healthcare-facility-level microdata  (MicroData Instrument Inc)

Journal: Nature Medicine

Article Title: Spatial and temporal fluctuations in COVID-19 fatality rates in Brazilian hospitals

doi: 10.1038/s41591-022-01807-1

Figure Lengend Snippet: Policy summary

Article Snippet: Main findings and limitations , For Brazil, we show that COVID-19 fatality rates in hospitals have fluctuated substantially both geographically and temporally since the beginning of the pandemic. In several cities, shock periods are characterized by in-hospital fatality rates exceeding 50% in patients aged 70 years and older. Using healthcare-facility-level microdata on personnel and equipment, we measured healthcare pressure at the city level and found strong associations with the fluctuating COVID-19 in-hospital fatality rates. These associations are confirmed in a Bayesian model that accounts for the emergence and rapid spread of the SARS-CoV-2 Gamma variant. We estimate that approximately half of Brazil’s COVID-19 deaths in hospitals could have been avoided without pre-pandemic geographic inequities and without the multitude of pandemic healthcare pressures. Limitations of this study include sparsely available data on patient comorbidity factors and incomplete data on patient outcomes..

Techniques: Variant Assay, Infection

Journal: Nature Medicine

Article Title: Spatial and temporal fluctuations in COVID-19 fatality rates in Brazilian hospitals

doi: 10.1038/s41591-022-01807-1

Figure Lengend Snippet: a , The 14 states and state capitals in which Gamma was detected by 31 March 2021 and which were included in the analysis. b , Time evolution of SARS-CoV-2 Gamma variant frequencies in three locations, suggesting rapid expansion. Data from GISAID (dots) are shown along with the number of sequenced SARS-CoV-2 samples (text) and posterior median model fits (line) and associated 95% CrIs (gray ribbon). c , Weekly COVID-19 in-hospital fatality rates among hospitalized residents in Manaus with no evidence of vaccination before admission (dots), by age group (facets). Non-parametric loess mean estimates of time trends are shown as block solid lines along with 95% confidence intervals as gray ribbons. The date of Gamma’s first detection is indicated as the gray dotted vertical line.

Article Snippet: Main findings and limitations , For Brazil, we show that COVID-19 fatality rates in hospitals have fluctuated substantially both geographically and temporally since the beginning of the pandemic. In several cities, shock periods are characterized by in-hospital fatality rates exceeding 50% in patients aged 70 years and older. Using healthcare-facility-level microdata on personnel and equipment, we measured healthcare pressure at the city level and found strong associations with the fluctuating COVID-19 in-hospital fatality rates. These associations are confirmed in a Bayesian model that accounts for the emergence and rapid spread of the SARS-CoV-2 Gamma variant. We estimate that approximately half of Brazil’s COVID-19 deaths in hospitals could have been avoided without pre-pandemic geographic inequities and without the multitude of pandemic healthcare pressures. Limitations of this study include sparsely available data on patient comorbidity factors and incomplete data on patient outcomes..

Techniques: Variant Assay, Blocking Assay

Journal: Nature Medicine

Article Title: Spatial and temporal fluctuations in COVID-19 fatality rates in Brazilian hospitals

doi: 10.1038/s41591-022-01807-1

Figure Lengend Snippet: a , Non-parametric median estimates (lines) and 95% confidence interval (ribbons) of age-standardized COVID-19 in-hospital fatality rates (black, right-hand-side axis) are shown against the healthcare pressure index of ICU admissions over 3 weeks per available ICU bed in each city (color, left-hand-side axis). The date of first detection of Gamma is added as a vertical dashed line. b , Heat map of Pearson correlation coefficients between age-standardized in-hospital fatality rates and each pandemic healthcare pressure index. SARI, severe acute respiratory infection; wk, week.

Article Snippet: Main findings and limitations , For Brazil, we show that COVID-19 fatality rates in hospitals have fluctuated substantially both geographically and temporally since the beginning of the pandemic. In several cities, shock periods are characterized by in-hospital fatality rates exceeding 50% in patients aged 70 years and older. Using healthcare-facility-level microdata on personnel and equipment, we measured healthcare pressure at the city level and found strong associations with the fluctuating COVID-19 in-hospital fatality rates. These associations are confirmed in a Bayesian model that accounts for the emergence and rapid spread of the SARS-CoV-2 Gamma variant. We estimate that approximately half of Brazil’s COVID-19 deaths in hospitals could have been avoided without pre-pandemic geographic inequities and without the multitude of pandemic healthcare pressures. Limitations of this study include sparsely available data on patient comorbidity factors and incomplete data on patient outcomes..

