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Observational Study
. 2021 Aug;22(8):1565-1573.e4.
doi: 10.1016/j.jamda.2021.06.005. Epub 2021 Jun 12.

Decreased Mortality Over Time During the First Wave in Patients With COVID-19 in Geriatric Care: Data From the Stockholm GeroCovid Study

Hong Xu  1 , Sara Garcia-Ptacek  2 , Martin Annetorp  2 , Tommy Cederholm  3 , Georg Engel  4 , Malin Engström  5 , Håkan Erlandsson  6 , Charlotte Julius  7 , Miia Kivipelto  2 , Lars Göran Lundberg  7 , Carina Metzner  2 , Linda Sandberg  7 , Josefina Skogö Nyvang  8 , Carina Sühl Öberg  9 , Elisabet Åkesson  10 , Dorota Religa  2 , Maria Eriksdotter  2
Affiliations
Observational Study

Decreased Mortality Over Time During the First Wave in Patients With COVID-19 in Geriatric Care: Data From the Stockholm GeroCovid Study

Hong Xu et al. J Am Med Dir Assoc. 2021 Aug.

Abstract

Objective: To describe temporal changes in treatment, care, and short-term mortality outcomes of geriatric patients during the first wave of the COVID-19 pandemic.

Design: Observational study.

Setting and participants: Altogether 1785 patients diagnosed with COVID-19 and 6744 hospitalized for non-COVID-19 causes at 7 geriatric clinics in Stockholm from March 6 to July 31, 2020, were included.

Methods: Across admission month, patient vital signs and pharmacological treatment in relationship to risk for in-hospital death were analyzed using the Poisson regression model. Incidence rates (IRs) and incidence rate ratios (IRRs) of death are presented.

Results: In patients with COVID-19, the IR of mortality were 27%, 17%, 10%, 8%, and 2% from March to July, respectively, after standardization for demographics and vital signs. Compared with patients admitted in March, the risk of in-hospital death decreased by 29% [IRR 0.71, 95% confidence interval (CI) 0.51-0.99] in April, 61% (0.39, 0.26-0.58) in May, 68% (0.32, 0.19-0.55) in June, and 86% (0.14, 0.03-0.58) in July. The proportion of patients admitted for geriatric care with oxygen saturation <90% decreased from 13% to 1%, which partly explains the improvement of COVID-19 patient survival. In non-COVID-19 patients during the pandemic, mortality rates remained relatively stable (IR 1.3%-2.3%). Compared with non-COVID-19 geriatric patients, the IRR of death declined from 11 times higher (IRR 11.7, 95% CI 6.11-22.3) to 1.6 times (2.61, 0.50-13.7) between March and July in patients with COVID-19.

Conclusions and implications: Mortality risk in geriatric patients from the Stockholm region declined over time throughout the first pandemic wave of COVID-19. The improved survival rate over time was only partly related to improvement in saturation status at the admission of the patients hospitalized later throughout the pandemic. Lower incidence during the later months could have led to less severe hospitalized cases driving down mortality.

Keywords: COVID-19; geriatric; mortality.

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Figures

Fig. 1
Fig. 1
Trend of (A) initial vital signs and ongoing medications, and (B) incidence of in-hospital death of COVID-19 patients. ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker.
Fig. 2
Fig. 2
IRR and 95% CI for in-hospital death among COVID-19 patients.
Fig. 3
Fig. 3
(A) IRRs for in-hospital death by the days into-pandemic (continuous variable) using cubic splines. Model adjusted for age, sex, vital signs, and medications [use of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs), β-blocking agents, calcium channel blockers, diuretics, statins, LMWH, NOACs, warfarin, anti-platelets, nonsteroidal anti-inflammatory drugs, glucocorticoids, and antibiotics]. Data were reported as IRR (solid line) and 95% CIs (long-dash line). (B) Proportion of participants (n = 1785) across days into pandemic.
Supplementary Figure 1
Supplementary Figure 1
Flowchart.
Supplementary Figure 2
Supplementary Figure 2
Standardized incidence rate and 95% confidence interval of in-hospital death by age, sex, and initial saturation among COVID-19 patients.
See this image and copyright information in PMC

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