Mortality for Time-Sensitive Conditions at Urban vs Rural Hospitals During the COVID-19 Pandemic

Area of Science:

• Public Health
• Healthcare Management
• Epidemiology

Background:

• The COVID-19 pandemic caused significant healthcare system disruptions.
• These disruptions may have adversely affected outcomes for patients with time-sensitive medical conditions.

Purpose of the Study:

• To evaluate changes in in-hospital mortality for non-COVID-19 related hospitalizations concerning time-sensitive conditions during the pandemic.
• To analyze variations in mortality rates between urban and rural hospitals.

Main Methods:

• An interrupted time-series analysis was conducted on adult hospital discharge data from 3813 US hospitals.
• Data spanned the pandemic period (March 2020-December 2021) and a prepandemic period (January 2017-March 2020).
• In-hospital mortality for six conditions (acute myocardial infarction, hip fracture, gastrointestinal hemorrhage, pneumonia, sepsis, stroke) was assessed, with entropy weights used for patient characteristic alignment.

Main Results:

• In-hospital mortality increased for sepsis, pneumonia, acute myocardial infarction, hip fracture, and gastrointestinal hemorrhage during the pandemic.
• Sepsis and pneumonia mortality saw significant increases in both urban and rural hospitals, with higher rates in rural settings.
• Mortality increases for sepsis and pneumonia demonstrated a dose-response relationship with community COVID-19 transmission levels.

Conclusions:

• In-hospital mortality for several time-sensitive conditions rose during the COVID-19 pandemic.
• Developing targeted strategies for urban and rural hospitals is crucial to mitigate excess mortality during future public health emergencies.