https://doi.org/10.4081/monaldi.2021.1890
Demographic and clinical factors associated with early hospital Coronovirus disease 2019 deaths in a low middle income setting: A record-based analysis of 20,641 deaths from India
Submitted: April 19, 2021
Accepted: August 9, 2021
Published: September 14, 2021
Accepted: August 9, 2021
Abstract Views: 1083
PDF: 467
Supplementary: 91
Supplementary: 91
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Understanding the demographic and clinical characteristics cases and deaths is essential for better clinical and public health management of coronavirus disease-2019 (COVID-19) in resource-limited settings. We analyzed the COVID-19 deaths reported from India, to describe the demographic and clinical characteristics and identify the factors associated with early hospital deaths (within one day of hospitalization) and survival duration. We conducted a record review of the publicly available data on COVID-19 deaths reported between January 30th and November 30th, 2020. After imputation for missing data, we calculated unadjusted and adjusted prevalence ratio, and regression coefficient for factors associated with early hospital death and survival duration. Of the 20,641 COVID-19 deaths analyzed: a) 14,684 (71.1%) were males; b) 10,134 (50.9%) were aged <65 years; c) 9,722 (47.1%) treated at public hospitals and d) 5405 (27.1%) were early hospital deaths. Breathlessness was the most common presenting complaint. Diabetes (11,075,53.7%), hypertension (95,77,46.5%) and coronary artery disease (2,821,13.7%) were the common comorbidities. After adjustment, early hospital death was significantly higher among patients aged <65 years, without severe acute respiratory illness (SARI) at admission, non-diabetics, and cared at public hospitals compared to their counterparts. Similarly, the survival duration was at least one day higher among patients presented with SARI, chronic liver disease and cared at a private hospital. The analysis covered >10% of India's COVID-19 deaths, providing essential information regarding the COVID-19 epidemiology. The characteristics associated with early hospital death and survival duration among the COVID-19 fatalities may be deliberated as markers for prognosis and compared with survivors.
World Health Organization. Weekly epidemiological update. 2021. Accessed on: 2021 Mar 31. Available from: https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---23-march-2021
Johns Hopkins Coronavirus Resource Center [Internet]. Mortality Analyses Accessed on: 2021 Jan 1. Available from: https://coronavirus.jhu.edu/data/mortality
Fitzner J, Qasmieh S, Mounts AW, et al. Revision of clinical case definitions: Influenza-like illness and severe acute respiratory infection. Bull World Health Organ 2018;96:122–8.
DOI: https://doi.org/10.2471/BLT.17.194514
Indian Council of Medical Research. Strategy of COVID19 testing in India. New Delhi; 2020. Accessed on: 2021 Apr 18. Available from: https://www.icmr.gov.in/pdf/covid/strategy/Strategy_COVID19_testing_India.pdf
AlSamman M, Caggiula A, Ganguli S, et al. Non-respiratory presentations of COVID-19, a clinical review. Am J Emerg Med 2020;38:2444-54.
DOI: https://doi.org/10.1016/j.ajem.2020.09.054
World Health Organization. Gender and COVID-19: advocacy brief. 2020. Accessed on: 2020 Aug 25. Available from: https://apps.who.int/iris/bitstream/handle/10665/332080/WHO-2019-nCoV-Advocacy_brief-Gender-2020.1-eng.pdf?sequence=1&isAllowed=y
Upadhyaya A, Koirala S, Ressler R, Upadhyaya K. Factors affecting COVID-19 mortality: an exploratory study. J Health Res 2020. ahead-of-print.
DOI: https://doi.org/10.1108/JHR-09-2020-0448
Biswas M, Rahaman S, Biswas TK, Haque Z, Ibrahim B. Association of sex, age, and comorbidities with mortality in COVID-19 patients: A systematic review and meta-analysis. Intervirology 2021;64:36-47.
