Trends in Risk‐Adjusted 28‐Day Mortality Rates for Patients Hospitalized with COVID‐19 in England

Abstract

Early reports showed high mortality from coronavirus disease 2019 (COVID-19). Mortality rates have recently been lower; however, patients are also now younger, with fewer comorbidities. We explored 28-day mortality for patients hospitalized for COVID-19 in England over a 5-month period, adjusting for a range of potentially mitigating variables, including sociodemographics and comorbidities. Among 102,610 hospitalizations, crude mortality decreased from 33.4% (95% CI, 32.9-34.0) in March 2020 to 15.5% (95% CI, 14.1-17.0) in July. Adjusted mortality decreased from 33.4% (95% CI, 32.8-34.1) in March to 17.4% (95% CI, 11.3-26.9) in July. The relative risk of mortality decreased from a reference of 1 in March to 0.52 (95% CI, 0.34-0.80) in July. This demonstrates that the reduction in mortality is not solely due to changes in the demographics of those with COVID-19.

Dapagliflozin in patients with cardiometabolic risk factors hospitalised with COVID-19 (DARE-19): a randomised, double-blind, placebo-controlled, phase 3 trial

“…The rates of organ dysfunction and death were lower than initially anticipated due to improvement in standard of care for treatment of COVID-19. 27 , 28 , 38 Consequently, the accrued number of events would not allow detection of statistically significant treatment effects with a HR exceeding 0·72 (which is a possible explanation for the observed lack of statistical significance for the primary endpoint of prevention, given the observed HR of 0·80). Accordingly, we amended the protocol to elevate recovery from a secondary endpoint to be included as a dual primary outcome, as faster and more complete recovery had become an important treatment goal and a frequently used trial endpoint in patients hospitalised with COVID-19.…”

Maternal and perinatal outcomes of pregnant women with SARS-CoV-2 infection at the time of birth in England: national cohort study

“…The use of ICD-10 codes in this way to understand differences between admissions with and without SARS-CoV-2 infection has been established elsewhere. 9,39 The use of administrative data including diagnostic and procedure codes to establish exposures and outcomes (including in our study preeclampsia, neonatal adverse outcome, and SARS-CoV-2 status) has inherent limitations because the primary purpose of data recording is for payment rather than clinical research; known limitations include underrecording and misclassification. 40 This may particularly affect preeclampsia where there is a variation in diagnostic criteria and thresholds; gestational hypertension may be conflated with preeclampsia.…”

Trends in 30‐day mortality from COVID‐19 among older adults in the Veterans Affairs system

“…3 These are also similar to age-adjusted 28-day mortality trends in England. 4 Improvements in mortality over the first 10 months of the pandemic may reflect improved care for all hospitalized patients, for which even the oldest olds have benefitted as well. Given that older individuals do not always see the same benefit, and may even experience harm, from interventions in younger people, these data are reassuring.…”