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Abstract
Background In England, reported COVID-19 mortality rates increased during winter 2020/21 relative to earlier summer and autumn months. This study aimed to examine the association between COVID-19-related hospital bed-strain during this time and patient outcomes.
Methods This was a retrospective observational study using Hospital Episode Statistics data for England. All unique patients aged ≥18 years in England with a diagnosis of COVID-19 who had a completed (discharged alive or died in hospital) hospital stay with an admission date between 1 July 2020 and 28 February 2021 were included. Bed-strain was calculated as the number of beds occupied by patients with COVID-19 divided by the maximum COVID-19 bed occupancy during the study period. Bed-strain was categorised into quartiles for modelling. In-hospital mortality was the primary outcome of interest and length of stay a secondary outcome.
Results There were 253 768 unique hospitalised patients with a diagnosis of COVID-19 during a hospital stay. Patient admissions peaked in January 2021 (n=89 047), although the crude mortality rate peaked slightly earlier in December 2020 (26.4%). After adjustment for covariates, the mortality rate in the lowest and highest quartile of bed-strain was 23.6% and 25.3%, respectively (OR 1.13, 95% CI 1.09 to 1.17). For the lowest and the highest quartile of bed-strain, adjusted mean length of stay was 13.2 days and 11.6 days, respectively in survivors and was 16.5 days and 12.6 days, respectively in patients who died in hospital.
Conclusions High levels of bed-strain were associated with higher in-hospital mortality rates, although the effect was relatively modest and may not fully explain increased mortality rates during winter 2020/21 compared with earlier months. Shorter hospital stay during periods of greater strain may partly reflect changes in patient management over time.
- COVID-19
- hospitalisations
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. However, individuals and organisations can access HES data by direct request to NHS Digital.
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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. However, individuals and organisations can access HES data by direct request to NHS Digital.
Footnotes
Handling editor Mary Dawood
Contributors This study was designed and organised by AVN, WKG, JD and TWRB. Data cleaning, analysis was by WKG, supported by JD, JH and FH. Writing of the first draft was by WKG. All authors critically reviewed the manuscript and agreed to submission of the final draft. WKG is guarantor for this study and accepts full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish.
Funding JH and FH received a fellowship from Distributed Research Utilising Advanced Computing (DiRAC), which paid their salaries.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; internally peer reviewed.
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