Adjusted Case Fatality Rate Research Articles

Sepsis in Latvia-Incidence, Outcomes, and Healthcare Utilization: A Retrospective, Observational Study.

This study explores the incidence, outcomes, and healthcare resource utilization concerning sepsis in Latvia's adult population. Using a merged database from the National Health Service and the Latvian Centre for Disease Prevention and Control, sepsis-related hospitalizations were analyzed from 2015-2020. Findings revealed a 53.1% surge in sepsis cases from 2015-2018 with subsequent stabilization. This spike was more prominent among elderly patients. The age/sex adjusted case fatality rate rose from 34.7% in 2015 to 40.5% in 2020. Of the 7764 sepsis survivors, the one-year mortality rate was 12% compared to 2.2% in a reference group of 20,686 patients with infections but no further signs of sepsis. Sepsis survivors also incurred higher healthcare costs, driven by longer rehospitalizations and increased pharmaceutical needs, though they accessed outpatient services less frequently than the reference group. These findings underscore the growing detection of sepsis in Latvia, with survivors facing poorer outcomes and suggesting the need for enhanced post-sepsis outpatient care.

Epidemiology of hospitalized patients with COVID-19 in a tertiary care hospital.

COVID-19, caused by the betacoronavirus SARS-CoV-2, has overwhelmed the world's health systems. To describe the epidemiological characteristics of patients treated in a tertiary care hospital. A retrospective cohort study of patients diagnosed with or suspected of having COVID-19 from March 23 to July 31, 2020 was conducted. 4,401 patients were hospitalized at Central Military Hospital, out of which 35 % were beneficiaries, 26 % civilians, 28 % active military personnel, and only 11 %, retired military personnel. Male gender predominated, both in hospitalized patients and in those who died, as well as the O+ group and absence of comorbidities; among the observed comorbidities, the main ones were overweight and diabetes. Hospitalized patients' median age was 49 years, while median age of those who died was 62 years; women older than 51 years had a higher risk of dying. Adjusted case fatality rate was 18.5 %; 50 % died within the first six days. In this study, the epidemiological characteristics and main comorbidities in Mexican patients with SARS-CoV-2 infection were identified.

A deconvolution approach to modelling surges in COVID-19 cases and deaths

The COVID-19 pandemic continues to emphasize the importance of epidemiological modelling in guiding timely and systematic responses to public health threats. Nonetheless, the predictive qualities of these models remain limited by their underlying assumptions of the factors and determinants shaping national and regional disease landscapes. Here, we introduce epidemiological feature detection, a novel latent variable mixture modelling approach to extracting and parameterizing distinct and localized features of real-world trends in daily COVID-19 cases and deaths. In this approach, we combine methods of peak deconvolution that are commonly used in spectroscopy with the susceptible-infected-recovered-deceased model of disease transmission. We analyze the second wave of the COVID-19 pandemic in Israel, Canada, and Germany and find that the lag time between reported cases and deaths, which we term case-death latency, is closely correlated with adjusted case fatality rates across these countries. Our findings illustrate the spatiotemporal variability of both these disease metrics within and between different disease landscapes. They also highlight the complex relationship between case-death latency, adjusted case fatality rate, and COVID-19 management across various degrees of decentralized governments and administrative structures, which provides a retrospective framework for responding to future pandemics and disease outbreaks.

Estimating the infection burden of COVID-19 in Malaysia.

Malaysia has reported 2.75 million cases and 31,485 deaths as of 30 December 2021. Underestimation remains an issue due to the underdiagnosis of mild and asymptomatic cases. We aimed to estimate the burden of COVID-19 cases in Malaysia based on an adjusted case fatality rate (aCFR). Data on reported cases and mortalities were collated from the Ministry of Health official GitHub between 1 March 2020 and 30 December 2021. We estimated the total and age-stratified monthly incidence rates, mortality rates, and aCFR. Estimated new infections were inferred from the age-stratified aCFR. The total estimated infections between 1 March 2020 and 30 December 2021 was 9,955,000-cases (95% CI: 6,626,000-18,985,000). The proportion of COVID-19 infections in ages 0-11, 12-17, 18-50, 51-65, and above 65 years were 19.9% (n = 1,982,000), 2.4% (n = 236,000), 66.1% (n = 6,577,000), 9.1% (n = 901,000), 2.6% (n = 256,000), respectively. Approximately 32.8% of the total population in Malaysia was estimated to have been infected with COVID-19 by the end of December 2021. These estimations highlight a more accurate infection burden in Malaysia. It provides the first national-level prevalence estimates in Malaysia that adjusted for underdiagnosis. Naturally acquired community immunity has increased, but approximately 68.1% of the population remains susceptible. Population estimates of the infection burden are critical to determine the need for booster doses and calibration of public health measures.

