TY - JOUR
T1 - Association between caseload surge and covid-19 survival in 558 u.s. hospitals, march to august 2020
AU - Kadri, Sameer S.
AU - Sun, Junfeng
AU - Lawandi, Alexander
AU - Strich, Jeffrey R.
AU - Busch, Lindsay M.
AU - Keller, Michael
AU - Babiker, Ahmed
AU - Yek, Christina
AU - Malik, Seidu
AU - Krack, Janell
AU - Dekker, John P.
AU - Spaulding, Alicen B.
AU - Ricotta, Emily
AU - Powers, John H.
AU - Rhee, Chanu
AU - Klompas, Michael
AU - Athale, Janhavi
AU - Boehmer, Tegan K.
AU - Gundlapalli, Adi V.
AU - Bentley, William
AU - Deblina Datta, S.
AU - Danner, Robert L.
AU - Demirkale, Cumhur Y.
AU - Warner, Sarah
N1 - Publisher Copyright:
© 2021 American College of Physicians. All rights reserved.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - Background: Several U.S. hospitals had surges in COVID-19 caseload, but their effect on COVID-19 survival rates remains unclear, especially independent of temporal changes in survival. Objective: To determine the association between hospitals' severity-weighted COVID-19 caseload and COVID-19 mortality risk and identify effect modifiers of this relationship. Design: Retrospective cohort study. (ClinicalTrials.gov: NCT04688372) Setting: 558 U.S. hospitals in the Premier Healthcare Database. Participants: Adult COVID-19-coded inpatients admitted from March to August 2020 with discharge dispositions by October 2020. Measurements: Each hospital-month was stratified by percentile rank on a surge index (a severity-weighted measure of COVID-19 caseload relative to pre-COVID-19 bed capacity). The effect of surge index on risk-adjusted odds ratio (aOR) of in-hospital mortality or discharge to hospice was calculated using hierarchical modeling; interaction by surge attributes was assessed. Results: Of 144116 inpatients with COVID-19 at 558 U.S. hospitals, 78144 (54.2%) were admitted to hospitals in the top surge index decile. Overall, 25344 (17.6%) died; crude COVID- 19 mortality decreased over time across all surge index strata. However, compared with nonsurging (<50th surge index percentile) hospital-months, aORs in the 50th to 75th, 75th to 90th, 90th to 95th, 95th to 99th, and greater than 99th percentiles were 1.11 (95% CI, 1.01 to 1.23), 1.24 (CI, 1.12 to 1.38), 1.42 (CI, 1.27 to 1.60), 1.59 (CI, 1.41 to 1.80), and 2.00 (CI, 1.69 to 2.38), respectively. The surge index was associated with mortality across ward, intensive care unit, and intubated patients. The surge-mortality relationship was stronger in June to August than in March to May (slope difference, 0.10 [CI, 0.033 to 0.16]) despite greater corticosteroid use and more judicious intubation during later and higher-surging months. Nearly 1 in 4 COVID- 19 deaths (5868 [CI, 3584 to 8171]; 23.2%) was potentially attributable to hospitals strained by surging caseload. Limitation: Residual confounding. Conclusion: Despite improvements in COVID-19 survival between March and August 2020, surges in hospital COVID-19 caseload remained detrimental to survival and potentially eroded benefits gained from emerging treatments. Bolstering preventive measures and supporting surging hospitals will save many lives.
AB - Background: Several U.S. hospitals had surges in COVID-19 caseload, but their effect on COVID-19 survival rates remains unclear, especially independent of temporal changes in survival. Objective: To determine the association between hospitals' severity-weighted COVID-19 caseload and COVID-19 mortality risk and identify effect modifiers of this relationship. Design: Retrospective cohort study. (ClinicalTrials.gov: NCT04688372) Setting: 558 U.S. hospitals in the Premier Healthcare Database. Participants: Adult COVID-19-coded inpatients admitted from March to August 2020 with discharge dispositions by October 2020. Measurements: Each hospital-month was stratified by percentile rank on a surge index (a severity-weighted measure of COVID-19 caseload relative to pre-COVID-19 bed capacity). The effect of surge index on risk-adjusted odds ratio (aOR) of in-hospital mortality or discharge to hospice was calculated using hierarchical modeling; interaction by surge attributes was assessed. Results: Of 144116 inpatients with COVID-19 at 558 U.S. hospitals, 78144 (54.2%) were admitted to hospitals in the top surge index decile. Overall, 25344 (17.6%) died; crude COVID- 19 mortality decreased over time across all surge index strata. However, compared with nonsurging (<50th surge index percentile) hospital-months, aORs in the 50th to 75th, 75th to 90th, 90th to 95th, 95th to 99th, and greater than 99th percentiles were 1.11 (95% CI, 1.01 to 1.23), 1.24 (CI, 1.12 to 1.38), 1.42 (CI, 1.27 to 1.60), 1.59 (CI, 1.41 to 1.80), and 2.00 (CI, 1.69 to 2.38), respectively. The surge index was associated with mortality across ward, intensive care unit, and intubated patients. The surge-mortality relationship was stronger in June to August than in March to May (slope difference, 0.10 [CI, 0.033 to 0.16]) despite greater corticosteroid use and more judicious intubation during later and higher-surging months. Nearly 1 in 4 COVID- 19 deaths (5868 [CI, 3584 to 8171]; 23.2%) was potentially attributable to hospitals strained by surging caseload. Limitation: Residual confounding. Conclusion: Despite improvements in COVID-19 survival between March and August 2020, surges in hospital COVID-19 caseload remained detrimental to survival and potentially eroded benefits gained from emerging treatments. Bolstering preventive measures and supporting surging hospitals will save many lives.
UR - http://www.scopus.com/inward/record.url?scp=85117425753&partnerID=8YFLogxK
U2 - 10.7326/M21-1213
DO - 10.7326/M21-1213
M3 - Article
C2 - 34224257
AN - SCOPUS:85117425753
SN - 0003-4819
VL - 174
SP - 1240
EP - 1251
JO - Annals of Internal Medicine
JF - Annals of Internal Medicine
IS - 9
ER -