Clinical management of COVID-19 in hospitals and the community: A snapshot from a medical insurance database in South Africa

BACKGROUND: Little is known about the clinical care, use of medicines, and risk factors associated with mortality among the population with private health insurance with COVID-19 in South Africa. METHODS: This was a retrospective cross-sectional study using claims data of patients with confirmed COVID-19. Sociodemographics, comorbidities, severity, concurrent/progressive comorbidity, drug treatment, and outcomes were extracted from administrative data. Univariate and multivariate logistic regression models were used to explore the risk factors associated with in-hospital death. RESULTS: This study included 154,519 patients with COVID-19; only 24% were categorized as severe because they received in-hospital care. Antibiotic (42.8%) and steroid (30%) use was high in this population. After adjusting for known comorbidities, concurrent/progressive diagnosis of the following conditions were associated with higher in-hospital death odds: acute respiratory distress syndrome (aOR = 1.55; 95% CI = 1.44–1.68), septic shock (aOR = 1.55; 95% CI = 2.00–4.12), pneumonia (aOR = 1.35; 95% CI = 1.24–1.47), acute renal failure (aOR = 2.30; 95% CI = 2.09–2.5), and stroke (aOR = 2.09; 95% CI = 1.75–2.49). The use of antivirals (aOR = 0.47; 95% CI= 0.40–0.54), and/or steroids (aOR = 0.46; 95% CI = 0.43–0.50) were associated with decreased death odds. The use of antibiotics in-hospital was not associated with increased survival (aOR = 0.97; 95% CI = 0.91–1.04). CONCLUSIONS: Comorbidities remain significant risk factors for death mediated by organ failure. The use of antibiotics did not change the odds of death, suggesting inappropriate use.