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Multicenter Study
. 2021 Sep 2;22(5):1051-1059.
doi: 10.5811/westjem.2021.5.52583.

Mortality Variations of COVID-19 from Different Hospital Settings During Different Pandemic Phases: A Multicenter Retrospective Study

Eric H Chou  1   2 , Chih-Hung Wang  3   4 , Chu-Lin Tsai  3   4 , John Garrett  5 , Toral Bhakta  1 , Andrew Shedd  1 , Dahlia Hassani  1 , Robert Risch  6 , James d'Etienne  2 , Gerald O Ogola  7 , Matthew Huei-Ming Ma  3   4 , Tsung-Chien Lu  3   4 , Hao Wang  1   2   5
Affiliations
Multicenter Study

Mortality Variations of COVID-19 from Different Hospital Settings During Different Pandemic Phases: A Multicenter Retrospective Study

Eric H Chou et al. West J Emerg Med. .

Abstract

Introduction: Diverse coronavirus disease 2019 (COVID-19) mortalities have been reported but focused on identifying susceptible patients at risk of more severe disease or death. This study aims to investigate the mortality variations of COVID-19 from different hospital settings during different pandemic phases.

Methods: We retrospectively included adult (≥18 years) patients who visited emergency departments (ED) of five hospitals in the state of Texas and who were diagnosed with COVID-19 between March-November 2020. The included hospitals were dichotomized into urban and suburban based on their geographic location. The primary outcome was mortality that occurred either during hospital admission or within 30 days after the index ED visit. We used multivariable logistic regression to investigate the associations between independent variables and outcome. Generalized additive models were employed to explore the mortality variation during different pandemic phases.

Results: A total of 1,788 adult patients who tested positive for COVID-19 were included in the study. The median patient age was 54.6 years, and 897 (50%) patients were male. Urban hospitals saw approximately 59.5% of the total patients. A total of 197 patients died after the index ED visit. The analysis indicated visits to the urban hospitals (odds ratio [OR] 2.14, 95% confidence interval [CI], 1.41, 3.23), from March to April (OR 2.04, 95% CI, 1.08, 3.86), and from August to November (OR 2.15, 95% CI, 1.37, 3.38) were positively associated with mortality.

Conclusion: Visits to the urban hospitals were associated with a higher risk of mortality in patients with COVID-19 when compared to visits to the suburban hospitals. The mortality risk rebounded and showed significant difference between urban and suburban hospitals since August 2020. Optimal allocation of medical resources may be necessary to bridge this gap in the foreseeable future.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. This study was funded by a grant from National Taiwan University Hospital (NTUH) for Chih-Hung Wang (110-S4808), and a grant from the Ministry of Science and Technology (MOST), Taiwan for Tsung-Chien Lu (109-2823-8-002-013-CV). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The authors report no conflict of interest.

Figures

Figure 1
Figure 1
Patient inclusion flowchart. RT-PCR, reverse transcription polymerase chain reaction; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; ED, emergency department.
Figure 2
Figure 2
Generalized additive model plots for nonparametric modelling of the mortality variation (represented as logit of the probability of death) during different pandemic phases. A. Total cohort; B. Urban hospitals; C. Suburban hospitals. Logit (p), where p represented the probability for death.
See this image and copyright information in PMC

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