Demographic and clinical factors associated with early hospital Coronovirus disease 2019 deaths in a low middle income setting: A record-based analysis of 20,641 deaths from India

Abstract

Understanding the demographic and clinical characteristics of cases and deaths is essential for better clinical and public health management of coronavirus disease-2019 (COVID-19) in resource-limited settings. We analyzed the COVID-19 deaths reported from India, to describe the demographic and clinical characteristics and identify the factors associated with early hospital deaths (within one day of hospitalization) and survival duration. We conducted a record review of the publicly available data on COVID-19 deaths reported between January 30th and November 30th, 2020. After imputation for missing data, we calculated unadjusted and adjusted prevalence ratios, and regression coefficient for factors associated with early hospital deaths and survival duration. Of the 20, 641 COVID-19 deaths analyzed: a) 14, 684 (71.1%) were males; b) 10, 134 (50.9%) were aged <65 years; c) 9, 722 (47.1%) treated at public hospitals and d) 5405 (27.1%) were early hospital deaths. Breathlessness was the most common presenting complaint. Diabetes (11, 075, 53.7%), hypertension (95, 77, 46.5%) and coronary artery disease (2, 821, 13.7%) were the common comorbidities. After adjustment, early hospital death was significantly higher among patients aged <65 years, without severe acute respiratory illness (SARI) at admission, nondiabetics, and cared at public hospitals compared to their counterparts. Similarly, the survival duration was at least one day higher among patients presented with SARI, chronic liver disease and cared at a private hospital. The analysis covered >10% of India's COVID-19 deaths, providing essential information regarding the COVID-19 epidemiology. The characteristics associated with early hospital death and survival duration among the COVID-19 fatalities may be deliberated as markers for prognosis and compared with survivors.