Reduction in Risk of Death Among Patients Admitted With COVID-19 Between the First and Second Epidemic Waves in New York City. (25th August 2022)

• Record Type: Journal Article
• Authors: Bowen, Anthony; Zucker, Jason; Shen, Yanhan; Huang, Simian; Yan, Qiheng; Annavajhala, Medini K; Uhlemann, Anne-Catrin; Kuhn, Louise; Sobieszczyk, Magdalena; Castor, Delivette
• Is Part Of: Open forum infectious diseases. Volume 9:Number 9(2022)
• Publication Date: 2022-08-25
• Subjects: COVID-19 -- Cox regression -- epidemics -- mortality; Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofac436
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Many regions have experienced successive epidemic waves of coronavirus disease 2019 (COVID-19) since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with heterogeneous differences in mortality. Elucidating factors differentially associated with mortality between epidemic waves may inform clinical and public health strategies. Methods: We examined clinical and demographic data among patients admitted with COVID-19 during the first (March–August 2020) and second (August 2020–March 2021) epidemic waves at an academic medical center in New York City. Results: Hospitalized patients (n = 4631) had lower overall and 30-day in-hospital mortality, defined as death or discharge to hospice, during the second wave (14% and 11%) than the first (22% and 21%). The wave 2 in-hospital mortality decrease persisted after adjusting for several potential confounders. Adjusting for the volume of COVID-19 admissions, a measure of health system strain, accounted for the mortality difference between waves. Several demographic and clinical patient factors were associated with an increased risk of mortality independent of wave: SARS-CoV-2 cycle threshold, do-not-intubate status, oxygen requirement, and intensive care unit admission. Conclusions: This work suggests that the increased in-hospital mortality rates observed during the first epidemic wave were partly due to strain on hospital resources. Preparations for future epidemics should prioritize evidence-based patient risks, treatment paradigms, and approaches to augment hospital capacity. Abstract : Using clinical and demographic data from COVID-19 hospitalizations at a tertiary New York City medical center, we show that a reduction in in-hospital mortality during the second epidemic wave was associated with decreased strain on healthcare resources.