Pandemic Worsened In-Hospital Mortality for Non–COVID-19 Time-Sensitive Conditions

In-hospital mortality for time-sensitive conditions not related to COVID-19 was worse during the COVID-19 pandemic compared with the prepandemic period, according to a study published online in JAMA Network Open.

“Increases in inpatient mortality were greater and more persistent (ie, in each month throughout the pandemic) for non–COVID-19 sepsis and pneumonia than for other selected conditions,” wrote corresponding author H. Joanna Jiang, PhD, of the Agency for Healthcare Research and Quality, Rockville, Maryland, and study coauthors. “Increases in the odds of mortality for these 2 conditions were also more sensitive to the community COVID-19 burden.”

The study investigated how pandemic-related disruptions affected in-hospital mortality for patients with 6 time-sensitive conditions unrelated to COVID-19: acute myocardial infarction, hip fracture, gastrointestinal hemorrhage, pneumonia, sepsis, and stroke. Researchers compared mortality rates during the COVID-19 pandemic (March 8, 2020, to December 31, 2021) with the prepandemic period (January 1, 2017, to March 7, 2020). They also compared mortality changes at urban and rural hospitals. In all, the study included 18.6 million hospitalizations at 3813 US hospitals.

Compared with the prepandemic period, the odds of in-hospital mortality for sepsis increased 27% at urban hospitals and 35% at rural hospitals during the pandemic. In-hospital mortality for pneumonia increased 48% at urban hospitals and 46% at rural hospitals, according to the study. At both rural and urban hospitals, mortality increases for sepsis and pneumonia showed a dose-response association with the community COVID-19 level. The study also found the odds of in-hospital mortality for acute myocardial infarction increased 9% at urban hospitals and was responsive to the COVID-19 level in the community. At rural hospitals, mortality odds increased 32% for hip fracture. At urban hospitals, mortality odds increased 15% for gastrointestinal hemorrhage.

Researchers reported no overall change in the odds of mortality for stroke.

“This cohort study found increases in in-hospital mortality for non–COVID-19 time-sensitive conditions during the pandemic, often with differential magnitudes and temporal patterns at urban and rural hospitals…” researchers wrote. “Mobilizing strategies tailored to the different needs of urban and rural hospitals may help reduce the likelihood of excess deaths during future public health crises.”

Reference

Jiang HJ, Henke RM, Fingar KR, Liang L, Agniel D. Mortality for time-sensitive conditions at urban vs rural hospitals during the COVID-19 pandemic. JAMA Netw Open. 2024;7(3):e241838. doi:10.1001/jamanetworkopen.2024.1838