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Trends in COVID-19 case-fatality rates in Brazilian public hospitals: A longitudinal cohort of 398,063 hospital admissions from 1st March to 3rd October 2020

BACKGROUND: Almost 200,000 deaths from COVID-19 were reported in Brazil in 2020. The case fatality rate of a new infectious disease can vary by different risk factors and over time. We analysed the trends and associated factors of COVID-19 case fatality rates in Brazilian public hospital admissions...

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Autores principales: Zimmermann, Ivan Ricardo, Sanchez, Mauro Niskier, Frio, Gustavo Saraiva, Alves, Layana Costa, Pereira, Claudia Cristina de Aguiar, Lima, Rodrigo Tobias de Sousa, Machado, Carla, Santos, Leonor Maria Pacheco, da Silva, Everton Nunes
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284655/
https://www.ncbi.nlm.nih.gov/pubmed/34270568
http://dx.doi.org/10.1371/journal.pone.0254633
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author Zimmermann, Ivan Ricardo
Sanchez, Mauro Niskier
Frio, Gustavo Saraiva
Alves, Layana Costa
Pereira, Claudia Cristina de Aguiar
Lima, Rodrigo Tobias de Sousa
Machado, Carla
Santos, Leonor Maria Pacheco
da Silva, Everton Nunes
author_facet Zimmermann, Ivan Ricardo
Sanchez, Mauro Niskier
Frio, Gustavo Saraiva
Alves, Layana Costa
Pereira, Claudia Cristina de Aguiar
Lima, Rodrigo Tobias de Sousa
Machado, Carla
Santos, Leonor Maria Pacheco
da Silva, Everton Nunes
author_sort Zimmermann, Ivan Ricardo
collection PubMed
description BACKGROUND: Almost 200,000 deaths from COVID-19 were reported in Brazil in 2020. The case fatality rate of a new infectious disease can vary by different risk factors and over time. We analysed the trends and associated factors of COVID-19 case fatality rates in Brazilian public hospital admissions during the first wave of the pandemic. METHODS: A retrospective cohort of all COVID-19-related admissions between epidemiological weeks 10–40 in the Brazilian Public Health System (SUS) was delimited from available reimbursement records. Smoothing time series and survival analyses were conducted to evaluate the trends of hospital case fatality rates (CFR) and the probability of death according to factors such as sex, age, ethnicity, comorbidities, length of stay and ICU use. RESULTS: With 398,063 admissions and 86,452 (21.7%) deaths, the overall age-standardized hospital CFR trend decreased throughout the period, varying from 31.8% (95%CI: 31.2 to 32.5%) in week 10 to 18.2% (95%CI: 17.6 to 18.8%) in week 40. This decreasing trend was observed in all sex, age, ethnic groups, length of stay and ICU admissions. Consistently, later admission (from July to September) was an independent protective factor. Patients 80+ year old had a hazard ratio of 8.18 (95% CI: 7.51 to 8.91). Ethnicity, comorbidities, and ICU need were also associated with the death risk. Although also decreasing, the CFR was always around 40–50% in people who needed an ICU admission. CONCLUSIONS: The overall hospital CFR of COVID-19 has decreased in Brazilian public hospitals during the first wave of the pandemic in 2020. Nevertheless, during the entire period, the CFR was still very high, suggesting the need for improving COVID-19 hospital care in Brazil.
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spelling pubmed-82846552021-07-28 Trends in COVID-19 case-fatality rates in Brazilian public hospitals: A longitudinal cohort of 398,063 hospital admissions from 1st March to 3rd October 2020 Zimmermann, Ivan Ricardo Sanchez, Mauro Niskier Frio, Gustavo Saraiva Alves, Layana Costa Pereira, Claudia Cristina de Aguiar Lima, Rodrigo Tobias de Sousa Machado, Carla Santos, Leonor Maria Pacheco da Silva, Everton Nunes PLoS One Research Article BACKGROUND: Almost 200,000 deaths from COVID-19 were reported in Brazil in 2020. The case fatality rate of a new infectious disease can vary by different risk factors and over time. We analysed the trends and associated factors of COVID-19 case fatality rates in Brazilian public hospital admissions during the first wave of the pandemic. METHODS: A retrospective cohort of all COVID-19-related admissions between epidemiological weeks 10–40 in the Brazilian Public Health System (SUS) was delimited from available reimbursement records. Smoothing time series and survival analyses were conducted to evaluate the trends of hospital case fatality rates (CFR) and the probability of death according to factors such as sex, age, ethnicity, comorbidities, length of stay and ICU use. RESULTS: With 398,063 admissions and 86,452 (21.7%) deaths, the overall age-standardized hospital CFR trend decreased throughout the period, varying from 31.8% (95%CI: 31.2 to 32.5%) in week 10 to 18.2% (95%CI: 17.6 to 18.8%) in week 40. This decreasing trend was observed in all sex, age, ethnic groups, length of stay and ICU admissions. Consistently, later admission (from July to September) was an independent protective factor. Patients 80+ year old had a hazard ratio of 8.18 (95% CI: 7.51 to 8.91). Ethnicity, comorbidities, and ICU need were also associated with the death risk. Although also decreasing, the CFR was always around 40–50% in people who needed an ICU admission. CONCLUSIONS: The overall hospital CFR of COVID-19 has decreased in Brazilian public hospitals during the first wave of the pandemic in 2020. Nevertheless, during the entire period, the CFR was still very high, suggesting the need for improving COVID-19 hospital care in Brazil. Public Library of Science 2021-07-16 /pmc/articles/PMC8284655/ /pubmed/34270568 http://dx.doi.org/10.1371/journal.pone.0254633 Text en © 2021 Zimmermann et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Zimmermann, Ivan Ricardo
Sanchez, Mauro Niskier
Frio, Gustavo Saraiva
Alves, Layana Costa
Pereira, Claudia Cristina de Aguiar
Lima, Rodrigo Tobias de Sousa
Machado, Carla
Santos, Leonor Maria Pacheco
da Silva, Everton Nunes
Trends in COVID-19 case-fatality rates in Brazilian public hospitals: A longitudinal cohort of 398,063 hospital admissions from 1st March to 3rd October 2020
title Trends in COVID-19 case-fatality rates in Brazilian public hospitals: A longitudinal cohort of 398,063 hospital admissions from 1st March to 3rd October 2020
title_full Trends in COVID-19 case-fatality rates in Brazilian public hospitals: A longitudinal cohort of 398,063 hospital admissions from 1st March to 3rd October 2020
title_fullStr Trends in COVID-19 case-fatality rates in Brazilian public hospitals: A longitudinal cohort of 398,063 hospital admissions from 1st March to 3rd October 2020
title_full_unstemmed Trends in COVID-19 case-fatality rates in Brazilian public hospitals: A longitudinal cohort of 398,063 hospital admissions from 1st March to 3rd October 2020
title_short Trends in COVID-19 case-fatality rates in Brazilian public hospitals: A longitudinal cohort of 398,063 hospital admissions from 1st March to 3rd October 2020
title_sort trends in covid-19 case-fatality rates in brazilian public hospitals: a longitudinal cohort of 398,063 hospital admissions from 1st march to 3rd october 2020
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284655/
https://www.ncbi.nlm.nih.gov/pubmed/34270568
http://dx.doi.org/10.1371/journal.pone.0254633
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