Ramos-Rincón José-Manuel, Sánchez-Paya José, González-De-La-Aleja Pilar, Rodríguez-Díaz Juan-Carlos, Merino Esperanza
Department of Internal Medicine, Alicante Institute for Health and Biomedical Research (ISABIAL), Dr. Balmis General University Hospital, Alicante, Spain.
Miguel Hernández University of Elche, Alicante, Spain.
Front Public Health. 2025 Feb 4;13:1488283. doi: 10.3389/fpubh.2025.1488283. eCollection 2025.
The study aimed to analyze in-hospital mortality (IHM) among all COVID-19 patients hospitalized in Spain between March 1, 2020, and December 31, 2021, and to compare two distinct periods: the prevaccination period (March 1, 2020, to January 31, 2021) and the vaccination period (February 1, 2021, to December 31, 2021). The objective was to assess the impact of vaccination on IHM and identify associated risk factors, using data from Spain's national hospitalization registry.
This retrospective analysis used data from the Spanish National Surveillance System for Hospital Data. The primary outcome was in-hospital mortality (IHM). Multivariate logistic regression identified risk factors across the overall study period, as well as during the prevaccination and vaccination periods. Risk factors included age (in 20-year intervals), sex, comorbidities (e.g., hypertension, diabetes, chronic kidney failure, obesity, neurodegenerative disorders, and others), and admission to the intensive care unit.
A total of 524,314 COVID-19 hospitalizations were recorded in Spain, with 329,690 during the prevaccination period and 194,624 during the vaccination period. Hospitalization rates dropped from 697/100,000 people to 411/100,000, and in-hospital mortality (IHM) decreased from 16.2 to 11.5% (adjusted odds ratio [AOR]: 0.71, 95% CI: 0.70-0.73, < 0.001). IHM rose with age, from 0.8% in patients aged 18-39 to 31.7% in those ≥80 years ( < 0.001), but significant decreases were observed across all age groups after vaccination, especially in those ≥80 years (AOR: 0.76, 95% CI: 0.75-0.79, < 0.001). Risk factors for IHM remained consistent, with leukemia, neoplasm, and lymphoma posing the highest risks, while female sex (AOR: 0.75, 95% CI: 0.74-0.77, < 0.001) and dyslipidemia (AOR: 0.85, 95% CI: 0.32-0.86, < 0.001) were protective factors.
During the vaccination period, the risk of in-hospital mortality (IHM) was 29% lower than in the prevaccination period, after adjusting for sex, age, and comorbidities. This reduced risk was observed across sexes, age groups, and comorbidities. The risk factors for IHM remained consistent between the two periods, with age as the main risk factor, while female sex and dyslipidemia were identified as protective factors.
本研究旨在分析2020年3月1日至2021年12月31日期间在西班牙住院的所有新冠肺炎患者的院内死亡率（IHM），并比较两个不同时期：疫苗接种前时期（2020年3月1日至2021年1月31日）和疫苗接种时期（2021年2月1日至2021年12月31日）。目的是利用西班牙国家住院登记处的数据评估疫苗接种对院内死亡率的影响，并确定相关风险因素。
这项回顾性分析使用了西班牙国家医院数据监测系统的数据。主要结局是院内死亡率（IHM）。多变量逻辑回归确定了整个研究期间以及疫苗接种前和疫苗接种期间的风险因素。风险因素包括年龄（以20岁为间隔）、性别、合并症（如高血压、糖尿病、慢性肾衰竭、肥胖、神经退行性疾病等）以及入住重症监护病房。
西班牙共记录了524314例新冠肺炎住院病例，其中疫苗接种前时期为329690例，疫苗接种时期为194624例。住院率从697/10万人降至411/10万人，院内死亡率（IHM）从16.2%降至11.5%（调整后的优势比[AOR]：0.71，95%置信区间：0.70 - 0.73，P < 0.001）。院内死亡率随年龄增长而上升，从18 - 39岁患者的0.8%升至80岁及以上患者的31.7%（P < 0.001），但疫苗接种后所有年龄组的死亡率均显著下降，尤其是80岁及以上患者（AOR：0.76，95%置信区间：0.75 - 0.79，P < 0.001）。院内死亡率的风险因素保持一致，白血病、肿瘤和淋巴瘤风险最高，而女性（AOR：0.75，95%置信区间：0.74 - 0.77，P < 0.001）和血脂异常（AOR：0.85，95%置信区间：0.32 - 0.86，P < 0.001）为保护因素。
在调整性别、年龄和合并症后，疫苗接种期间的院内死亡风险比疫苗接种前时期低29%。在各性别、年龄组和合并症中均观察到这种风险降低。两个时期院内死亡率的风险因素保持一致，年龄是主要风险因素，而女性和血脂异常被确定为保护因素。
