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Mortality Variations of COVID-19 from Different Hospital Settings During Different Pandemic Phases: A Multicenter Retrospective Study

Authors :
Eric H. Chou
Chih-Hung Wang
Chu-Lin Tsai
John Garrett
Toral Bhakta
Andrew Shedd
Dahlia Hassani
Robert Risch
James d’Etienne
Gerald O. Ogola
Matthew Huei-Ming Ma
Tsung-Chien Lu
Hao Wang
Source :
Western Journal of Emergency Medicine, Vol 22, Iss 5 (2021)
Publication Year :
2021
Publisher :
eScholarship Publishing, University of California, 2021.

Abstract

Introduction: Diverse coronavirus disease 2019 (COVID-19) mortalities have been reported but focused on identifying susceptible patients at risk of more severe disease or death. This study aims to investigate the mortality variations of COVID-19 from different hospital settings during different pandemic phases. Methods: We retrospectively included adult (≥18 years) patients who visited emergency departments (ED) of five hospitals in the state of Texas and who were diagnosed with COVID-19 between March–November 2020. The included hospitals were dichotomized into urban and suburban based on their geographic location. The primary outcome was mortality that occurred either during hospital admission or within 30 days after the index ED visit. We used multivariable logistic regression to investigate the associations between independent variables and outcome. Generalized additive models were employed to explore the mortality variation during different pandemic phases. Results: A total of 1,788 adult patients who tested positive for COVID-19 were included in the study. The median patient age was 54.6 years, and 897 (50%) patients were male. Urban hospitals saw approximately 59.5% of the total patients. A total of 197 patients died after the index ED visit. The analysis indicated visits to the urban hospitals (odds ratio [OR] 2.14, 95% confidence interval [CI], 1.41, 3.23), from March to April (OR 2.04, 95% CI, 1.08, 3.86), and from August to November (OR 2.15, 95% CI, 1.37, 3.38) were positively associated with mortality. Conclusion: Visits to the urban hospitals were associated with a higher risk of mortality in patients with COVID-19 when compared to visits to the suburban hospitals. The mortality risk rebounded and showed significant difference between urban and suburban hospitals since August 2020. Optimal allocation of medical resources may be necessary to bridge this gap in the foreseeable future.

Details

Language :
English
ISSN :
19369018
Volume :
22
Issue :
5
Database :
Directory of Open Access Journals
Journal :
Western Journal of Emergency Medicine
Publication Type :
Academic Journal
Accession number :
edsdoj.587404f38e72424980079ac66a53b63a
Document Type :
article
Full Text :
https://doi.org/10.5811/westjem.2021.5.52583