The first 20 months of the COVID-19 pandemic: Mortality, intubation and ICU rates among 104,590 patients hospitalized at 21 United States health systems Journal Article

Authors: Fiore, M. C.; Smith, S. S.; Adsit, R. T.; Bolt, D. M.; Conner, K. L.; Bernstein, S. L.; Eng, O. D.; Lazuk, D.; Gonzalez, A.; Jorenby, D. E.; D’Angelo, H.; Kirsch, J. A.; Williams, B.; Nolan, M. B.; Hayes-Birchler, T.; Kent, S.; Kim, H.; Piasecki, T. M.; Slutske, W. S.; Lubanski, S.; Yu, M.; Suk, Y.; Cai, Y.; Kashyap, N.; Mathew, J. P.; McMahan, G.; Rolland, B.; Tindle, H. A.; Warren, G. W.; An, L. C.; Boyd, A. D.; Brunzell, D. H.; Carrillo, V.; Chen, L. S.; Davis, J. M.; Dilip, D.; Ellerbeck, E. F.; Iturrate, E.; Jose, T.; Khanna, N.; King, A.; Klass, E.; Newman, M.; Shoenbill, K. A.; Tong, E.; Tsoh, J. Y.; Wilson, K. M.; Theobald, W. E.; Baker, T. B.
Article Title: The first 20 months of the COVID-19 pandemic: Mortality, intubation and ICU rates among 104,590 patients hospitalized at 21 United States health systems
Abstract: Main objective There is limited information on how patient outcomes have changed during the COVID-19 pandemic. This study characterizes changes in mortality, intubation, and ICU admission rates during the first 20 months of the pandemic. Study design and methods University of Wisconsin researchers collected and harmonized electronic health record data from 1.1 million COVID-19 patients across 21 United States health systems from February 2020 through September 2021. The analysis comprised data from 104,590 adult hospitalized COVID-19 patients. Inclusion criteria for the analysis were: (1) age 18 years or older; (2) COVID-19 ICD-10 diagnosis during hospitalization and/or a positive COVID-19 PCR test in a 14-day window (+/- 7 days of hospital admission); and (3) health system contact prior to COVID-19 hospitalization. Outcomes assessed were: (1) mortality (primary), (2) endotracheal intubation, and (3) ICU admission. Results and significance The 104,590 hospitalized participants had a mean age of 61.7 years and were 50.4% female, 24% Black, and 56.8% White. Overall risk-standardized mortality (adjusted for age, sex, race, ethnicity, body mass index, insurance status and medical comorbidities) declined from 16% of hospitalized COVID-19 patients (95% CI: 16% to 17%) early in the pandemic (February-April 2020) to 9% (CI: 9% to 10%) later (July-September 2021). Among subpopulations, males (vs. females), those on Medicare (vs. those on commercial insurance), the severely obese (vs. normal weight), and those aged 60 and older (vs. younger individuals) had especially high mortality rates both early and late in the pandemic. ICU admission and intubation rates also declined across these 20 months. Conclusions Mortality, intubation, and ICU admission rates improved markedly over the first 20 months of the pandemic among adult hospitalized COVID-19 patients although gains varied by sub-population. These data provide important information on the course of COVID-19 and identify hospitalized patient groups at heightened risk for negative outcomes. Trial registration Identifier: NCT04506528 ( NCT04506528). Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
Keywords: adolescent; adult; aged; middle aged; major clinical study; united states; polymerase chain reaction; demography; health care; health insurance; medicare; intensive care unit; hospitalization; intensive care units; body mass; comorbidity; hospital admission; sex difference; epidemiology; intubation; hospital mortality; clinical outcome; pandemic; mortality rate; endotracheal intubation; intubation, intratracheal; humans; human; male; female; article; pandemics; coronavirus disease 2019; covid-19; sars-cov-2
Journal Title: PLoS ONE
Volume: 17
Issue: 9
ISSN: 1932-6203
Publisher: Public Library of Science  
Date Published: 2022-09-28
Start Page: e0274571
Language: English
DOI: 10.1371/journal.pone.0274571
PUBMED: 36170336
PROVIDER: scopus
PMCID: PMC9518859
Notes: Article -- Export Date: 1 November 2022 -- Source: Scopus
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MSK Authors
  1. Deepika Dilip
    11 Dilip