Mellor Jonathon, Jones Owen, Ward Thomas
UK Health Security Agency, 10 South Colonnade, Poplar, London, UK.
J Epidemiol Glob Health. 2024 Dec;14(4):1579-1590. doi: 10.1007/s44197-024-00310-9. Epub 2024 Oct 8.
As the impact of the SARS-CoV-2 pandemic extends into 2023 and beyond, the treatment and outcomes of infected patients continues to evolve. Unlike earlier in the pandemic there are now further infectious disease pressures placed on hospitals, which influence patient care and triage decisions.
The manuscript uses individual patient records linked with associated hospital management information of system pressure characteristics to attribute COVID-19 hospitalisation fatality risks (HFR) to patients and hospitals, using generalised additive mixed effects models.
Between 01 September 2022 and 09 October 2023, the COVID-19 hospitalisation fatality risk in England was estimated as 12.71% (95% confidence interval (CI) 12.53%, 12.88%). Staff absences had an adjusted odds ratio of 1.038 (95% CI 1.017, 1.060) associated with the HFR when accounting for patient and hospital characteristics.
This observational research presents evidence that a range of local hospital effects can have a meaningful impact on the risk of death from COVID-19 once hospitalised and should be accounted for when reporting estimates. We show that both the patient case mix and hospital pressures impact estimates of patient outcomes.
随着严重急性呼吸综合征冠状病毒2（SARS-CoV-2）大流行的影响持续到2023年及以后，感染患者的治疗和结果不断演变。与大流行早期不同，现在医院面临着更多的传染病压力，这影响了患者护理和分诊决策。
本手稿使用与系统压力特征相关的医院管理信息相链接的个体患者记录，通过广义相加混合效应模型，将新冠肺炎住院死亡风险（HFR）归因于患者和医院。
在2022年9月1日至2023年10月9日期间，英国新冠肺炎住院死亡风险估计为12.71%（95%置信区间（CI）为12.53%，12.88%）。在考虑患者和医院特征时，工作人员缺勤与HFR的调整比值比为1.038（95%CI为1.017，1.060）。
这项观察性研究表明，一系列当地医院因素会对新冠肺炎住院后的死亡风险产生重大影响，在报告估计值时应予以考虑。我们表明，患者病例组合和医院压力都会影响患者预后的估计。
