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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


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.

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