DOI: https://doi.org/10.1159/000512592
Carrillo-Vega MF, Salinas-Escudero G, García-Peña C, et al. Early estimation of the risk factors for hospitalization and mortality by COVID-19 in Mexico. PLoS One 2020;15:e0238905.
DOI: https://doi.org/10.1371/journal.pone.0238905
Ioannou GN, Locke E, Green P, et al. Risk Factors for hospitalization, mechanical ventilation, or death among 10 131 US veterans with SARS-CoV-2 infection. JAMA Netw Open 2020;3:e2022310.
DOI: https://doi.org/10.1001/jamanetworkopen.2020.22310
Du Y, Tu L, Zhu P, et al. Clinical features of 85 fatal cases of COVID-19 from Wuhan: A retrospective observational study. Am J Respir Crit Care Med 2020;201:1372–9.
DOI: https://doi.org/10.1164/rccm.202003-0543OC
Goodman KE, Magder LS, Baghdadi JD, et al. Impact of sex and metabolic comorbidities on COVID-19 mortality risk across age groups: 66,646 inpatients across 613 U.S. hospitals. Clin Infect Dis 2020; ciaa1787. Online ahead of print.
DOI: https://doi.org/10.1093/cid/ciaa1787
Wortham JM, Lee JT, Althomsons S, et al. Characteristics of persons who died with COVID-19 - United States, February 12-May 18, 2020. MMWR Morb Mortal Wkly Rep 2020;69:923–9.
DOI: https://doi.org/10.4324/9781003141402-17
Pantea Stoian A, Pricop-Jeckstadt M, Pana A, et al. Death by SARS-CoV 2: a Romanian COVID-19 multi-centre comorbidity study. Sci Rep 2020;10:21613.
DOI: https://doi.org/10.1038/s41598-020-78575-w
Palmieri L, Palmer K, Lo Noce C, et al. Differences in the clinical characteristics of COVID-19 patients who died in hospital during different phases of the pandemic: national data from Italy. Aging Clin Exp Res 2021;33:193-9.
DOI: https://doi.org/10.1007/s40520-020-01764-0
Mena G, Montané E, Rodríguez M, et al. Patient characterization and adverse health care-related events in SARS-CoV-2 infected patients who died in a tertiary hospital. Med Clin (Barc) 2021;156:277-80.
DOI: https://doi.org/10.1016/j.medcle.2020.11.009
Gulseth HL, Helland E, Johansen KI, et al. Deaths after confirmed SARS-CoV-2 in Norway [Article in English, Norwegian]. 2020;140:0693.
Korean Society of Infectious Diseases and Korea Centers for Disease Control and Prevention. Analysis on 54 mortality cases of Coronavirus disease 2019 in the Republic of Korea from January 19 to March 10, 2020. J Korean Med Sci 2020;35:e132.
DOI: https://doi.org/10.3346/jkms.2020.35.e132
Bhatia R, Klausner J. Estimating individual risks of COVID-19-associated hospitalization and death using publicly available data. PLoS One 2020;15:e0243026. Available from:
DOI: https://doi.org/10.1371/journal.pone.0243026
Department of Health & Family Welfare [Internet]. COVID-19 Information Portal. 2020. Accessed on: 2021 Jan 7. Available from: https://covid19.karnataka.gov.in/govt_bulletin/en
Department of Health & Family Welfare [Internet]. Daily Bulletin – StopCoronaTN. 2020. Accessed on: 2021 Jan 7. Available from: https://stopcorona.tn.gov.in/daily-bulletin/
Purohit BC. Inter-state disparities in health care and financial burden on the poor in India. J Health Soc Policy 2004;18:37-60.
DOI: https://doi.org/10.1300/J045v18n03_03
Pulla P. What counts as a Covid-19 death? BMJ 2020;370:m2859.
