Observational studyBMJ open2022
Factors associated with, and variations in, COVID-19 hospital death rates in England's first two waves: observational study.
Observational study in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.
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The trial behind it
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Who cites it
6 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Risk of COVID-19 death for people with a pre-existing cancer diagnosis prior to COVID-19-vaccination: A systematic review and meta-analysis.International journal of cancer · 2024Pooled it
- Reconstructing severe acute respiratory infection dynamics from ICD-10 hospital discharge data: a 10-year analysis of 11.2 million discharges in Ecuador, 2014-2023.Frontiers in public health · 2026Article
- COVID-19 inpatient care performance in the unified health system, São Paulo state, Brazil: an application of standardized mortality ratio for hospitals' comparisons : COVID-19 inpatient care performance in SUS, Brazil.BMC health services research · 2024Observational
- COVID-19 inpatient mortality in Brazil from 2020 to 2022: a cross-sectional overview study based on secondary data.International journal for equity in health · 2023Article
- Acute and chronic kidney disease and risk of hospital mortality during COVID-19 pandemic waves in the pre-vaccination era.Clinical kidney journal · 2023Article
- Cytokine Levels and Severity of Illness Scoring Systems to Predict Mortality in COVID-19 Infection.Healthcare (Basel, Switzerland) · 2023Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo assess patient-level and hospital-level predictors of death and variation in death rates following admission for COVID-19 in England's first two waves after accounting for random variation. To quantify the correlation between hospitals' first and second wave death rates.
designObservational study using administrative data.
settingAcute non-specialist hospitals in England.
participantsAll patients admitted with a primary diagnosis of COVID-19. PRIMARY AND SECONDARY OUTCOMES: In-hospital death.
resultsHospital Episode Statistics (HES) data were extracted for all acute hospitals in England for COVID-19 admissions from March 2020 to March 2021. In wave 1 (March to July 2020), there were 74 484 admissions and 21 883 deaths (crude rate 29.4%); in wave 2 (August 2020 to March 2021), there were 165 642 admissions and 36 040 deaths (21.8%). Wave 2 patients were younger, with more hypertension and obesity but lower rates of other comorbidities. Mortality improved for all ages; in wave 2, it peaked in December 2020 at 24.2% (lower than wave 1's peak) but halved by March 2021. In multiple multilevel modelling combining HES with hospital-level data from Situational Reports, wave 2 and wave 1 variables significantly associated with death were mostly the same. The median odds ratio for wave 1 was just 1.05 and for wave 2 was 1.07. At 99.8% control limits, 3% of hospitals were high and 7% were low funnel plot outliers in wave 1; these figures were 9% and 12% for wave 2. Four hospitals were (low) outliers in both waves. The correlation between hospitals' adjusted mortality rates between waves was 0.45 (p<0.0001). Length of stay was similar in each wave.
conclusionsEngland's first two COVID-19 waves were similar regarding predictors and moderate interhospital variation. Despite the challenges, variation in death rates and length of stay between hospitals was modest and might be accounted for by unobserved patient factors.
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