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Trends in COVID-19 Risk-Adjusted Mortality Rates

Leora I Horwitz1,2,3, Simon A Jones1,2, Robert J Cerfolio4

  • 1Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, New York.

Journal of Hospital Medicine
|November 4, 2020
PubMed

Insights

COVID-19 (coronavirus disease 2019) mortality has decreased, even when accounting for patient demographics and clinical factors. This study suggests improved outcomes in a New York health system from March to August 2020.

Area of Science:

  • Infectious Diseases
  • Epidemiology
  • Critical Care Medicine

Background:

  • Early phases of the COVID-19 pandemic were associated with high in-hospital mortality rates.
  • Recent observations suggest a decline in COVID-19 mortality, prompting investigation into contributing factors.
  • Changes in patient demographics, including age and comorbidities, may influence observed mortality trends.

Purpose of the Study:

  • To investigate the association between changing patient demographics and hospital mortality during the COVID-19 pandemic.
  • To determine if the decrease in COVID-19 mortality rates is attributable to improved treatments or shifts in patient characteristics.
  • To analyze in-hospital mortality trends adjusted for demographic and clinical factors within an academic health system.

Main Methods:

  • Retrospective analysis of 5,121 hospitalizations for COVID-19 from March to August 2020 across three hospitals.
  • In-hospital mortality or discharge to hospice was the primary outcome measure.
  • Statistical adjustment for demographic factors, comorbidities, admission vital signs, and laboratory results was performed.

Main Results:

  • Adjusted in-hospital mortality for COVID-19 decreased significantly from 25.6% in March to 7.6% in August 2020.
  • The standardized mortality ratio declined from 1.26 in March to 0.38 in August, indicating a substantial reduction in observed versus expected deaths.
  • The average probability of death decreased by 18.2 percentage points from March to August, after accounting for patient characteristics.

Conclusions:

  • COVID-19 hospital mortality has demonstrably decreased within this academic health system.
  • The observed reduction in mortality persists even after adjusting for changes in patient demographics and clinical profiles.
  • These findings suggest a genuine improvement in COVID-19 outcomes over time, independent of patient population shifts.

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