Comparison of the COVID-19 mortality occurring in hospitals and those brought in dead within Malaysia

Measuring the success of the control of COVID-19 in any country includes a review of the mortality especially to compare the deaths of those dying in hospitals and those brought in dead (BID). The objective of this study was to compare the death groups with the demographic factors that influenced the type of death.

This was a case-control study (1:1 ratio) looking at COVID-19 secondary public data from March 2020 to February 2021. Data such as the basic demographic data and comorbidities were analysed descriptively and then using a binary-logistic regression analysis to compare the independent variables against the outcome of BID. From the database, 120 cases were included as BID (4 excluded due to insufficient information) and 120 patients from the 1006 who passed away in hospital were randomly selected as comparators. The data was analysed in SPSS v21.0.

The mean age for the BID was 59.59 (SD: 18.74), with more males (70.8%) than females (29.2%), of which 61.7% were Malaysians, 46.7% from the state of Sabah, and 64.2% having at least one co-morbidity (50% of them had hypertension). A univariate binary logistic regression analysis yielded factors such as age, nationality, and presence of any co-morbidities that are favourable to be included into the multivariate analysis. From the final analysis, the only factor that distinguished the BID from those dying in the hospital was being a foreigner (AOR: 4.32 [95%CI: 2.02-9.24], p<0.001).

This concluded that foreigners in Malaysia were likely to die from COVID-19 outside of the hospital compared to Malaysians. Amongst the reasons that needed to be addressed were cost, accessibility issues regarding medical care, and the testing policies in Malaysia.