Regional Differences in COVID-19 Mortality Rates in the Kingdom of Saudi Arabia: A Simulation of the New Model of Care.

Abdullah A Alharbi,Saleh S Alghamdi,Ahmad Y Alqassim,Mohammed A Muaddi

doi:10.7759/cureus.20797

Abstract

BackgroundThis study aimed to assess regional COVID-19 mortality rates and compare the five proposed business units (BUs). MethodsA cross-sectional study was conducted in the Ministry of Health (MOH) hospitals in the Kingdom of Saudi Arabia (KSA). We included 1743 adults (≥ 18 years of age) with COVID-19 admitted to any of 30 MOH hospitals.ResultsThe inpatients had confirmed mild to severe COVID-19 between March and mid-July 2020. The central BU (Riyadh) was used as the reference. MOH electronic health record data were reviewed and utilized, including variables reflecting hospital course (mortality and discharge status). The primary outcome was COVID-19-related inpatient death. Covariates included patient demographics, pre-existing chronic diseases, and COVID-19-related complications. The data were analysed using univariate and multivariate logistic regression. KSA inpatient mortality was 30%. Univariate and multivariate logistic regression analysis suggested that COVID-19-related mortality was significantly higher in the northern and western BUs and significantly lower in the southern and eastern BUs than in the central BU. On controlling for other variables, adjusted odds ratios (AORs) for essential COVID-19 mortality predictors during admission, using the central BU as a reference, were as 9.90 [95% CI, 4.53-21.61] and 1.55 [95% CI, 1.04-2.13] times higher in the northern and western BUs, respectively, and 0.60 [95% CI, 0.36-0.99] and 0.23 [95% CI, 0.14-0.038] times lower in the southern and eastern BUs, respectively.ConclusionThe five BUs differed in COVID-19 mortality rates after adjusting for patient and disease characteristics, with the differences consistent with those in the regions comprising the BUs. These outcome differences apparently relate to differences in healthcare resources and quality.

Highlights

On 5 January 2021, the global mortality rates of the 2019 coronavirus disease (COVID-19) pandemic, caused by SARS-CoV-2, were approximately 2.2%, based on 1,864.933 deaths among 86,298,213 cases [1,2,3]
Univariate and multivariate logistic regression analysis suggested that COVID-19-related mortality was significantly higher in the northern and western business units (BUs) and significantly lower in the southern and eastern BUs than in the central BU
On controlling for other variables, adjusted odds ratios (AORs) for essential COVID-19 mortality predictors during admission, using the central BU as a reference, were as 9.90 [95% CI, 4.53-21.61] and 1.55 [95% CI, 1.04-2.13] times higher in the northern and western BUs, respectively, and 0.60 [95% CI, 0.36-0.99] and 0.23 [95% CI, 0.14-0.038] times lower in the southern and eastern BUs, respectively

Summary

Introduction

On 5 January 2021, the global mortality rates of the 2019 coronavirus disease (COVID-19) pandemic, caused by SARS-CoV-2, were approximately 2.2%, based on 1,864.933 deaths among 86,298,213 cases [1,2,3]. In the Kingdom of Saudi Arabia (KSA), as of 6 January 2021, the national average mortality rate for all cases, both inpatient and outpatient, was 1.7%, based on 6,272 deaths among 363,377 confirmed cases [4]. Variations in COVID-19 mortality rates between different KSA regions have been reported. Several international studies have identified risk factors associated with higher mortality from confirmed COVID-19 infection, including increasing age and pre-existing chronic conditions, such as Type 2 diabetes mellitus (DM2), cardiovascular disease, and obesity. Studies including all fifty states in the United States have shown higher mortality rates in states with a higher average age [8]. This study aimed to assess regional COVID-19 mortality rates and compare the five proposed business units (BUs)

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