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. 2021 May 3;4(5):e218828.
doi: 10.1001/jamanetworkopen.2021.8828.

Trends in Patient Characteristics and COVID-19 In-Hospital Mortality in the United States During the COVID-19 Pandemic

Gregory A Roth  1 , Sophia Emmons-Bell  1 , Heather M Alger  2 , Steven M Bradley  3   4   5 , Sandeep R Das  6   7 , James A de Lemos  6   7 , Emmanuela Gakidou  1 , Mitchell S V Elkind  8   9 , Simon Hay  1 , Jennifer L Hall  2   10 , Catherine O Johnson  1 , David A Morrow  11 , Fatima Rodriguez  12 , Christine Rutan  2 , Saate Shakil  1 , Reed Sorensen  1 , Laura Stevens  2   13 , Tracy Y Wang  14 , Jason Walchok  2 , Joseph Williams  2 , Christopher Murray  1
Affiliations

Trends in Patient Characteristics and COVID-19 In-Hospital Mortality in the United States During the COVID-19 Pandemic

Gregory A Roth et al. JAMA Netw Open. .

Abstract

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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Conflict of interest statement

Conflict of Interest Disclosures: Dr Alger reported being employed by the American Heart Association (AHA) during the conduct of the study. Dr Elkind reported receiving royalties from UpToDate outside the submitted work; and serving as an unpaid officer of the AHA. Dr Hall reported being an employee of the AHA. Dr Morrow reported receiving personal fees from Bayer Pharma, Merck & Co, Novartis, and Roche Diagnostics outside the submitted work; and serving as a member of the TIMI Study group, which has received institutional research grant support through Brigham and Women’s Hospital from Abbott Laboratories, Amgen, Anthos Therapeutics, Arca Biopharma, AstraZeneca, Bayer HealthCare Pharmaceuticals, BRAHMS, Daiichi-Sankyo, Eisai, GlaxoSmithKline, Intarcia, Janssen, Merck & Co, Novartis, Pfizer, Poxel, Quark Pharmaceuticals, Regeneron, Roche, Siemens, The Medicines Company, and Zora Biosciences. Dr Rodriguez reported receiving grants from the AHA/Robert Wood Johnson Harold Amos Medical Faculty Development Program and the National Heart, Lung, and Blood Institute during the conduct of the study; and receiving personal fees from HealthPals, Janssen, Novartis, and Novo Nordisk outside the submitted work. Ms Rutan reported being an employees of the AHA. Dr Wang reported receiving research grants to the Duke Clinical Research Institute from Abbott, AstraZeneca, Boston Scientific, Bristol Myers Squibb, Cryolife, Chiesi, Merck & Co, Portola, and Regeneron; and receiving personal fees from AstraZeneca, Bristol Myers Squibb, Cryolife, and Novartis outside the submitted work. Dr Williams reported being an employee of the AHA during the conduct of the study. No other disclosures were reported.

Figures

Figure.
Figure.. Unadjusted and Adjusted Odds of Inpatient Death in May and June, July and August, and September Through November Compared With March and April, 2020
Odds ratios (ORs) calculated as the exponentiated effect size of each logistic regression. Unadjusted ORs represent logistic regression of inpatient death against month, stratified by age. Adjusted ORs represent logistic regression of inpatient death against month and characteristics known at admission (sex, heart rate, respiratory rate, systolic blood pressure, creatinine concentration, oxygen saturation, presence of interstitial infiltrates, and use of supplemental oxygen, and history of cancer, cerebrovascular disease, chronic kidney disease, heart failure, diabetes, hypertension, coronary artery bypass grafting or percutaneous coronary intervention, pulmonary disease, and smoking), stratified by age, with a random effect on hospital identification.
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