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COVID-19 Mortality in Swedish Intensive Care Units: A Multicenter Survival Analysis
Gustaf Forsberg1,2, Knut Taxbro3,4,5, Sören Berg1,2
1Department of Cardiothoracic and Vascular Surgery, Linköping University Hospital, Linköping, Sweden.
Acta Anaesthesiologica Scandinavica
|June 14, 2026
Summary
Critically ill COVID-19 patients admitted to Swedish ICUs showed significant 90-day mortality differences based on their initial hospital. These variations persisted even after adjusting for patient factors and healthcare region, suggesting hospital-specific influences on outcomes.
Area of Science:
- Critical Care Medicine
- Epidemiology
- Health Services Research
Background:
- Global and regional variations in COVID-19 patient mortality have been noted.
- Geographic disparities in mortality rates among critically ill COVID-19 patients in Sweden require investigation.
- Understanding factors contributing to these regional variations is crucial for improving patient outcomes.
Purpose of the Study:
- To determine if COVID-19 patient mortality differences persist after adjusting for case-mix.
- To identify independent factors associated with regional variations in mortality.
- To analyze the impact of the initial hospital of intensive care unit (ICU) admission on mortality.
Main Methods:
- A multicenter cohort study of adult COVID-19 patients admitted to seven ICUs across three Swedish healthcare counties (March 2020 - July 2021).
- Data collected included patient characteristics, disease severity (SAPS3, Charlson comorbidity index), respiratory support, and treatments.
- A mixed-effects Cox proportional hazards model was employed to analyze 90-day mortality.
Main Results:
- Seven hundred and forty-seven patients were included, with unadjusted 90-day mortality ranging from 8.5% to 30%.
- After adjusting for confounders (age, sex, comorbidities, BMI, smoking status), calendar time, and healthcare county, all hospitals showed significantly increased 90-day mortality compared to the lowest mortality hospital (Hazard Ratios 2.38-5.06).
- Initial ICU admission to smaller hospitals was associated with higher mortality risk.
Conclusions:
- Significant differences in 90-day mortality exist among critically ill COVID-19 patients based on the hospital of first ICU admission.
- These mortality disparities remained significant after adjusting for patient characteristics, calendar time, and healthcare county.
- Further research is needed to explore organizational and contextual determinants influencing these observed mortality variations.
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