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

  1. Sara Garcia-Ptacek
  2. Hong Xu
  3. Martin Annetorp
  4. Viktoria Bäck Jerlardtz
  5. Tommy Cederholm
  6. Malin Engström
  7. Miia Kivipelto
  8. Lars Göran Lundberg
  9. Carina Metzner
  10. Maria Olsson
  11. Josefina Skogö Nyvang
  12. Carina Sühl Öberg
  13. Elisabet Åkesson
  14. Dorota Religa
  15. Maria Eriksdotter

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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.

KEY POINTS

Question

Multiple previous reports in different countries and settings have shown higher case fatality ratio or hospitalized case fatality ratio for COVID-19 in the first wave compared to the second wave of the pandemic. However, less is known about how the COVID-19 waves specifically affected the care of geriatric patients, including those with conditions other than COVID.

Findings

The total number of hospitalizations was 5,320 for COVID-19 and 32,243 for non-COVID-cases. In COVID-patients, the 30-day mortality rate was highest at the beginning of the first wave (29% in March-April 2020), reached 17% at the second wave peak (November-December) followed by 11-13% in the third wave (March-July 2021). The mortality in non-COVID geriatric patients showed a similar trend, but of lower magnitude (5-10%). During the incidence peaks, COVID-19 hospitalizations displaced non-COVID geriatric patients.

Meaning

Hospital admissions and 30-day mortality after hospitalizations for COVID-19 increased in periods of high community transmission, albeit with decreasing mortality rates from wave 1 to 3, with a possible vaccination effect in wave 3. Thus, the healthcare system could not compensate for the high community spread of COVID-19 during the pandemic peaks, which also led to displacing care for non-COVID geriatric patients. These results are important for planning healthcare resources in future health emergencies.

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  1. ScreenIT

    SciScore for 10.1101/2021.12.22.21268237: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All analyses were performed using R (https://www.r-project.org) and Stata version 17.0 (StataCorp, College Station, TX).
    https://www.r-project.org
    suggested: (R Project for Statistical Computing, RRID:SCR_001905)
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and limitations: In Sweden, geriatric hospitalizations are indicated on criteria of biological (and not chronological aging). Non-frail and non-comorbid older patients may have been hospitalized in other clinics (eg. infectious diseases) and not included in our cohort. Nine out of eleven existing geriatric clinics in Stockholm participated in the study. Living situation, comorbidities and medications were obtained from electronic health records with imperfect ascertainment. Medications were considered present if they were present or prescribed within 24h of hospitalization and would have included both newly prescribed medications and those removed after admission. We did not have information on vaccination, which would have been useful for assessing the decline of mortality in the third wave of the pandemic. Strengths of this study are the large geriatric cohort including nine out of eleven geriatric clinics in Stockholm treating patients with COVID-19. Also novel is the analysis of geriatric hospitalizations for other causes and the long study period including three pandemic waves over a period of 17 months.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  2. Version published to 10.1101/2021.12.22.21268237v1 on medRxiv