COVID-19 Hospital Activity and Outcomes During the First and Second Waves of the Pandemic in England: Analysis of the Hospital Episodes Statistics Database

Abstract

Background: The aim of this study was 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 a retrospective observational study that used data from the Hospital Episode Statistics dataset for England. All patients aged ≥ 18 years in England with a diagnosis of COVID-19 who had a hospital stay that was completed (discharged alive or died) between 1st March 2020 and 31st March 2021 were included. In-hospital mortality was the primary outcome of interest. The first wave was defined as 1st March-31st August 2020 and the second wave as 1st September 2020 to 31st March 2021. Multivariable logistic regression was used to model the relationship between mortality and the covariates: age, sex, deprivation, ethnicity, discharge/admission date and a number of comorbidities.Findings: Over the 13 months, 374,244 unique patients had a diagnosis of COVID-19 during a hospital stay, of whom 93,701 (25.0%) 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, with all having higher odds of mortality during the second wave than White ethnicity patients.Interpretation: 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.Funding Information: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.Declaration of Interests: The authors declare that there is no conflict of interest.Ethics Approval Statement: Consent from individuals involved in this study was not required for this analysis of the Hospital Episodes Statistics (HES) administrative dataset. The analysis and presentation of data follows current NHS Digital guidance for the use of HES data for research purposes. Reported data are anonymised to the level required by ISB1523 Anonymisation Standard for Publishing Health and Social Care Data.