Mortality rates for hospitalized COVID patients declined through 2020
In 2020, in-hospital mortality dropped from 19.1% in March and April to 10.8% in September through November in COVID-19 patients in the United States, according to a study yesterday in JAMA Network Open.
While some associations with age, male sex, high body mass index (BMI), and comorbidities were seen, overall, the researchers say that neither these factors nor COVID-19 severity fully explained the decline.
The researchers looked at 20,736 hospitalized COVID-19 patients in 107 hospitals. From March and April to September through November, the proportion of women increased from 43.6% to 48.4%, BMI increased from 30.4 to 31.6, and the mean age went from 62.1 to 61.4.
Average hospital length of stay also changed, going from 10.7 days to 7.5. As the study went on, patients were put on mechanical ventilation less (23.3% to 13.9%) but were prescribed supplementary oxygen on admittance more (23.0% to 35.9%). Overall, the mortality rate was 15.8% (3,271).
While mortality rates declined across all nine months, the largest drop was from March and April to May and June, going from 19.1% to 11.9% (adjusted odds ratio [aOR] for in-hospital mortality, 0.66; 95% confidence interval [CI], 0.58 to 0.76). The adjusted odds for in-hospital death were comparable the rest of the time (aOR, 0.58 for July and August, 0.59 for September through November).
“Our findings suggest that the decline in mortality could be due to overloaded hospitals and changes in treatment,” lead author Gregory Roth, MD, MPH, said in an Institute for Health Metrics and Evaluation press release. Uses of azithromycin and remdesivir, for instance, spiked during the study, although no conclusive studies have been done on their benefits.
“[The study] speaks to a crucial need for information sharing and identifying hospital best practices that can prevent mortality rates from increasing again, particularly during possible future waves of COVID-19 infections.”
May 3 JAMA Netw Open study
May 3 Institute for Health Metrics and Evaluation press release
Pandemic linked with mental health changes in older Americans
Almost 1 in 5 US adults ages 50 to 80 said they were experiencing worse depression or sadness since the start of the COVID-19 pandemic, and 28% reported worse anxiety or worry, according to a University of Michigan poll today.
About 46% of adults said they felt isolated, down from 56% in a spring 2020 poll but still up 28% from before the pandemic.
The poll’s 2,023 respondents (who were weighted to reflect population figures) took the survey in January 2021. Since the pandemic started, mental health was more likely to be worse in women (22% vs 14% in men), people 64 or younger (20% vs 15%), White people (20% vs 17% of Hispanics and 15% of Black people), and those with a college degree or more (22% vs 18% in those with some college;16% with a high school degree or less).
People with fair or poor health were also more likely to say their mental health had worsened since the start of the pandemic (24% vs 17%).
Almost 90% (87%) said they are at least somewhat comfortable talking about their mental health, and most said they would talk to their primary care provider (31%) compared with a mental health professional (25%), spouse or partner (25%), or family and friends (11%).
Nearly one in three (29%) said they had made a lifestyle change to improve their mental health since the pandemic started, and 13% said they already had talked to a primary care provider about a new mental health concern. While 71% say they wouldn’t hesitate to see a mental health provider in the future, 29% said they didn’t think a professional would be helpful (21%), they were embarrassed (16%), or they had concerns about the cost (14%).
“With most older adults getting vaccinated, it’s important to ensure adequate access to mental health screening and care to detect and address any lingering effects of this prolonged period of stress,” said Lauren Gerlach, DO, MSc, in a press release. Gerlach worked with the poll team at the University of Michigan.
May 4 University of Michigan study and press release