COVID-19 cases and deaths after implementation of prevention strategies, Saudi Arabia.

To prevent the spread of coronavirus disease 2019 (COVID-19), the Saudi Arabian Government introduced a number of measures in different phases (e.g. social distancing, curfew and lockdown). This study describes the incidence of COVID-19 in Saudi Arabia during different phases of prevention strategies and assesses their effects on controlling the spread of the disease. This cross-sectional study used COVID-19 data for 2 March-5 July 2020 from the Ministry of Health website. The period was divided into five phases based on prevention strategies implemented to control the infection. The incidence, point prevalence, case fatality, overall mortality rate and recovery rates for COVID-19 infection were assessed at the national, regional and city levels. At the end of phase 5 on 5 July 2020, the nationwide incidence of COVID-19 was 11%, total recovery rate 70%, case fatality rate 0.9% and adjusted case fatality rate 1.4% (adjusted for time lag for mortality). The COVID-19 point prevalence increased from 2.1/100 000 population in phase 1 to 178.2/100 000 population in phase 5. A high recovery rate (68.7%) was observed in phase 4 accompanied with lower overall mortality and incidence in phase 5. The eastern region of Saudi Arabia had the highest point prevalence of COVID-19 infection (450.5 per 100 000 population), while Jeddah and Mecca had the highest overall mortality. The health system of Saudi Arabia efficiently used lockdown and curfew periods to prepare for management of confirmed cases of COVID-19, reflected by the decreased incidence and mortality rates in phase 5.

Epidemiología de los pacientes hospitalizados con COVID-19 en un hospital de tercer nivel

Introduction: COVID-19, caused by the betacoronavirus SARS-CoV-2, has overwhelmed the world’s health systems. Objective: To describe the epidemiological characteristics of patients treated in a tertiary care hospital. Methods: A retrospective cohort study of patients diagnosed with or suspected of having COVID-19 from March 23 to July 31, 2020 was conducted. Results: 4,401 patients were hospitalized at the Central Military Hospital, out of which 35 % were beneficiaries, 26 % civilians, 28 % active military, and only 11%, retired military. Male gender predominated, both in hospitalized patients and in those who died, as well as the O+ group and absence of comorbidities; among the observed comorbidities, the main ones were overweight and diabetes. Hospitalized patients’ median age was 49 years, while median age of those who died was 62 years; women older than 51 years had a higher risk of dying. Adjusted case fatality rate was 18.5 %; 50 % died within the first six days. Conclusions: In this study, the epidemiological characteristics and main comorbidities in Mexican patients with SARS-CoV-2 infection were identified.

COVID-19 case fatality risk by age and gender in a high testing setting in Latin America: Chile, March\u2013August 2020

BackgroundEarly severity estimates of coronavirus disease 2019 (COVID-19) are critically needed to assess the potential impact of the ongoing pandemic in different demographic groups. Here we estimate the real-time delay-adjusted case fatality rate across nine age groups by gender in Chile, the country with the highest testing rate for COVID-19 in Latin America.MethodsWe used a publicly available real-time daily series of age-stratified COVID-19 cases and deaths reported by the Ministry of Health in Chile from the beginning of the epidemic in March through August 31, 2020. We used a robust likelihood function and a delay distribution to estimate real-time delay-adjusted case-fatality risk and estimate model parameters using a Monte Carlo Markov Chain in a Bayesian framework.ResultsAs of August 31, 2020, our estimates of the time-delay adjusted case fatality rate (CFR) for men and women are 4.16% [95% Credible Interval (CrI): 4.09–4.24%] and 3.26% (95% CrI: 3.19–3.34%), respectively, while the overall estimate is 3.72% (95% CrI: 3.67–3.78%). Seniors aged 80 years and over have an adjusted CFR of 56.82% (95% CrI: 55.25–58.34%) for men and 41.10% (95% CrI: 40.02–42.26%) for women. Results showed a peak in estimated CFR during the June peak of the epidemic. The peak possibly reflects insufficient laboratory capacity, as illustrated by high test positivity rates (33% positive 7-day average nationally in June), which may have resulted in lower reporting rates.ConclusionsSeverity estimates from COVID-19 in Chile suggest that male seniors, especially among those aged ≥ 70 years, are being disproportionately affected by the pandemic, a finding consistent with other regions. The ongoing pandemic is imposing a high death toll in South America, and Chile has one of the highest reported mortality rates globally thus far. These real-time estimates may help inform public health officials' decisions in the region and underscore the need to implement more effective measures to ameliorate fatality.

Demystifying the varying case fatality rates (CFR) of COVID-19 in India: Lessons learned and future directions.

