Mortality reduction in older COVID-19-patients hospitalized in Spain during the second pandemic wave from the SEMI-COVID-19 Registry

Abstract

In 2020, the COVID-19 pandemic followed a two-wave pattern in most countries. Hospital admission for COVID-19 in one wave or another could have afected mortality, especially among the older persons. The objective of this study was to evaluate whether the admission of older patients during the diferent waves, before SARS-CoV-2 vaccination was available, was associated with a diferent mortality. We compared the mortality rates of patients hospitalized during 2020 before (frst wave) and after (second wave) July 7, 2020, included in the SEMI-COVID-19 Registry, a large, multicenter, retrospective cohort of patients admitted to 126 Spanish hospitals for COVID-19. A multivariate logistic regression analysis was performed to control for changes in either the patient or disease profle. As of December 26, 2022, 22,494 patients had been included (17,784 from the frst wave and 4710 from the second one). Overall mortality was 20.4% in the frst wave and 17.2% in the second wave (risk diference (RD) − 3.2%; 95% confdence interval (95% CI) − 4.4 to − 2.0). Only patients aged 70 and older (10,973 patients: 8571 in the frst wave and 2386 in the second wave) had a signifcant reduction in mortality (RD − 7.6%; 95% CI − 9.7 to − 5.5) (unadjusted relative risk reduction: 21.6%). After adjusting for age, comorbidities, variables related to the severity of the disease, and treatment received, admission during the second wave remained a protective factor. In Spain, patients aged 70 years and older admitted during the second wave of the COVID-19 pandemic had a signifcantly lower risk of mortality, except in severely dependent persons in need of corticosteroid treatment. This efect is independent of patient characteristics, disease severity, or treatment received. This suggests a protective efect of a better standard of care, greater clinical expertise, or a lesser degree of healthcare system overload.