Techniques: Infection

Journal: Nature Medicine

Article Title: Spatial and temporal fluctuations in COVID-19 fatality rates in Brazilian hospitals

doi: 10.1038/s41591-022-01807-1

Figure Lengend Snippet: SARI admissions in this and the following two weeks per hospital resource are shown in colour, with y-axis on the left. In ( a ), demand per critical care bed is shown, and in ( b ) demand per physician. Non-parametric mean estimates of age-standardised COVID-19 in-hospital fatality rates are shown in black, with 95% confidence intervals as grey ribbons, and y-axis on the right. Pearson correlation coefficients ( r ) are shown in the upper left corner, and dates of Gamma’s first detection as vertical black lines.

Article Snippet: Main findings and limitations , For Brazil, we show that COVID-19 fatality rates in hospitals have fluctuated substantially both geographically and temporally since the beginning of the pandemic. In several cities, shock periods are characterized by in-hospital fatality rates exceeding 50% in patients aged 70 years and older. Using healthcare-facility-level microdata on personnel and equipment, we measured healthcare pressure at the city level and found strong associations with the fluctuating COVID-19 in-hospital fatality rates. These associations are confirmed in a Bayesian model that accounts for the emergence and rapid spread of the SARS-CoV-2 Gamma variant. We estimate that approximately half of Brazil’s COVID-19 deaths in hospitals could have been avoided without pre-pandemic geographic inequities and without the multitude of pandemic healthcare pressures. Limitations of this study include sparsely available data on patient comorbidity factors and incomplete data on patient outcomes..

Techniques:

Journal: Nature Medicine

Article Title: Spatial and temporal fluctuations in COVID-19 fatality rates in Brazilian hospitals

doi: 10.1038/s41591-022-01807-1

Figure Lengend Snippet: Individual-level records of hospital admissions with severe acute respiratory infection across Brazil are mandatory to report to the SIVEP-Gripe database, and publicly available records between 20 January 2020 and 26 July 2021 were downloaded on 31 January 2022. Data used to derive COVID-19 in-hospital fatality rates are shown in blue, and data used to derive the healthcare pressure indices are shown in yellow .

Article Snippet: Main findings and limitations , For Brazil, we show that COVID-19 fatality rates in hospitals have fluctuated substantially both geographically and temporally since the beginning of the pandemic. In several cities, shock periods are characterized by in-hospital fatality rates exceeding 50% in patients aged 70 years and older. Using healthcare-facility-level microdata on personnel and equipment, we measured healthcare pressure at the city level and found strong associations with the fluctuating COVID-19 in-hospital fatality rates. These associations are confirmed in a Bayesian model that accounts for the emergence and rapid spread of the SARS-CoV-2 Gamma variant. We estimate that approximately half of Brazil’s COVID-19 deaths in hospitals could have been avoided without pre-pandemic geographic inequities and without the multitude of pandemic healthcare pressures. Limitations of this study include sparsely available data on patient comorbidity factors and incomplete data on patient outcomes..

Techniques: Infection

Journal: Nature Medicine

Article Title: Spatial and temporal fluctuations in COVID-19 fatality rates in Brazilian hospitals

doi: 10.1038/s41591-022-01807-1

Figure Lengend Snippet: ICU admissions in this and the following two weeks per hospital resource are shown in colour, with y-axis on the left. In ( a ), demand per ventilator is shown, and in ( b ) demand per intensive care specialist. Non-parametric mean estimates of age-standardised COVID-19 in-hospital fatality rates are shown in black, with 95% confidence intervals as grey ribbons, and y-axis on the right. Pearson correlation coefficients ( r ) are shown in the upper left corner, and dates of Gamma’s first detection as vertical lines.

Article Snippet: Main findings and limitations , For Brazil, we show that COVID-19 fatality rates in hospitals have fluctuated substantially both geographically and temporally since the beginning of the pandemic. In several cities, shock periods are characterized by in-hospital fatality rates exceeding 50% in patients aged 70 years and older. Using healthcare-facility-level microdata on personnel and equipment, we measured healthcare pressure at the city level and found strong associations with the fluctuating COVID-19 in-hospital fatality rates. These associations are confirmed in a Bayesian model that accounts for the emergence and rapid spread of the SARS-CoV-2 Gamma variant. We estimate that approximately half of Brazil’s COVID-19 deaths in hospitals could have been avoided without pre-pandemic geographic inequities and without the multitude of pandemic healthcare pressures. Limitations of this study include sparsely available data on patient comorbidity factors and incomplete data on patient outcomes..

