Association of survival of COVID 19 hospitalized patients with epidemic level in Golestan province

Abstract

Background: Appreciating the various dimensions of the coronavirus disease 2019 (COVID-19) pandemic can improve health systems and prepare them to deal better with future pandemics and public health events. This study was conducted to investigate the association between the survival of hospitalized patients with COVID-19 and the epidemic risk stratification of the disease in Golestan province, Iran. Methods: In this retrospective study, all patients with COVID-19 who were hospitalized in the hospitals of Golestan province of Iran from February 20, 2020, to December 19, 2022, and were registered in the Medical Care Monitoring Center (MCMC) system (85,885 individuals) were examined. The survival distribution and length of hospital stay within the mentioned time interval were examined using Kaplan-Meier analysis. The community's epidemic risk status (ERS) was determined based on the daily incidence statistics of COVID-19. The relationship of the ERS and other variables (age, gender, underlying disease, disease severity, etc.) with survival and length of hospital stay were examined using the log-rank test and univariate and multiple Cox regression modeling. Results: Out of 68,983 individuals whose data were correctly recorded, the mean age was 49 (SD=23.98) years, and 52.8% were women. In total, 11.1% eventually died. The median length of hospital stay was 4 (IQR=5) days, varying significantly with age, gender, ERS, underlying diseases, and COVID-19 severity (P<0.001 for all). The adjusted hazard ratio of death for the ERS at medium, high, and very high-risk status compared to the low-risk status increased by 19%, 26%, and 56%, respectively (P<0.001 for all). Conclusions: Enhancing preparedness, facilitating rapid rises in hospital capacities, and developing backup healthcare capacities can prevent excessive hospital referrals and overcapacity hospital visits during health crises, allowing for greater control at the community level and preventing further deaths.