Clinical management of COVID-19 in hospitals and the community: A snapshot from a medical insurance database in South Africa.
COVID severity
Clinical care
Covid medicine utilization
Covid mortality
Covid risk factors
Health insured Covid
Journal
International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases
ISSN: 1878-3511
Titre abrégé: Int J Infect Dis
Pays: Canada
ID NLM: 9610933
Informations de publication
Date de publication:
Jul 2022
Jul 2022
Historique:
received:
07
12
2021
revised:
23
03
2022
accepted:
18
04
2022
pubmed:
27
4
2022
medline:
25
5
2022
entrez:
26
4
2022
Statut:
ppublish
Résumé
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. 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. 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). 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.
Sections du résumé
BACKGROUND
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
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
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
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.
Identifiants
pubmed: 35470024
pii: S1201-9712(22)00231-4
doi: 10.1016/j.ijid.2022.04.032
pmc: PMC9027768
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
170-173Informations de copyright
Copyright © 2022. Published by Elsevier Ltd.
Déclaration de conflit d'intérêts
Declaration of Competing Interest The authors declare no competing interests.
Références
J Econ Behav Organ. 2021 Feb;182:311-330
pubmed: 33362321
N Engl J Med. 2020 May 7;382(19):1787-1799
pubmed: 32187464
Int Immunopharmacol. 2021 Jan;90:107157
pubmed: 33187911
AIDS Care. 2010 Mar;22(3):271-8
pubmed: 20390506
Antiviral Res. 2020 May;177:104762
pubmed: 32147496
J Allergy Clin Immunol. 2020 Jul;146(1):110-118
pubmed: 32294485
Eur J Clin Nutr. 2020 Jun;74(6):864-870
pubmed: 32404898
Crit Care. 2020 Jun 18;24(1):356
pubmed: 32552872
Nature. 2020 Aug;584(7821):430-436
pubmed: 32640463
Lancet Glob Health. 2021 Sep;9(9):e1216-e1225
pubmed: 34252381
Clin Infect Dis. 2021 Oct 5;73(7):e2095-e2106
pubmed: 33095853
AIDS. 2015 Jul 17;29(11):1401-9
pubmed: 26091299
Crit Care. 2020 Dec 14;24(1):696
pubmed: 33317589
J Mol Histol. 2020 Dec;51(6):613-628
pubmed: 33011887
Sci Rep. 2021 Feb 19;11(1):4263
pubmed: 33608563
Int J Stroke. 2020 Jun;15(4):385-389
pubmed: 32310015
Blood Purif. 2021;50(6):740-749
pubmed: 33752209
Med Mal Infect. 2020 Jun;50(4):384
pubmed: 32240719
Lancet Infect Dis. 2020 Sep;20(9):1034-1042
pubmed: 32422204
J Infect Public Health. 2021 May;14(5):570-576
pubmed: 33848886
Blood Purif. 2021;50(6):767-771
pubmed: 33412548
Medicine (Baltimore). 2021 Feb 5;100(5):e23991
pubmed: 33592854
BMC Neurol. 2021 Jan 30;21(1):43
pubmed: 33514335