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      Temporal trends of COVID-19 mortality and hospitalisation rates: an observational cohort study from the US Department of Veterans Affairs

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          Abstract

          Objectives

          To investigate the temporal trends of 30-day mortality and hospitalisation in US Veterans with COVID-19 and 30-day mortality in hospitalised veterans with COVID-19 and to decompose the contribution of changes in the underlying characteristics of affected populations to these temporal changes.

          Design

          Observational cohort study.

          Setting

          US Department of Veterans Affairs.

          Participants

          49 238 US veterans with a positive COVID-19 test between 20 March 2020 and 19 September 2020; and 9428 US veterans hospitalised with a positive COVID-19 test during the same period.

          Outcome measures

          30-day mortality rate and hospitalisation rate.

          Results

          Between 20 March 2020 and 19 September 2020 and in COVID-19 positive individuals, 30-day mortality rate dropped by 9.2% from 13.6% to 4.4%; hospitalisation rate dropped by 16.8% from 33.8% to 17.0%. In hospitalised COVID-19 individuals, 30-day mortality rate dropped by 12.7% from 23.5% to 10.8%. Among COVID-19 positive individuals, decomposition analyses suggested that changes in demographic, health and contextual characteristics, COVID-19 testing capacity, and hospital occupancy rates accounted for 40.2% and 33.3% of the decline in 30-day mortality and hospitalisation, respectively. Changes in the underlying characteristics of hospitalised COVID-19 individuals accounted for 29.9% of the decline in 30-day mortality.

          Conclusion

          Between March and September 2020, changes in demographic and health characteristics of people infected with COVID-19 contributed measurably to the substantial decline in 30-day mortality and hospitalisation.

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          Most cited references30

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          Making Neighborhood-Disadvantage Metrics Accessible — The Neighborhood Atlas

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            Estimating GFR using the CKD Epidemiology Collaboration (CKD-EPI) creatinine equation: more accurate GFR estimates, lower CKD prevalence estimates, and better risk predictions.

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              Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Synopsis of the 2017 American College of Cardiology/American Heart Association Hypertension Guideline

              In November 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) released a clinical practice guideline for the prevention, detection, evaluation, and treatment of high blood pressure (BP) in adults. This article summarizes the major recommendations.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2021
                16 August 2021
                16 August 2021
                : 11
                : 8
                : e047369
                Affiliations
                [1 ]departmentClinical Epidemiology Center , VA Saint Louis Health Care System , Saint Louis, Missouri, USA
                [2 ]Veterans Research and Education Foundation of Saint Louis , Saint Louis, Missouri, USA
                [3 ]departmentDepartment of Epidemiology and Biostatistics, College for Public Health and Social Justice , Saint Louis University , Saint Louis, Missouri, USA
                [4 ]departmentInstitute for Public Health , Washington University in Saint Louis , Saint Louis, Missouri, USA
                [5 ]departmentDepartment of Medicine , Washington University School of Medicine , Saint Louis, Missouri, USA
                [6 ]departmentNephrology Section, Medicine Service , VA Saint Louis Health Care System , Saint Louis, Missouri, USA
                Author notes
                [Correspondence to ] Dr Ziyad Al-Aly; zalaly@ 123456gmail.com
                Author information
                http://orcid.org/0000-0003-0170-6905
                http://orcid.org/0000-0002-2457-9382
                http://orcid.org/0000-0002-2600-0434
                Article
                bmjopen-2020-047369
                10.1136/bmjopen-2020-047369
                8370839
                34400452
                a87e8b3b-a2c2-4930-af23-073a7cede253
                © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 29 November 2020
                : 07 June 2021
                Funding
                Funded by: United States Department of Veterans Affairs;
                Categories
                Epidemiology
                1506
                2474
                1692
                Original research
                Custom metadata
                unlocked

                Medicine
                covid-19,epidemiology,general medicine (see internal medicine)
                Medicine
                covid-19, epidemiology, general medicine (see internal medicine)

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