Impact of the local care environment and social characteristics on aggregated hospital fatality rate from COVID-19 in France: a nationwide observational study.

J-D Zeitoun, M Faron, J H Lefèvre

Journal: Public health 2021;189():104-109

PMID: 33197731

Free Full Text on PubMed Central View on PubMed

Abstract

OBJECTIVES

We aimed to investigate possible differences in the aggregated hospital fatality rate from coronavirus disease 2019 (COVID-19) in France at the early phase of the outbreak and to determine whether factors related to population or healthcare supply before the pandemic could be associated with outcome differences.

STUDY DESIGN

This is a nationwide observational study including all French hospitals from January 24, 2020, to April 11, 2020.

METHODS

We analyzed the aggregated hospital fatality rate. A Poisson regression was performed to investigate associations between characteristics pertaining to populational health, socio-economic context and local healthcare supply at baseline, and the chosen outcome.

RESULTS

On April 11, 2020, a total number of 30,960 patients were hospitalized among the 3046 French healthcare facilities, including 6832 patients in the intensive care unit (ICU). A total of 8581 deaths due to COVID-19 had been recorded, with a median mortality rate per 10,000 people per department of 0.53 (interquartile range: 0.29-1.90). There were significant variations between the 95 French departments even after adjusting for outbreak inception (P < 0.001). After multivariable analysis, four factors were independently associated with a significantly higher aggregated hospital fatality rate: a higher ICU capacity at baseline (estimate = 1.47; P = 0.00791), a lower density of general practitioners (estimate = 0.95; P = 0.0205), a lower fraction of activity from the for-profit private sector (estimate = 0.99; P < 0.001), and the ratio of people older than 75 years (estimate = 0.91; P = 0.0023).

CONCLUSIONS

The aggregated hospital fatality rate from COVID-19 in France seems to vary among geographic areas, with some factors pertaining to local healthcare supply being associated with the outcome.

Address: Centre d'Epidémiologie Clinique, Hôtel Dieu Hospital, Assistance Publique-Hôpitaux de Paris, France; Department of Gastroenterology and Nutrition, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France. Electronic address: [email protected].; Departments of Surgical Oncology and Department of Biostatistics and Epidemiology, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; Oncostat U1018, Inserm, Université Paris-Saclay, Équipe Labellisée Ligue Contre le Cancer, Villejuif, France.; Sorbonne Université, Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, F-75012, Paris, France; INSERM, UMRS 938, Centre de Recherche Saint-Antoine, Equipe "Instabilité des Microsatellites et Cancers", Equipe labellisée par la Ligue Nationale contre le Cancer, F-75012, Paris, France.

DOI: 10.1016/j.puhe.2020.09.015

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MeSH Terms: Aged, Aged, 80 and over, COVID-19, Community Health Services, Female, France, Health Services Research, Hospital Mortality, Humans, Intensive Care Units, Male, Middle Aged, SARS-CoV-2, Socioeconomic Factors, Sociological Factors