Techniques:

Journal: Nature Medicine

Article Title: Spatial and temporal fluctuations in COVID-19 fatality rates in Brazilian hospitals

doi: 10.1038/s41591-022-01807-1

Figure Lengend Snippet: a , Estimated weekly age-standardized COVID-19 in-hospital fatality rates, averaged across SARS-CoV-2 variants. Posterior median estimates (line) are shown with 95% CrIs (ribbon) and the lowest estimated fatality rates before detection of Gamma in each state capital (dotted horizontal line). b , Estimated ratio in lowest in-hospital fatality rates in each location relative to that seen in Belo Horizonte. c , Estimated ratio in in-hospital fatality rates for Gamma versus non-Gamma lineages of SARS-CoV-2. d , Estimated multiplier to the lowest age-standardized fatality rates before Gamma’s detection shown in a , which is associated with the pandemic healthcare pressure indices. In each plot, posterior median estimates are shown as dots and 95% CrIs as linerange. Box plots summarize posterior medians across locations ( n = 14): the middle line is the median; the box limits represent the upper and lower quartiles; and the whiskers extend to the extreme values that are no further than 1.5 times the interquartile range. Multipliers and ratios in b – d are reported on a logarithmic scale. Posterior estimates with CrI width larger than 3 were removed for clarity of presentation.

Article Snippet: Main findings and limitations , For Brazil, we show that COVID-19 fatality rates in hospitals have fluctuated substantially both geographically and temporally since the beginning of the pandemic. In several cities, shock periods are characterized by in-hospital fatality rates exceeding 50% in patients aged 70 years and older. Using healthcare-facility-level microdata on personnel and equipment, we measured healthcare pressure at the city level and found strong associations with the fluctuating COVID-19 in-hospital fatality rates. These associations are confirmed in a Bayesian model that accounts for the emergence and rapid spread of the SARS-CoV-2 Gamma variant. We estimate that approximately half of Brazil’s COVID-19 deaths in hospitals could have been avoided without pre-pandemic geographic inequities and without the multitude of pandemic healthcare pressures. Limitations of this study include sparsely available data on patient comorbidity factors and incomplete data on patient outcomes..

Techniques:

Journal: Nature Medicine

Article Title: Spatial and temporal fluctuations in COVID-19 fatality rates in Brazilian hospitals

doi: 10.1038/s41591-022-01807-1

Figure Lengend Snippet: Temporal fluctuations in COVID-19-attributable in-hospital fatality rate and avoidable COVID-19-attributable deaths in hospitals

Article Snippet: Main findings and limitations , For Brazil, we show that COVID-19 fatality rates in hospitals have fluctuated substantially both geographically and temporally since the beginning of the pandemic. In several cities, shock periods are characterized by in-hospital fatality rates exceeding 50% in patients aged 70 years and older. Using healthcare-facility-level microdata on personnel and equipment, we measured healthcare pressure at the city level and found strong associations with the fluctuating COVID-19 in-hospital fatality rates. These associations are confirmed in a Bayesian model that accounts for the emergence and rapid spread of the SARS-CoV-2 Gamma variant. We estimate that approximately half of Brazil’s COVID-19 deaths in hospitals could have been avoided without pre-pandemic geographic inequities and without the multitude of pandemic healthcare pressures. Limitations of this study include sparsely available data on patient comorbidity factors and incomplete data on patient outcomes..

Techniques:

Journal: Nature Medicine

Article Title: Spatial and temporal fluctuations in COVID-19 fatality rates in Brazilian hospitals

doi: 10.1038/s41591-022-01807-1

Figure Lengend Snippet: Reported COVID-19 attributable deaths in the SIVEP-Gripe platform were adjusted for in-hospital underreporting, by counting a proportion of hospitalised patients with as of yet unreported outcome as fatal, and for likely out-of-hospital under-reporting, by comparison against population excess deaths derived from all-cause mortality data of the Brazilian Civil Registry . The date of Gamma’s first detection in each city is shown as a vertical dotted line.

Article Snippet: Main findings and limitations , For Brazil, we show that COVID-19 fatality rates in hospitals have fluctuated substantially both geographically and temporally since the beginning of the pandemic. In several cities, shock periods are characterized by in-hospital fatality rates exceeding 50% in patients aged 70 years and older. Using healthcare-facility-level microdata on personnel and equipment, we measured healthcare pressure at the city level and found strong associations with the fluctuating COVID-19 in-hospital fatality rates. These associations are confirmed in a Bayesian model that accounts for the emergence and rapid spread of the SARS-CoV-2 Gamma variant. We estimate that approximately half of Brazil’s COVID-19 deaths in hospitals could have been avoided without pre-pandemic geographic inequities and without the multitude of pandemic healthcare pressures. Limitations of this study include sparsely available data on patient comorbidity factors and incomplete data on patient outcomes..

Techniques: Derivative Assay