Studies describe patterns of COVID hospital, home deaths in US

Three newly published studies in Open Forum Infectious Diseases detail COVID-19 deaths in 2020 and 2021, including one describing an increase in US hospital deaths during a community surge, one finding a rise in the risk of dying at home in North Carolina, and one showing a reduced risk of hospital death in New York City in the second pandemic wave.US hospital deaths amid community surgeIn the first study, University of Texas researchers assessed death rates in 416,962 adult COVID-19 patients at 229 US academic and 432 community hospitals in the Vizient Clinical Database before and during a community case surge from September 2020 to March 2021.The unadjusted proportion of deaths among hospital patients released from the hospital was 9% before and during the surge, spiking to 12% when cases peaked and then declined.

Relative to before the surge, the risk-adjusted odds ratio for death during the period of rising cases was 1.14, peaking at 1.37 and then falling to 1.30 as cases declined.The surge-related increase in hospital deaths was observed in seven of nine geographic areas and was higher in community hospitals than for academic centers. "The similarity of the pattern across settings suggests shared factors contributed to elevated risk," the researchers wrote. "One possible explanation is that limited bed capacity shifted admitting preference to the most severely ill."They added that the link between community COVID-19 surges and in-hospital deaths could not be explained by differences in demographic, clinical, or hospital characteristics."These data support healthcare policies aimed at containing pandemic surges to prevent case overloads for hospitals, public health and public policy efforts to provide supplemental