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Observational Study
. 2020 Nov 23;10(11):e042712.
doi: 10.1136/bmjopen-2020-042712.

Retrospective cohort study of admission timing and mortality following COVID-19 infection in England

Ahmed Alaa  1 , Zhaozhi Qian  2 , Jem Rashbass  3 , Jonathan Benger  4 , Mihaela van der Schaar  2
Affiliations
Observational Study

Retrospective cohort study of admission timing and mortality following COVID-19 infection in England

Ahmed Alaa et al. BMJ Open. .

Abstract

Objectives: We investigated whether the timing of hospital admission is associated with the risk of mortality for patients with COVID-19 in England, and the factors associated with a longer interval between symptom onset and hospital admission.

Design: Retrospective observational cohort study of data collected by the COVID-19 Hospitalisation in England Surveillance System (CHESS). Data were analysed using multivariate regression analysis.

Setting: Acute hospital trusts in England that submit data to CHESS routinely.

Participants: Of 14 150 patients included in CHESS until 13 May 2020, 401 lacked a confirmed diagnosis of COVID-19 and 7666 lacked a recorded date of symptom onset. This left 6083 individuals, of whom 15 were excluded because the time between symptom onset and hospital admission exceeded 3 months. The study cohort therefore comprised 6068 unique individuals.

Main outcome measures: All-cause mortality during the study period.

Results: Timing of hospital admission was an independent predictor of mortality following adjustment for age, sex, comorbidities, ethnicity and obesity. Each additional day between symptom onset and hospital admission was associated with a 1% increase in mortality risk (HR 1.01; p<0.005). Healthcare workers were most likely to have an increased interval between symptom onset and hospital admission, as were people from Black, Asian and minority ethnic (BAME) backgrounds, and patients with obesity.

Conclusion: The timing of hospital admission is associated with mortality in patients with COVID-19. Healthcare workers and individuals from a BAME background are at greater risk of later admission, which may contribute to reports of poorer outcomes in these groups. Strategies to identify and admit patients with high-risk and those showing signs of deterioration in a timely way may reduce the consequent mortality from COVID-19, and should be explored.

Keywords: health policy; infectious diseases; public health.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Patients’ flow diagram. CHESS, COVID-19 Hospitalisation in England Surveillance System.
Figure 2
Figure 2
Kaplan-Meier survival curves for the subcohorts of patients admitted to hospital after more than 1 week (A), 2 weeks (B) and 3 weeks (C) of exhibiting COVID-19 symptoms.
Figure 3
Figure 3
Hazard ratios for mortality (based on a Cox proportional hazards regression model).
Figure 4
Figure 4
Predictors of later hospital admission.
See this image and copyright information in PMC

References

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