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  • COVID-19 hospital activity and in-hospital mortality during the first and second waves of the pandemic in England: an observational study

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Respiratory epidemiology
Original research
COVID-19 hospital activity and in-hospital mortality during the first and second waves of the pandemic in England: an observational study
  1. William K Gray1,
  2. Annakan V Navaratnam1,2,
  3. Jamie Day1,
  4. Julia Wendon3,
  5. Tim W R Briggs1
  1. 1 Getting It Right First Time, NHS England and NHS Improvement London, London, UK
  2. 2 Royal National Ear, Nose and Throat Hospital, University College London Hospitals NHS Foundation Trust, London, UK
  3. 3 Liver Intensive Care Unit, King's College London, London, UK
  1. Correspondence to Annakan V Navaratnam, Getting It Right First Time, NHS England and NHS Improvement, London, UK; annakan.navaratnam{at}nhs.net

Abstract

Introduction We aimed to examine the profile of, and outcomes for, all people hospitalised with COVID-19 across the first and second waves of the pandemic in England.

Methods This was an exploratory retrospective analysis of observational data from the Hospital Episode Statistics data set for England. All patients aged ≥18 years in England with a diagnosis of COVID-19 who had a hospital stay that was completed between 1 March 2020 and 31 March 2021 were included. In-hospital mortality was the primary outcome of interest. The second wave was identified as starting on 1 September 2020. Multilevel logistic regression modelling was used to investigate the relationship between mortality and demographic, comorbidity and temporal covariates.

Results Over the 13 months, 374 244 unique patients had a diagnosis of COVID-19 during a hospital stay, of whom 93 701 (25%) died in hospital. Adjusted mortality rates fell from 40%–50% in March 2020 to 11% in August 2020 before rising to 21% in January 2021 and declining steadily to March 2021. Improvements in mortality rates were less apparent in older and comorbid patients. Although mortality rates fell for all ethnic groups from the first to the second wave, declines were less pronounced for Bangladeshi, Indian, Pakistani, other Asian and black African ethnic groups.

Conclusions There was a substantial decline in adjusted mortality rates during the early part of the first wave which was largely maintained during the second wave. The underlying reasons for consistently higher mortality risk in some ethnic groups merits further study.

  • COVID-19
  • clinical epidemiology
  • emergency medicine
  • pneumonia
  • respiratory infection
  • viral infection

Data availability statement

Data may be obtained from a third party and are not publicly available. This report does not contain patient identifiable data. Consent from individuals involved in this study was not required. Requests for any underlying data cannot be granted by the authors because the data were acquired under licence/data sharing agreement from NHS Digital, for which conditions of use (and further use) apply. Individuals and organisations wishing to access Hospital Episodes Statistics data can make a request directly to NHS Digital.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/thoraxjnl-2021-218025

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. This report does not contain patient identifiable data. Consent from individuals involved in this study was not required. Requests for any underlying data cannot be granted by the authors because the data were acquired under licence/data sharing agreement from NHS Digital, for which conditions of use (and further use) apply. Individuals and organisations wishing to access Hospital Episodes Statistics data can make a request directly to NHS Digital.

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    Footnotes

    • Contributors This study was designed and organised by AVN, WKG, JD and TWRB. Data cleaning and analysis was by WKG, supported by JD. Writing of the first draft was by AVN and WKG. All authors critically reviewed the manuscript and agreed to submission of the final draft. WKG is responsible for the overal content as the guarantor

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.