 (15.5) years. The mean (SD) hospital-level RSER for the 955 hospitals was 11.8% (2.5%). The mean RSER in the worst-performing quintile of hospitals was 15.65% compared with 9.06% in the best-performing quintile (absolute difference, 6.59 percentage points; 95% CI, 6.38%-6.80%; P < .001). Mean RSERs in all but 1 of the 398 hospitals improved; 376 (94%) improved by at least 25%. The overall mean (SD) RSER declined from 16.6% (4.0%) to 9.3% (2.1%). The absolute difference in rates of mortality or referral to hospice between the worst-and best-performing quintiles of hospitals decreased from 10.54 percentage points (95% CI, 10.03%-11.05%; P < .001) to 5.59 percentage points (95% CI, 5.33%-5.86%; P < .001). Higher county-level COVID-19 case rates were associated with worse RSERs, and case rate declines were associated with improvement in RSERs. CONCLUSIONS AND RELEVANCEOver the first months of the pandemic, COVID-19 mortality rates in this cohort of US hospitals declined. Hospitals did better when the prevalence of COVID-19 in their surrounding communities was lower.

Characteristics, Outcomes, and Trends of Patients With COVID-19–Related Critical Illness at a Learning Health System in the United States

“…Our study of more than 450 patients with COVID-19–related critical illness across 5 hospitals within an academic health system during the initial surge of the pandemic adds support to many findings published by other centers in the United States and globally ( 1–10 , 12 ), and offers some important additions to our rapidly evolving understanding of the epidemiology of this novel disease. These additions, as well as those in reports from other centers that continue to be released, are particularly important as the United States and other nations combat ongoing and new surges related to opening economies, reduced mitigation strategies, and seasonal changes, among other factors ( 18 ).…”

“…We examined all-cause 28-day in-hospital mortality over 2 measures of health system COVID-19 experience: intervals of time and intervals of cumulative COVID-19 patient volume. Other studies have reported a learning effect ( 5 , 10 , 12 , 23 ). Our results support the notion that outcomes improved during the pandemic independent of patient-level factors.…”

Increased mortality among individuals hospitalised with COVID-19 during the second wave in South Africa

“…(11) Studies have shown that a strain on hospital capacity has been associated with increased mortality in non-pandemic settings. (35) COVID-19 mortality in hospitals seems to be higher when the incidence of COVID-19 in the community was high or increasing (36,37) and when the number of hospitalisations were highest. (19) In addition, the rapid escalation in cases resulted in hospital resource constraints affecting outcomes.…”

Temporal variations in the severity of COVID-19 illness by race and ethnicity

“…There are several potential explanations for our findings. The overall decline in COVID-19 illness severity, with a reported mortality rate as high as 16.6% in January-April and declining to 9.3% by May-June, 26 has been associated with broadening demographics of the populations at risk, in addition to rapidly advancing therapeutics such as remdesivir, baricitinib and monoclonal antibodies. [27][28][29] As for other disease states, new therapeutics are often not available to all segments of society simultaneously and thus can exacerbate disparities in healthcare access, utilisation and outcomes.…”