DOI: https://doi.org/10.1136/bmj.m2859
Angeli F, Bachetti T, Group for the MS. Temporal changes in co-morbidities and mortality in patients hospitalized for COVID-19 in Italy. Eur J Intern Med 2020;82:123.
DOI: https://doi.org/10.1016/j.ejim.2020.10.019
Zhang B, Zhou X, Qiu Y, et al. Clinical characteristics of 82 cases of death from COVID-19. PLoS One 2020;15:e0235458.
DOI: https://doi.org/10.1371/journal.pone.0235458
Deiana G, Azara A, Dettori M, et al. Deaths in SARS-CoV-2 positive patients in Italy: The influence of underlying health conditions on lethality. Int J Environ Res Public Health 2020;17:1–10.
DOI: https://doi.org/10.3390/ijerph17124450
Office of the Registrar General & Census Commissioner of India [Internet]. Census of India: Age Structure and Marital Status. Accessed on: 2021 Jan 6. Available from: https://censusindia.gov.in/Census_And_You/age_structure_and_marital_status.aspx
World Health Organization. Social stigma associated with COVID-19. 2020. Accessed on: 2021 Jan 6. Available from: https://www.who.int/docs/default-source/coronaviruse/covid19-stigma-guide.pdf
Hua J, Chen R, Zhao L, et al. Epidemiological features and medical care-seeking process of patients with COVID-19 in Wuhan, China. ERJ Open Res 2020;6:00142–2020.
DOI: https://doi.org/10.1183/23120541.00142-2020
Yang J, Zheng Y, Gou X, et al. Prevalence of comorbidities and its effects in coronavirus disease 2019 patients: A systematic review and meta-analysis. Int J Infect Dis 2020;94:91-5.
DOI: https://doi.org/10.1016/j.ijid.2020.03.017
Kuuire VZ, Bisung E, Rishworth A, et al.Health-seeking behaviour during times of illness: a study among adults in a resource poor setting in Ghana. J Public Health (Oxf) 2016;38:e545–53.
DOI: https://doi.org/10.1093/pubmed/fdv176
The Hindu [Internet]. Late referrals of the critically ill put govt. hospitals in a fix. Accessed on: 2021 Jul 15. Available from: https://www.thehindu.com/news/national/tamil-nadu/late-referrals-of-the-critically-ill-put-govt-hospitals-in-a-fix/article34773873.ece
Khan L, Ul Khaliq N, Ullah A, et al. COVID-19 pandemic: Mechanistic approaches and gender vulnerabilities. Saudi Pharm J 2020;28:1874.
DOI: https://doi.org/10.1016/j.jsps.2020.11.014
Griffith DM, Sharma G, Holliday CS, et al. Men and COVID-19: A biopsychosocial approach to understanding sex differences in mortality and recommendations for practice and policy interventions. Prev Chronic Dis 2020;17:E63.
DOI: https://doi.org/10.5888/pcd17.200247
Gunnarsson R, Nordeman L, Stibrant Sunnerhagen K, Billhult A. Gender differences in care-seeking behavior and health care consumption after work-related whiplash injuries. Eur J Public Health 2014;24: cku166-154.
DOI: https://doi.org/10.1093/eurpub/cku166.154
Matheson FI, Smith KLW, Fazli GS, et al. Physical health and gender as risk factors for usage of services for mental illness. J Epidemiol Community Health 2014;68:971–8.
DOI: https://doi.org/10.1136/jech-2014-203844
Nabalamba A, Millar WJ. Going to the doctor. Health Rep 2007;18:23–35.
Li AJ, Li X. Sex-dependent immune response and lethality of COVID-19. Stem Cell Res 2020;50:102116.
DOI: https://doi.org/10.1016/j.scr.2020.102116
Pivonello R, Auriemma RS, Pivonello C, et al. Sex disparities in COVID-19 severity and outcome: Are men weaker or women stronger? Neuroendocrinology 2020. Online ahead of print.
