Patients hospitalized during the COVID-29 pandemic for unrelated conditions were 20% more likely to die than in the prepandemic period.
Over the last 2 years, hospitals and COVID-19 became intrinsically linked. Hospital admissions for non-COVID-19 diseases declined significantly after the coronavirus outbreak. However, these other illnesses, injuries, and infections persisted during the SARS-CoV-2 pandemic. Certainly, people avoiding emergency care due to stay-at-home orders or fear of contracting COVID-19 increased the number of non-COVID-19 deaths.
One study, published yesterday in the Journal of the American Medical Association (JAMA), analyzed how the outcomes of non-COVID-19 patients were affected by the pandemic. The investigators hypothesized that the change in risk of death from prepandemic to pandemic would be most significant among disadvantaged patients, patients with more severe diagnoses, patients admitted to lower-quality hospitals, and patients admitted to hospitals with a higher proportion of COVID-19 admissions.
The cohort study compared patterns of mortality after 30 days in the hospital in the 12 months of 2019 (prepandemic) to the 18 months of April 1, 2020-September 30, 2021 (pandemic). From January 2019—September 2021, the investigators graphed the changes in mortality from the prepandemic period to pandemic period, using multilevel analyses and adjusting for reason for admission, hospital characteristics, and county.
The study included 4626 acute care hospitals across the US, accounting for 20 common non-COVID-19 conditions. Testing for interactions, the investigators assessed whether changes in morality over time differed by reason for admission, performing stratified analyses whenever changes were significant. The investigators examined whether there was an association between COVID-19 hospital prevalence and non-COVID-19 mortality, and whether changes in mortality varied by admission and hospital characteristics.
There was a total of 8448758 non-COVID-19 medical admissions in all of 2019 and April 2020—September 2021, across a total of 5573419 admittees. The average patient age was 73.66 years, 52.82% were female, and 77.35% were White, 11.87% were Black, 6.34% were Hispanic, and 4.44% were categorized as “other” (Asian, North American Native, or unknown).
The reasons for admittance in the prepandemic (2019) period differed from the pandemic (April 1, 2020‚—September 30, 2021) period. Pandemic admissions had a lower percentage of Medicaid-eligible patients (26.7% versus 28.9%), and a higher percentage of nursing home patients (12.9% vs 12.1%). Predictably, there was a significant drop in non-COVID-19 hospital admissions in March and April 2020. Non-COVID-19 mortality rates, which were 8.9-10.2% during 2019, increased to 12.4% in March 2020 and 13.5% in April 2020. All geographical areas had peaks in mortality from March-May 2020, October 2020-January 2021, and August-September 2021.
Unadjusted mortality rates for non-COVID-19 admissions increased from 9.43% in the prepandemic period to 11.48% during the pandemic. In the multilevel model, patients hospitalized during the pandemic for unrelated conditions were 20% more likely to die than in the prepandemic period. Admissions for pneumonia, cellulitis, and urinary tract infections had the highest mortality increases, while alcohol-related deaths did not increase.
The largest mortality increases were noted in Black and Hispanic patients, Medicaid-eligible patients, patients in ZIP codes associated with lower education levels, patients admitted to lower quality hospitals, and patients admitted to hospitals with a higher proportion of COVID-19 cases.
“The COVID-19 pandemic is a major stress test for US hospitals,” the study authors wrote. They concluded that health systems should monitor hospital admissions and mortalities in non-COVID-19 patients, especially among racial and ethnic minorities and other socioeconomically disadvantaged persons. Using prepandemic mortality rates as a point of comparison, hospitals can implement and monitor measures to improve access and care for non-COVID-19 illnesses as the pandemic continues.