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Nationwide Analysis of the Outcomes and Mortality of Hospitalized COVID-19 Patients
Ameesh Isath1, Aaqib H Malik1, Akshay Goel1
1Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY.
Insights
The largest US study of over 1.6 million hospitalized COVID-19 patients in 2020 found a 13.6% inpatient mortality rate. Racial and socioeconomic disparities significantly increased mortality risk for minority groups.
Area of Science:
- Public Health
- Epidemiology
- Infectious Diseases
Background:
- The Coronavirus disease 2019 (COVID-19) pandemic has had a global impact, with the United States experiencing a high burden of cases.
- Previous research on hospitalized COVID-19 patients was limited by small sample sizes, necessitating larger-scale investigations.
Purpose of the Study:
- To analyze a large cohort of hospitalized COVID-19 patients in the US to determine mortality predictors and identify disparities.
- To provide comprehensive data on COVID-19 inpatient outcomes from the largest available US inpatient database.
Main Methods:
- Utilized the National Inpatient Sample database for 2020, identifying COVID-19 hospitalizations using ICD-10-CM code U07.1.
- Employed multivariate logistic regression to identify predictors of inpatient mortality.
- Statistical analysis was performed using STATA 16.0.
Main Results:
- A weighted total of 1,678,995 COVID-19 hospitalizations were identified.
- Overall inpatient mortality was 13.6%, rising to 55.9% for patients requiring mechanical ventilation.
- Key mortality predictors included advanced age, male sex, diabetes, chronic kidney disease, heart failure, arrhythmia, obesity, and coagulopathy.
- Significant racial disparities were observed, with Black, Hispanic, and Native American patients facing higher adjusted odds of mortality.
- Lower socioeconomic status, indicated by low median household income, was associated with increased mortality risk.
Conclusions:
- This study of over 1.6 million hospitalized COVID-19 patients in the US highlights a substantial inpatient mortality rate, particularly among ventilated individuals.
- Significant socioeconomic and racial disparities contribute to higher mortality odds for minority populations.
- Findings underscore the need for targeted interventions to address health inequities in COVID-19 care.
Introduction:
The Coronavirus disease 2019 (COVID-19) pandemic has affected people worldwide with the United States (US) with the largest number of reported cases currently. Previous studies in hospitalized COVID-19 patients have been limited by sample size.
Methods:
The National Inpatient Sample database which is the largest inpatient database in the US was queried in the year 2020 for the diagnosis of COVID-19 based on ICD-10-CM U07.1 and associated outcomes. Multivariate logistic regression analysis was used to identify predictors of mortality. STATA 16.0 was used for statistical analysis.
Results:
A weighted total of 1,678,995 hospitalizations for COVID-19 were identified. Median age of admitted patients with COVID-19 was 65 year (51-77) with 47.9% female and 49.2% White. Majority of the patients admitted were >65 years of age (49.3%). Hypertension and diabetes were the most common comorbidities (64.2% and 39.5%, respectively). Overall inpatient mortality was 13.2% and increasing to 55.9% in patients requiring mechanical ventilation. Trend of inpatient mortality was significantly decreasing over the year. Predictors of inpatient mortality included age, male sex, diabetes, chronic kidney disease, heart failure, arrythmia, obesity, and coagulopathy. Despite a lower proportion of patients admitted to hospital with COVID-19, Black, Hispanic, and Native Americans were at an increased adjusted odds of inpatient mortality. Disparity was also noted in income, with low median household income associated with higher risk of mortality.
Conclusion:
In the largest US cohort with >1.6 million hospitalized COVID-19 patients in 2020, overall inpatient mortality was 13.6% with significantly higher mortality in ventilated patients. Significant socioeconomic and racial disparities were present with minorities at higher odds of mortality.
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