Mortality trends among hospitalised COVID-19 patients in Sweden: A nationwide observational cohort study
Background: It is important to know if mortality among hospitalised COVID-19 patients has changed as the pandemic has progressed. The aim of this study was to describe the dynamics over time of mortality among patients hospitalised for COVID-19 in Sweden, using nationwide data compiled by the Swedis...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-05-01
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| Series: | The Lancet Regional Health. Europe |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666776221000314 |
| _version_ | 1818649618240503808 |
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| author | Kristoffer Strålin Erik Wahlström Sten Walther Anna M Bennet-Bark Mona Heurgren Thomas Lindén Johanna Holm Håkan Hanberger |
| author_facet | Kristoffer Strålin Erik Wahlström Sten Walther Anna M Bennet-Bark Mona Heurgren Thomas Lindén Johanna Holm Håkan Hanberger |
| author_sort | Kristoffer Strålin |
| collection | DOAJ |
| description | Background: It is important to know if mortality among hospitalised COVID-19 patients has changed as the pandemic has progressed. The aim of this study was to describe the dynamics over time of mortality among patients hospitalised for COVID-19 in Sweden, using nationwide data compiled by the Swedish National Board of Health and Welfare. Methods: Observational cohort study where all patients hospitalised in Sweden between March 1 and September 30, 2020, with SARS-CoV-2 RNA positivity 14 days before to 5 days after admission and a discharge code for COVID-19 were included. Outcome was 60-day all-cause mortality. Patients were categorised according to month of hospital admission. Poisson regression was used to estimate the relative risk of death by month of admission, adjusting for, age, sex, comorbidities, care dependency, country of birth, healthcare region, and Simplified Acute Physiology, version 3 (patients in intensive care units; ICU). Findings: A total of 17,140 patients were included, of which 2943 died within 60 days of admission. The overall 60-day mortality was thus 17·2% (95% CI, 16·6%-17·7%), and it decreased from 24·7% (95% CI, 23·0%-26·5%) in March to 10·4% (95% CI, 8·9%-12·1%) post-wave (July-September). Adjusted relative risk (RR) of death was 0·46 (95% CI, 0·39–0·54) post-wave, using March as reference. Corresponding RR for patients not admitted to ICU and those admitted to ICU were 0·49 (95% CI, 0·42–0·59) and 0·49 (95% CI, 0·33–0·72), respectively. The proportion of patients admitted to ICU decreased from 19·4% (95% CI, 17·9%-21·1%) in the March cohort to 8·9% (95% CI, 7·5%-10·6%) post-wave. Interpretation: There was a gradual decline in mortality during the spring of 2020 in Swedish hospitalised COVID-19 patients, independent of baseline patient characteristics. Future research is needed to explain the reasons for this decline. The changing COVID-19 mortality should be taken into account when management and results of studies from the first pandemic wave are evaluated. Funding: This study was funded by Sweden's National Board of Health and Welfare. |
| first_indexed | 2024-12-17T01:37:11Z |
| format | Article |
| id | doaj.art-0012823a91a74b47872ae4abfea1f673 |
| institution | Directory Open Access Journal |
| issn | 2666-7762 |
| language | English |
| last_indexed | 2024-12-17T01:37:11Z |
| publishDate | 2021-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Europe |
| spelling | doaj.art-0012823a91a74b47872ae4abfea1f6732022-12-21T22:08:24ZengElsevierThe Lancet Regional Health. Europe2666-77622021-05-014100054Mortality trends among hospitalised COVID-19 patients in Sweden: A nationwide observational cohort studyKristoffer Strålin0Erik Wahlström1Sten Walther2Anna M Bennet-Bark3Mona Heurgren4Thomas Lindén5Johanna Holm6Håkan Hanberger7Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden; National Program Area for Infectious Diseases, National System for Knowledge-Driven Management within Healthcare, Sweden's Regions in Collaboration, SwedenNational Board of Health and Welfare, SwedenSwedish Intensive Care Registry, Värmland County Council, Karlstad, Sweden; Department of Cardiothoracic and Vascular Surgery, Heart Centre, Linköping University Hospital, Linköping, Sweden; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, SwedenNational Board of Health and Welfare, SwedenNational Board of Health and Welfare, SwedenNational Board of Health and Welfare, SwedenNational Board of Health and Welfare, SwedenDivision of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, SE-581 83 Linköping, Sweden; Department of Infectious Diseases, University Hospital Region Östergötland, Sweden; Corresponding author at: Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, SE-581 83 Linköping, Sweden.Background: It is important to know if mortality among hospitalised COVID-19 patients has changed as the pandemic has progressed. The aim of this study was to describe the dynamics over time of mortality among patients hospitalised for COVID-19 in Sweden, using nationwide data compiled by the Swedish National Board of Health and Welfare. Methods: Observational cohort study where all patients hospitalised in Sweden between March 1 and September 30, 2020, with SARS-CoV-2 RNA positivity 14 days before to 5 days after admission and a discharge code for COVID-19 were included. Outcome was 60-day all-cause mortality. Patients were categorised according to month of hospital admission. Poisson regression was used to estimate the relative risk of death by month of admission, adjusting for, age, sex, comorbidities, care dependency, country of birth, healthcare region, and Simplified Acute Physiology, version 3 (patients in intensive care units; ICU). Findings: A total of 17,140 patients were included, of which 2943 died within 60 days of admission. The overall 60-day mortality was thus 17·2% (95% CI, 16·6%-17·7%), and it decreased from 24·7% (95% CI, 23·0%-26·5%) in March to 10·4% (95% CI, 8·9%-12·1%) post-wave (July-September). Adjusted relative risk (RR) of death was 0·46 (95% CI, 0·39–0·54) post-wave, using March as reference. Corresponding RR for patients not admitted to ICU and those admitted to ICU were 0·49 (95% CI, 0·42–0·59) and 0·49 (95% CI, 0·33–0·72), respectively. The proportion of patients admitted to ICU decreased from 19·4% (95% CI, 17·9%-21·1%) in the March cohort to 8·9% (95% CI, 7·5%-10·6%) post-wave. Interpretation: There was a gradual decline in mortality during the spring of 2020 in Swedish hospitalised COVID-19 patients, independent of baseline patient characteristics. Future research is needed to explain the reasons for this decline. The changing COVID-19 mortality should be taken into account when management and results of studies from the first pandemic wave are evaluated. Funding: This study was funded by Sweden's National Board of Health and Welfare.http://www.sciencedirect.com/science/article/pii/S2666776221000314 |
| spellingShingle | Kristoffer Strålin Erik Wahlström Sten Walther Anna M Bennet-Bark Mona Heurgren Thomas Lindén Johanna Holm Håkan Hanberger Mortality trends among hospitalised COVID-19 patients in Sweden: A nationwide observational cohort study The Lancet Regional Health. Europe |
| title | Mortality trends among hospitalised COVID-19 patients in Sweden: A nationwide observational cohort study |
| title_full | Mortality trends among hospitalised COVID-19 patients in Sweden: A nationwide observational cohort study |
| title_fullStr | Mortality trends among hospitalised COVID-19 patients in Sweden: A nationwide observational cohort study |
| title_full_unstemmed | Mortality trends among hospitalised COVID-19 patients in Sweden: A nationwide observational cohort study |
| title_short | Mortality trends among hospitalised COVID-19 patients in Sweden: A nationwide observational cohort study |
| title_sort | mortality trends among hospitalised covid 19 patients in sweden a nationwide observational cohort study |
| url | http://www.sciencedirect.com/science/article/pii/S2666776221000314 |
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