DOI: https://doi.org/10.1159/000513346
Galbadage T, Peterson BM, Wang JS, et al. Molecular mechanisms lead to sex-specific COVID-19 prognosis and targeted therapies. Front Med 2020;7:589060.
DOI: https://doi.org/10.3389/fmed.2020.589060
Wenham C, Smith J, Davies SE, et al. Women are most affected by pandemics - lessons from past outbreaks. Nature 2020;583:194–8.
DOI: https://doi.org/10.1038/d41586-020-02006-z
Wu Z hong, Tang Y, Cheng Q. Diabetes increases the mortality of patients with COVID-19: a meta-analysis. Acta Diabetol 2021;58:139-44.
DOI: https://doi.org/10.1007/s00592-020-01546-0
Kumar A, Arora A, Sharma P, et al. Is diabetes mellitus associated with mortality and severity of COVID-19? A meta-analysis. Diabetes Metab Syndr Clin Res Rev 2020;14:535–45.
DOI: https://doi.org/10.1016/j.dsx.2020.04.044
Geldsetzer P, Manne-Goehler J, Theilmann M, et al. Diabetes and hypertension in India: A nationally representative study of 1.3 million adults. JAMA Intern Med 2018;178:363–72.
DOI: https://doi.org/10.1001/jamainternmed.2017.8094
Cimerman S, Chebabo A, Cunha CA da, Rodríguez-Morales AJ. Deep impact of COVID-19 in the healthcare of Latin America: the case of Brazil. Braz J Infect Dis 2020;24:93-5.
DOI: https://doi.org/10.1016/j.bjid.2020.04.005
Bastos LS, Niquini RP, Lana RM, et al. COVID-19 and hospitalizations for SARI in Brazil: A comparison up to the 12th epidemiological week of 2020. Cad Saude Publica 2020;36:e00070120.
DOI: https://doi.org/10.1590/0102-311x00070120
de Oliveira SB, Ganem F, de Araújo WN, et al.Imputation method to reduce undetected severe acute respiratory infection cases during the coronavirus disease outbreak in Brazil. Rev Soc Bras Med Trop 2020;53:e20200528.
DOI: https://doi.org/10.1590/0037-8682-0528-2020
Gupta N, Praharaj I, Bhatnagar T, et al. Severe acute respiratory illness surveillance for coronavirus disease 2019, India, 2020. Indian J Med Res 2020;151:236-40.
Patankar A, Modi P, Uppe A, et al. COVID-19 and management of severe acute respiratory infection (SARI): A questionnaire-based study among Indian healthcare professionals. Curr Heal Sci J 2020;46:156–66.
Indian Council of Medical Research [Internet]. Guidance for appropriate recording of COVID-19 related deaths in India. 2020. Accessed on: 2021 Jan 6. Available from: https://www.mgims.ac.in/files/covid/Guidance_appropriate_recording_of_related_deaths_India.pdf
Supporting Agencies
NoneHow to Cite
Gandhi Periyasamy, Aravind, Soundappan Kathirvel, Tanveer Rehman, and Amarjeet Singh. 2021. “Demographic and Clinical Factors Associated With Early Hospital Coronovirus Disease 2019 Deaths in a Low Middle Income Setting: A Record-Based Analysis of 20,641 Deaths from India”. Monaldi Archives for Chest Disease 92 (2). https://doi.org/10.4081/monaldi.2021.1890.
Copyright (c) 2021 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Jacopo Cefalo, Carmine Salerni, Giulia Ferranti, Manuela Bimbatti, Laura Moneghini, Paolo Carlucci, Ottavia Viganò, Giulia Marchetti, Umberto Gianelli, Stefano Centanni, Giovanni Sotgiu, Michele Mondoni, Mediastinal lymphadenopathies and skin lesions in a 49-year-old Sinhalese man , Monaldi Archives for Chest Disease: Early Access
You may also start an advanced similarity search for this article.
