Decreased Mortality Over Time During the First Wave in Patients With COVID-19 in Geriatric Care: Data From the Stockholm GeroCovid Study

Abstract

\n Objective\n To describe temporal changes in treatment, care, and short-term mortality outcomes of geriatric patients during the first wave of the COVID-19 pandemic.\n \n Design\n Observational study.\n \n Setting and Participants\n Altogether 1,785 patients diagnosed with COVID-19 and 6,744 hospitalized for non-COVID-19 causes at seven geriatric clinics in Stockholm from March 6th to July 31st, 2020 were included.\n \n Methods\n Across admission month, patient vital signs and pharmacological treatment in relationship to risk for in-hospital death were analyzed using the Poisson regression model. Incidence rates (IR) and Incidence rate ratios (IRR) of death are presented.\n \n Results\n In patients with COVID-19, the IR of mortality were 27%, 17%, 10%, 8%, and 2% from March to July, respectively, after standardization for demographics and vital signs. Compared with patients admitted in March, the risk of in-hospital death decreased by 29%(IRR 0.71, 95% CI 0.51-0.99) in April, 61%(0.39, 0.26-0.58) in May, 68%(0.32, 0.19-0.55) in June and 86%(0.14, 0.03-0.58) in July. The proportion of patients admitted for geriatric care with oxygen saturation <90% decreased from 13% to 1%, which partly explains the improvement of COVID-19 patient survival. In non-COVID-19 patients during the pandemic, mortality rates remained relatively stable (IR 1.3%-2.3%). Compared with non-COVID-19 geriatric patients, the IRR of death declined from 11 times higher (IRR 11.7, 95%CI 6.11-22.3) to 1.6 times (2.61,0.50-13.7) between March and July in patients with COVID-19.\n \n Conclusions and Implications\n Mortality risk in geriatric patients from the Stockholm region declined over time throughout the first pandemic wave of COVID-19. The improved survival rate over time was only partly related to improvement in saturation status at the admission of the patients hospitalized later throughout the pandemic. Lower incidence during the later months could have led to less severe hospitalized cases driving down mortality.\n