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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 COV...

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Autores principales: Mametja, S., Dessie, Zelalem G., Matoti, L., Semenya, M., Moloabi, S., Essack, S.Y.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9027768/
https://www.ncbi.nlm.nih.gov/pubmed/35470024
http://dx.doi.org/10.1016/j.ijid.2022.04.032
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author Mametja, S.
Dessie, Zelalem G.
Matoti, L.
Semenya, M.
Moloabi, S.
Essack, S.Y.
author_facet Mametja, S.
Dessie, Zelalem G.
Matoti, L.
Semenya, M.
Moloabi, S.
Essack, S.Y.
author_sort Mametja, S.
collection PubMed
description 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.
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spelling pubmed-90277682022-04-22 Clinical management of COVID-19 in hospitals and the community: A snapshot from a medical insurance database in South Africa Mametja, S. Dessie, Zelalem G. Matoti, L. Semenya, M. Moloabi, S. Essack, S.Y. Int J Infect Dis Article 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. The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. 2022-07 2022-04-22 /pmc/articles/PMC9027768/ /pubmed/35470024 http://dx.doi.org/10.1016/j.ijid.2022.04.032 Text en © 2022 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Article
Mametja, S.
Dessie, Zelalem G.
Matoti, L.
Semenya, M.
Moloabi, S.
Essack, S.Y.
Clinical management of COVID-19 in hospitals and the community: A snapshot from a medical insurance database in South Africa
title Clinical management of COVID-19 in hospitals and the community: A snapshot from a medical insurance database in South Africa
title_full Clinical management of COVID-19 in hospitals and the community: A snapshot from a medical insurance database in South Africa
title_fullStr Clinical management of COVID-19 in hospitals and the community: A snapshot from a medical insurance database in South Africa
title_full_unstemmed Clinical management of COVID-19 in hospitals and the community: A snapshot from a medical insurance database in South Africa
title_short Clinical management of COVID-19 in hospitals and the community: A snapshot from a medical insurance database in South Africa
title_sort clinical management of covid-19 in hospitals and the community: a snapshot from a medical insurance database in south africa
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9027768/
https://www.ncbi.nlm.nih.gov/pubmed/35470024
http://dx.doi.org/10.1016/j.ijid.2022.04.032
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