Health Care System Overstretch and In-Hospital Mortality of Intubated Patients With COVID-19 in Greece From September 2020 to April 2022: Updated Retrospective Cohort Study.
JMIRx Med
; 5: e43341, 2024 Jun 10.
Article
in En
| MEDLINE
| ID: mdl-38864553
ABSTRACT
Background:
Our previous analysis showed how in-hospital mortality of intubated patients with COVID-19 in Greece is adversely affected by patient load and regional disparities.Objective:
We aimed to update this analysis to include the large Delta and Omicron waves that affected Greece during 2021-2022, while also considering the effect of vaccination on in-hospital mortality.Methods:
Anonymized surveillance data were analyzed from all patients with COVID-19 in Greece intubated between September 1, 2020, and April 4, 2022, and followed up until May 17, 2022. Time-split Poisson regression was used to estimate the hazard of dying as a function of fixed and time-varying covariates the daily total count of intubated patients with COVID-19 in Greece, age, sex, COVID-19 vaccination status, region of the hospital (Attica, Thessaloniki, or rest of Greece), being in an intensive care unit, and an indicator for the period from September 1, 2021.Results:
A total of 14,011 intubated patients with COVID-19 were analyzed, of whom 10,466 (74.7%) died. Mortality was significantly higher with a load of 400-499 intubated patients, with an adjusted hazard ratio (HR) of 1.22 (95% CI 1.09-1.38), rising progressively up to 1.48 (95% CI 1.31-1.69) for a load of ≥800 patients. Hospitalization away from the Attica region was also independently associated with increased mortality (Thessaloniki HR 1.22, 95% CI 1.13-1.32; rest of Greece HR 1.64, 95% CI 1.54-1.75), as was hospitalization after September 1, 2021 (HR 1.21, 95% CI 1.09-1.36). COVID-19 vaccination did not affect the mortality of these already severely ill patients, the majority of whom (11,944/14,011, 85.2%) were unvaccinated.Conclusions:
Our results confirm that in-hospital mortality of severely ill patients with COVID-19 is adversely affected by high patient load and regional disparities, and point to a further significant deterioration after September 1, 2021, especially away from Attica and Thessaloniki. This highlights the need for urgent strengthening of health care services in Greece, ensuring equitable and high-quality care for all.
COVID-19; COVID-19 patient; Delta; Greece; ICU; Omicron; deterioration; disparity; health care disparities; health care system; health disparity; health inequality; hospitalization; inequality; inpatient; intensive care unit; intubation; mortality; pandemic; patient load; public health; quality of care; region; right to health; surveillance; surveillance data; time; vaccination; vaccine
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Language:
En
Journal:
JMIRx Med
Year:
2024
Document type:
Article
Affiliation country:
Chipre
Country of publication:
Canadá