TY - JOUR
T1 - Temporal trends of COVID-19 mortality and hospitalisation rates
T2 - An observational cohort study from the US Department of Veterans Affairs
AU - Cai, Miao
AU - Bowe, Benjamin
AU - Xie, Yan
AU - Al-Aly, Ziyad
N1 - Funding Information:
Contributors Acquisition, analysis or interpretation of data, and statistical analysis: MC, BB, YX and ZA-A; drafting of the manuscript: MC and ZA-A; supervision and funding: ZA-A; concept and design and critical revision of the manuscript for important intellectual content: all authors. Funding This study was funded by the US Department of Veterans Affairs. The funders had no role in design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.
Publisher Copyright:
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2021/8/16
Y1 - 2021/8/16
N2 - Objectives To investigate the temporal trends of 30-day mortality and hospitalisation in US Veterans with COVID-19 and 30-day mortality in hospitalised veterans with COVID-19 and to decompose the contribution of changes in the underlying characteristics of affected populations to these temporal changes. Design Observational cohort study. Setting US Department of Veterans Affairs. Participants 49 238 US veterans with a positive COVID-19 test between 20 March 2020 and 19 September 2020; and 9428 US veterans hospitalised with a positive COVID-19 test during the same period. Outcome measures 30-day mortality rate and hospitalisation rate. Results Between 20 March 2020 and 19 September 2020 and in COVID-19 positive individuals, 30-day mortality rate dropped by 9.2% from 13.6% to 4.4%; hospitalisation rate dropped by 16.8% from 33.8% to 17.0%. In hospitalised COVID-19 individuals, 30-day mortality rate dropped by 12.7% from 23.5% to 10.8%. Among COVID-19 positive individuals, decomposition analyses suggested that changes in demographic, health and contextual characteristics, COVID-19 testing capacity, and hospital occupancy rates accounted for 40.2% and 33.3% of the decline in 30-day mortality and hospitalisation, respectively. Changes in the underlying characteristics of hospitalised COVID-19 individuals accounted for 29.9% of the decline in 30-day mortality. Conclusion Between March and September 2020, changes in demographic and health characteristics of people infected with COVID-19 contributed measurably to the substantial decline in 30-day mortality and hospitalisation.
AB - Objectives To investigate the temporal trends of 30-day mortality and hospitalisation in US Veterans with COVID-19 and 30-day mortality in hospitalised veterans with COVID-19 and to decompose the contribution of changes in the underlying characteristics of affected populations to these temporal changes. Design Observational cohort study. Setting US Department of Veterans Affairs. Participants 49 238 US veterans with a positive COVID-19 test between 20 March 2020 and 19 September 2020; and 9428 US veterans hospitalised with a positive COVID-19 test during the same period. Outcome measures 30-day mortality rate and hospitalisation rate. Results Between 20 March 2020 and 19 September 2020 and in COVID-19 positive individuals, 30-day mortality rate dropped by 9.2% from 13.6% to 4.4%; hospitalisation rate dropped by 16.8% from 33.8% to 17.0%. In hospitalised COVID-19 individuals, 30-day mortality rate dropped by 12.7% from 23.5% to 10.8%. Among COVID-19 positive individuals, decomposition analyses suggested that changes in demographic, health and contextual characteristics, COVID-19 testing capacity, and hospital occupancy rates accounted for 40.2% and 33.3% of the decline in 30-day mortality and hospitalisation, respectively. Changes in the underlying characteristics of hospitalised COVID-19 individuals accounted for 29.9% of the decline in 30-day mortality. Conclusion Between March and September 2020, changes in demographic and health characteristics of people infected with COVID-19 contributed measurably to the substantial decline in 30-day mortality and hospitalisation.
KW - COVID-19
KW - epidemiology
KW - general medicine (see internal medicine)
UR - http://www.scopus.com/inward/record.url?scp=85113709959&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2020-047369
DO - 10.1136/bmjopen-2020-047369
M3 - Article
C2 - 34400452
AN - SCOPUS:85113709959
VL - 11
JO - BMJ Open
JF - BMJ Open
SN - 2044-6055
IS - 8
M1 - e047369
ER -