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. 2022 Aug 17;13(1):4834.
doi: 10.1038/s41467-022-32458-y.

Trends in COVID-19 hospital outcomes in England before and after vaccine introduction, a cohort study

Peter D Kirwan  1 , Andre Charlett  2 , Paul Birrell  3   2 , Suzanne Elgohari  2 , Russell Hope  2 , Sema Mandal  2 , Daniela De Angelis  3   2 , Anne M Presanis  3
Affiliations

Trends in COVID-19 hospital outcomes in England before and after vaccine introduction, a cohort study

Peter D Kirwan et al. Nat Commun. .

Abstract

Widespread vaccination campaigns have changed the landscape for COVID-19, vastly altering symptoms and reducing morbidity and mortality. We estimate trends in mortality by month of admission and vaccination status among those hospitalised with COVID-19 in England between March 2020 to September 2021, controlling for demographic factors and hospital load. Among 259,727 hospitalised COVID-19 cases, 51,948 (20.0%) experienced mortality in hospital. Hospitalised fatality risk ranged from 40.3% (95% confidence interval 39.4-41.3%) in March 2020 to 8.1% (7.2-9.0%) in June 2021. Older individuals and those with multiple co-morbidities were more likely to die or else experienced longer stays prior to discharge. Compared to unvaccinated people, the hazard of hospitalised mortality was 0.71 (0.67-0.77) with a first vaccine dose, and 0.56 (0.52-0.61) with a second vaccine dose. Compared to hospital load at 0-20% of the busiest week, the hazard of hospitalised mortality during periods of peak load (90-100%), was 1.23 (1.12-1.34). The prognosis for people hospitalised with COVID-19 in England has varied substantially throughout the pandemic and according to case-mix, vaccination, and hospital load. Our estimates provide an indication for demands on hospital resources, and the relationship between hospital burden and outcomes.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Observed number of individuals hospitalised with COVID-19, by week of admission.
March 2020 to September 2021. Annotations shown for wave 1, wave 2, and wave 3. n = 259,727 individuals.
Fig. 2
Fig. 2. Vaccination status of hospitalised individuals, by month of admission and age group.
December 2020 to September 2021. n = 166,893 individuals with vaccination status reported.
Fig. 3
Fig. 3. Hospitalised fatality risk and median length of stay by month of hospital admission.
a Hospitalised fatality risk and b median length of stay in hospital prior to death or discharge by month of hospital admission. March 2020 to September 2021. Unadjusted for other covariates. n = 259,727 individuals. Error bars are 95% confidence intervals.
Fig. 4
Fig. 4. Hospitalised fatality risk and median length of stay by month of hospital admission and age group.
a Hospitalised fatality risk and b median length of stay in hospital prior to death or discharge by month of hospital admission and age group. March 2020 to September 2021. Unadjusted for other covariates. n = 259,727 individuals. Error bars are 95% confidence intervals.
Fig. 5
Fig. 5. Hospitalised fatality sub-distribution hazard ratio by month of hospital admission.
March 2020 to September 2021. Model includes stratification on age group, region of residence, and vaccination status, and regression adjustment (main effects) on month of hospital admission, sex, ethnicity, IMD quintile, hospital load, and CCI. Reference group: June 2020. n = 238,897 individuals with necessary information reported. Figure shows point estimate of hazard ratio with 95% confidence intervals.
Fig. 6
Fig. 6. Hospitalised fatality sub-distribution hazard ratio by vaccine status.
January 2021 to September 2021. Model includes stratification on age group, region of residence, and month of hospital admission, and regression adjustment (main effects) on vaccine status, sex, ethnicity, IMD quintile, hospital load, and CCI. Reference group: Unvaccinated. n = 126,679 individuals with necessary information reported. Figure shows point estimate of hazard ratio with 95% confidence intervals.
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