@Article{info:doi/10.2196/43341,
author="Lytras, Theodore",
title="Health Care System Overstretch and In-Hospital Mortality of Intubated Patients With COVID-19 in Greece From September 2020 to April 2022: Updated Retrospective Cohort Study",
journal="JMIRx Med",
year="2024",
month="Jun",
day="10",
volume="5",
pages="e43341",
keywords="COVID-19",
keywords="pandemic",
keywords="health care disparities",
keywords="intensive care unit",
keywords="right to health",
keywords="quality of care",
keywords="intubation",
keywords="mortality",
keywords="health disparity",
keywords="health inequality",
keywords="surveillance data",
keywords="inpatient",
keywords="COVID-19 patient",
keywords="hospitalization",
keywords="ICU",
keywords="disparity",
keywords="inequality",
keywords="surveillance",
keywords="health care system",
keywords="Greece",
keywords="region",
keywords="Delta",
keywords="Omicron",
keywords="vaccination",
keywords="vaccine",
keywords="public health",
keywords="patient load",
keywords="deterioration",
keywords="time",
abstract="Background: Our previous analysis showed how in-hospital mortality of intubated patients with COVID-19 in Greece is adversely affected by patient load and regional disparities. Objective: We aimed to update this analysis to include the large Delta and Omicron waves that affected Greece during 2021-2022, while also considering the effect of vaccination on in-hospital mortality. Methods: Anonymized surveillance data were analyzed from all patients with COVID-19 in Greece intubated between September 1, 2020, and April 4, 2022, and followed up until May 17, 2022. Time-split Poisson regression was used to estimate the hazard of dying as a function of fixed and time-varying covariates: the daily total count of intubated patients with COVID-19 in Greece, age, sex, COVID-19 vaccination status, region of the hospital (Attica, Thessaloniki, or rest of Greece), being in an intensive care unit, and an indicator for the period from September 1, 2021. Results: A total of 14,011 intubated patients with COVID-19 were analyzed, of whom 10,466 (74.7\%) died. Mortality was significantly higher with a load of 400-499 intubated patients, with an adjusted hazard ratio (HR) of 1.22 (95\% CI 1.09-1.38), rising progressively up to 1.48 (95\% CI 1.31-1.69) for a load of ?800 patients. Hospitalization away from the Attica region was also independently associated with increased mortality (Thessaloniki: HR 1.22, 95\% CI 1.13-1.32; rest of Greece: HR 1.64, 95\% CI 1.54-1.75), as was hospitalization after September 1, 2021 (HR 1.21, 95\% CI 1.09-1.36). COVID-19 vaccination did not affect the mortality of these already severely ill patients, the majority of whom (11,944/14,011, 85.2\%) were unvaccinated. Conclusions: Our results confirm that in-hospital mortality of severely ill patients with COVID-19 is adversely affected by high patient load and regional disparities, and point to a further significant deterioration after September 1, 2021, especially away from Attica and Thessaloniki. This highlights the need for urgent strengthening of health care services in Greece, ensuring equitable and high-quality care for all. ",
doi="10.2196/43341",
url="https://xmed.jmir.org/2024/1/e43341"
}