Clinical characteristics and factors associated with COVID-19-related mortality and hospital admission in 5 rural provinces in Indonesia: a retrospective cohort study

Abstract

BackgroundData on COVID-19 clinical characteristics and severity from resource-limited settings are limited. This study examined clinical characteristics and factors associated with COVID-19 mortality and hospitalisation in rural settings of Indonesia, from 1 January to 31 July, 2021.MethodsThis retrospective cohort included individuals diagnosed with COVID-19 based on polymerase chain reaction or rapid antigen diagnostic test, from Lampung, Gorontalo, Central Sulawesi, Southeast Sulawesi, and East Nusa Tenggara Provinces. We extracted demographic and clinical data, including hospitalisation and mortality from COVID-19 surveillance records. We used mixed-effect logistic regression to examine factors associated with COVID-19-related mortality and hospitalisation.ResultsOf 6,583 confirmed cases, 205 (3.1%) died, and 1,727 (26%) were hospitalised. The median age was 37 years (IQR 26-52), with 825 (12·53%) under 20 years, and 3,371 (51.21%) females. 4,533 (68.86%) cases were symptomatic, 319 (4.85%) had a clinical diagnosis of pneumonia, and 945 (14.36%) with at least one pre-existing comorbidity. The mortality and hospitalisation rate ranged from 2.0% and 13.4% in East Nusa Tenggara to 4.3% and 36·1% in Lampung. Age-specific mortality rates were 0.9% (2/340) for 0-4 years; 0% (0/112) for 5-9 years; 0.2% (1/498) for 10-19 years; 0.8% (11/1,385) for 20-29 years; 0.9% (12/1,382) for 30-39 years; 2% (23/1,095) for 40-49 years; 5% (57/1,064) for 50-59 years; 11% (62/576) for 60-69 years; 16% (37/232) for ≥70 years. Older age, pre-existing diabetes, liver diseases, malignancy, and pneumonia were associated with higher risk of mortality and hospitalisation. Pre-existing hypertension, cardiac diseases, chronic kidney disease, COPD, and immunocompromised condition were associated with risk of hospitalisation but not with mortality.ConclusionClinical characteristics and risk factors of severe COVID-19 outcomes in rural provinces were broadly similar to those in urban settings. The risk of COVID-19-related mortality and hospitalisation was associated with higher age, pre-existing chronic comorbidities, and clinical presentation of pneumonia.

Plant-Based Diets and Supplements Reduced COVID-19 Severity and Achieved Zero Mortality in Elderly Patients with Multiple Comorbidities

“…Comparable to the general population aged 50-55, the study found that the incidence of severe disease in the NPBD group was 5%. In contrast to the general population of Indonesia, which has a fatality rate of 5-17%, our study has a zero fatality rate [24][25][26][27]. Our research findings demonstrate that the PBD and supplementation intervention is effective for elderly individuals with multiple comorbidities.…”

“…Both groups responded well to our interventions; none of the participants' conditions worsened during their illness, and none needed to be hospitalized. The prevalence of severe COVID-19 in the PBD group was significantly lower at 2% compared to the general population, particularly among individuals aged 60-65, where the incidence ranges from 10% to 20% [24][25][26][27][28][29]. Comparable to the general population aged 50-55, the study found that the incidence of severe disease in the NPBD group was 5%.…”

“…The reference group for comparison in our study on COVID-19 severity and mortality was derived from the literature on the general population of Indonesia who contracted the virus between March 2020 and June 30, 2023. The mortality rate for this group was as follows: for those aged 40-49, it was 2-3%; for those aged 50-59, it was 5-8%; for those aged 60-69, it was 15-17%; and for those above 70 years of age, it was 18-20% [24][25][26][27]. For the severity rate of elderly individuals with comorbidities, according to the literature, it is estimated that approximately 5-20% of the elderly with multiple comorbidities developed severe illness.…”

“…To assess the severity and mortality of our study population, we will use a general population with a comparable age demographic, prevalent comorbidities, and unhealthy dietary habits (omnivorous) as a reference. According to the available literature [24][25][26][27][28][29], this group exhibits specific hospitalization and mortality rates when contracting COVID-19. We aim to employ this reference group as a basis for evaluating the severity and mortality of our study population.…”

“…In this study, we have chosen to define recovery based on the clinical symptoms, along with the presence or absence of a negative PCR result. According to the literature, the general recovery time for the elderly population is typically between 14 and 21 days [24][25][26][27][28][29].…”