Trends in Patient Characteristics and COVID-19 In-Hospital Mortality in the United States During the COVID-19 Pandemic | Critical Care Medicine | JAMA Network Open | JAMA Network
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    Original Investigation
    Public Health
    May 3, 2021

    Trends in Patient Characteristics and COVID-19 In-Hospital Mortality in the United States During the COVID-19 Pandemic

    Author Affiliations
    • 1Division of Cardiology, Department of Medicine, University of Washington, Seattle
    • 2American Heart Association, Dallas, Texas
    • 3Minneapolis Heart Institute, Minneapolis, Minnesota
    • 4Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
    • 5Associate Editor, JAMA Network Open
    • 6Cardiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
    • 7Parkland Health and Hospital System, Dallas, Texas
    • 8Department of Neurology, Vagelos College of Physicians and Surgeons, New York, New York
    • 9Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
    • 10University of Minnesota, Minneapolis
    • 11Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
    • 12Cardiovascular Institute, Division of Cardiovascular Medicine, Stanford University, Stanford, California
    • 13University of Colorado Anschutz Medical Campus, Aurora
    • 14Duke Clinical Research Institute, Durham, North Carolina
    JAMA Netw Open. 2021;4(5):e218828. doi:10.1001/jamanetworkopen.2021.8828
    Key Points

    Question  What factors are associated with observed trends in the in-hospital mortality rates in the United States during the first 9 months of the COVID-19 pandemic?

    Findings  In this cohort study of 20 736 patients, in-hospital mortality rates decreased in the US between March and November 2020, even after accounting for the changing mix in patient age, sex, comorbidities, and disease severity at the time of admission. Hospital and intensive care unit length of stay and use of mechanical ventilation decreased over time, whereas the use of glucocorticoids and remdesivir increased.

    Meaning  Changes in age, sex, comorbidities, and disease severity among patients with COVID-19 do not fully explain the decrease in the in-hospital mortality rates observed during the first 9 months of the COVID-19 pandemic.


    Importance  In-hospital mortality rates from COVID-19 are high but appear to be decreasing for selected locations in the United States. It is not known whether this is because of changes in the characteristics of patients being admitted.

    Objective  To describe changing in-hospital mortality rates over time after accounting for individual patient characteristics.

    Design, Setting, and Participants  This was a retrospective cohort study of 20 736 adults with a diagnosis of COVID-19 who were included in the US American Heart Association COVID-19 Cardiovascular Disease Registry and admitted to 107 acute care hospitals in 31 states from March through November 2020. A multiple mixed-effects logistic regression was then used to estimate the odds of in-hospital death adjusted for patient age, sex, body mass index, and medical history as well as vital signs, use of supplemental oxygen, presence of pulmonary infiltrates at admission, and hospital site.

    Main Outcomes and Measures  In-hospital death adjusted for exposures for 4 periods in 2020.

    Results  The registry included 20 736 patients hospitalized with COVID-19 from March through November 2020 (9524 women [45.9%]; mean [SD] age, 61.2 [17.9] years); 3271 patients (15.8%) died in the hospital. Mortality rates were 19.1% in March and April, 11.9% in May and June, 11.0% in July and August, and 10.8% in September through November. Compared with March and April, the adjusted odds ratios for in-hospital death were significantly lower in May and June (odds ratio, 0.66; 95% CI, 0.58-0.76; P < .001), July and August (odds ratio, 0.58; 95% CI, 0.49-0.69; P < .001), and September through November (odds ratio, 0.59; 95% CI, 0.47-0.73).

    Conclusions and Relevance  In this cohort study, high rates of in-hospital COVID-19 mortality among registry patients in March and April 2020 decreased by more than one-third by June and remained near that rate through November. This difference in mortality rates between the months of March and April and later months persisted even after adjusting for age, sex, medical history, and COVID-19 disease severity and did not appear to be associated with changes in the characteristics of patients being admitted.