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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...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2021
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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. |
format | Online Article Text |
id | pubmed-8284655 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
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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