Temporal trends in hospitalizations and 30-day mortality in older patients during the COVID pandemic from March 2020 to July 2021

Abstract

Importance: Previous reports have suggested reductions in mortality risk from COVID-19 throughout the first wave of the COVID-19 pandemic. Mortality changes later in the pandemic and pandemic effects on other types of geriatric hospitalizations are less studied. Objectives: To describe the changes in hospitalizations and 30-day mortality in Stockholm for patients 70+ receiving inpatient geriatric care for COVID-19 and other causes. Design: Observational study. For patients 70 or older, we present the incidence of 30-day mortality from COVID-19 in the Stockholm region, in relationship to geriatric hospitalizations and 30-day mortality after admission for COVID-19 and other causes. Setting: Hospitalizations for patients 70+ from geriatric clinics in Stockholm, Sweden hospitalized for COVID-19 or other causes between March 2020 and July 31, 2021, were included. Participants: The total number of geriatric hospitalizations for patients 70+ was 5,320 for COVID-19 and 32,243 for non-COVID-19 causes, corresponding to 4,565 individual COVID-19 patients and 19,308 non-COVID-19 patients. Exposure(s): The date of hospital admission to a geriatric clinic. Main Outcome(s) and Measure(s): 30-day mortality after admission. Results: In patients with COVID-19, the 30-day mortality rate was highest at the beginning of the first wave (29% in March-April 2020), decreased as the first wave subsided (7% July-August), increased again in the second wave (17% November-December), but failed to increase as much in the third wave (11-13% March-July 2021). In non-COVID-19 geriatric patients during the same period, the 30-day mortality presented a similar trend, but with a smaller magnitude of variation (5 to 10%). The number of persons 70 or older testing positive for COVID-19 in Stockholm reached two peaks in 2020 (April and December), fell in January 2021 and then increased again in March-April 2021. Conclusions and Relevance: During the first and second waves, hospital admissions and 30-day mortality after geriatric hospitalization for COVID-19 increased in periods of high community transmission, although the mortality peak was lower in wave 2 than in wave 1. The mortality for non-COVID geriatric cases was lower and more stable but also showed an increase with the pandemic peaks.

Bayesian Monitoring of COVID-19 in Sweden

“…It also assumes the relatively younger Stockholm demographics rather than the national one, and is therefore an underestimate of the national IFR. A later Sweden-wide IFR estimate of 0.76% [0.65, 0.87] was published in November 2020 [45] and aligns well with our estimate above. Although our 95% CrI is comparatively wide, this is partially due to modeling each period independently and without any regularization in the transition between periods.…”

“…The first two entries in the table overlap the estimates from [46]: Nov 2020 = [0.60, 1.46]%, and Jan 2021 = [0.56, 1.44]%. Clearly, the IFR was trending downwards and this is also known to be the case in Stockholm [45] as well as for the world in general [46]. Of interest is also the case fatality risk (CFR) [47], i.e., the risk of death conditioned on being diagnosed with the disease.…”

“…This procedure is evaluated across the same data as used in our live reports (N = 25). 44)- (45). The smoothing difference d smooth is the mean max relative difference between the pre-processed and raw data [H, W, D] as defined in (6).…”

Two Years with COVID-19: The Electronic Frailty Index Identifies High-Risk Patients in the Stockholm GeroCovid Study

“…There was a surge in admissions to the included clinics during the Omicron wave, yet we noticed a significantly lower mortality rate in that period compared to previous waves, which is consistent with recent studies suggesting a decreased disease severity of the Omicron variant [ 16 , 17 ]. Interestingly, patients admitted during the 1st, 2nd, and Omicron waves were older and frailer than those admitted during the 3rd wave in 2021, which may in part be explained by the more stringent selection of admissions during periods of high community spread of COVID-19, leading to a sicker, older, and frailer patient group [ 33 ].…”

“…We have previously shown that the Swedish eFI is associated with adverse outcomes in several geriatric patient groups (e.g., fragility fracture, congestive heart failure, dementia), but it is less clear if the eFI has similar utility in COVID-19 patients. Compared to regular geriatric patients who generally have lower and more stable mortality rates over time, CO-VID-19 patients admitted to geriatric hospitals in Sweden represent a different patient group, who typically have 398 DOI: 10.1159/000527206 higher mortality rates, younger age, and longer lengths of stay [32,33]. The primary aim of this study was to assess the association between the Swedish eFI and adverse outcomes (mortality, readmission, and length of stay) in hospitalized older COVID-19 patients across the pandemic waves.…”