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      Characteristics and Risk Factors for Mortality by COVID-19 Pandemic Waves in Fulton County, Georgia: A Cohort Study March 2020–February 2021

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          Abstract

          Background

          We examined differences in mortality among COVID-19 cases in the first, second and third waves of the COVID-19 pandemic.

          Methods

          A retrospective cohort study of COVID-19 cases in Fulton County, Georgia, USA, reported to a public health surveillance from March 2020 through February 2021. We estimated case fatality rates (CFR) by wave and used Cox proportional hazards random effects models in each wave, with random effects at individual and long-term-care-facility level, to determine risk factors associated with rates of mortality.

          Results

          Of 75,289 confirmed cases, 4,490 (6%) were diagnosed in wave one (CFR 31 deaths/100,000 person days [pd]), 24,293 (32%) in wave two (CFR 7 deaths/100,000 pd), and 46,506 (62%) in wave three (CFR 9 deaths/100,000 pd). Compared to females, males were more likely to die in each wave: Wave one (adjusted hazard ratio [aHR] 1.5, 95% confidence interval [CI] 1.2–1.8), wave two (aHR 1.5, 95% CI 1.2–1.8), and wave three (aHR 1.7, 95% CI 1.5–2.0). Compared to non-Hispanic Whites, non-Hispanic Blacks were more likely to die in each wave: Wave one (aHR 1.4, 95% CI 1.1–1.8), wave two (aHR 1.5, 95% CI 1.2–1.9), and wave three (aHR 1.7, 95% CI 1.4–2.0). Cases with any disability, chronic renal disease, and cardiovascular disease were more likely to die in each wave compared to those without these comorbidities.

          Conclusions

          Our study found gender and racial/ethnic disparities in COVID-19 mortality, and certain comorbidities associated with COVID-19 mortality. These factors have persisted throughout the COVID-19 pandemic waves, despite improvements in diagnosis and treatment.

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          Author and article information

          Journal
          Open Forum Infect Dis
          Open Forum Infect Dis
          ofid
          Open Forum Infectious Diseases
          Oxford University Press (US )
          2328-8957
          03 March 2022
          03 March 2022
          Affiliations
          [1 ] Office of Epidemiology, Fulton County Board of Health, Atlanta , Georgia, USA
          [2 ] Fulton County Government, Atlanta , Georgia, USA
          [3 ] Rollins School of Public Health, Emory University, Atlanta , Georgia, USA
          [4 ] Emory School of Medicine, Emory University, Atlanta , Georgia, USA
          Author notes
          Corresponding Author: Nathaniel Chishinga, MD, Piedmont Athens Regional Hospital, 1270 Prince Avenue, Suite 102, Athens, Georgia 30606, USA , nathaniel.chishinga@ 123456piedmont.org
          Article
          ofac101
          10.1093/ofid/ofac101
          8903476
          5ff967b8-bc62-4c32-8e8e-ee6bb1bc896e
          © The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

          This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence ( https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

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          Major Article
          AcademicSubjects/MED00290
          Custom metadata
          PAP
          accepted-manuscript

          covid-19,case fatality rate,mortality,risk factors,cohort
          covid-19, case fatality rate, mortality, risk factors, cohort

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