At the end of the second week of June 2020, the SARS-CoV-2 responsible for COVID-19 infected above 7.5 million people and killed over 400,000 worldwide. Estimation of case fatality rate (CFR) and determining the associated factors are critical for developing targeted interventions. The state-level adjusted case fatality rate (aCFR) was estimated by dividing the cumulative number of deaths on a given day by the cumulative number confirmed cases 8 days before, which is the average time-lag between diagnosis and death. We conducted fractional regression analysis to determine the predictors of aCFR. As of 13 June 2020, India reported 225 COVID-19 cases per million population (95% CI:224-226); 6.48 deaths per million population (95% CI:6.34-6.61) and an aCFR of 3.88% (95% CI:3.81-3.97) with wide variation between states. High proportion of urban population and population above 60 years were significantly associated with increased aCFR (p=0.08, p=0.05), whereas, high literacy rate and high proportion of women were associated with reduced aCFR (p<0.001, p=0.03). The higher number of cases per million population (p=0.001), prevalence of diabetes and hypertension (p=0.012), cardiovascular diseases (p=0.05), and any cancer (p<0.001) were significantly associated with increased aCFR. The performance of state health systems and proportion of public health expenditure were not associated with aCFR. Socio-demographic factors and burden of non-communicable diseases (NCDs) were found to be the predictors of aCFR. Focused strategies that would ensure early identification, testing and effective targeting of non-literate, elderly, urban population and people with comorbidities are critical to control the pandemic and fatalities.

Mortality among the early cases of COVID-19 and its association with key comorbidities in a large state in South India

Background: The mortality associated with the pandemic COVID-19 is a subject of intense scrutiny as COVID-19 can cause severe disease leading to hospitalization in ICU and potentially death, especially in the elderly with comorbidities. A statistical analysis is carried out to study the impact of age, gender and comorbidities on deaths among early one lakh infected population of Karnataka, a large state in south India.Methods: Daily case fatality rate and adjusted case fatality rate (CFR) (adjusted to median death time) are estimated. The impacts of age, gender and comorbidities on mortality outcomes of COVID patients are studied.Results: The daily CFR on 27th July for Karnataka is estimated from the dataset to be 1.93%. However, the adjusted CFR based on the median number of days from diagnosis to death was found to be 2.15% (95% confidence interval 2%-2.3%) on that day. The deaths among male patients outnumber those in females. As far as age of the patients is concerned, more than 50% of the deaths occurred in the age group 50-60 and 60-70 years. Majority of deaths reported in the state were associated with at least one of the comorbidity. Diabetes mellitus and hypertension were the most significant comorbidities.Conclusions: The daily adjusted CFR for the study region is found to be lower than the CFR of the whole nation. Also the age, gender and comorbidities were found to be associated with the deaths as opposed to the infection alone. It was also deduced that, patients with a history of diabetes or hypertension or ischemic heart disease or a combination of any of these were most likely to experience severe outcomes of the infection.

Effectiveness of Containment Measures to Control the Spread of COVID-19 in North Africa.

Since the first case of severe acute respiratory syndrome coronavirus-2, identified in December 2019, in Wuhan in China, the number of cases rapidly increased into a pandemic. Governments worldwide have adopted different strategies and measures to interrupt the transmission of coronavirus disease 2019 (COVID-19). The main objective was to report and evaluate the effectiveness of the adopted measures in North Africa countries. In these countries, the effective reproductive number R(t), the naïve case fatality rate, and the adjusted case fatality rate were estimated and compared on different dates. The obtained results show that the early strict application of containment measures and confinement could help contain the spread of the epidemic and maintain the number of deaths low. These measures might be useful for other countries that are experiencing the start of local COVID-19 outbreaks. They could also serve to halt the spread of new epidemics or pandemics.

Global dengue death before and after the new World Health Organization 2009 case classification: A systematic review and meta-regression analysis

BackgroundSince the introduction of 2009 WHO dengue case classification, no literature was found regarding its effect on dengue death. This study was to evaluate the effect of 2009 WHO dengue case classification towards dengue case fatality rate. MethodsVarious databases were used to search relevant articles since 1995. Studies included were cohort and cross-sectional studies, all patients with dengue infection and must report the number of death or case fatality rate. The Joanna Briggs Institute appraisal checklist was used to evaluate the risk of bias of the full-texts. The studies were grouped according to the classification adopted: WHO 1997 and WHO 2009. Meta-regression was employed using a logistic transformation (log-odds) of the case fatality rate. The result of the meta-regression was the adjusted case fatality rate and odds ratio on the explanatory variables. ResultsA total of 77 studies were included in the meta-regression analysis. The case fatality rate for all studies combined was 1.14% with 95% confidence interval (CI) of 0.82–1.58%. The combined (unadjusted) case fatality rate for 69 studies which adopted WHO 1997 dengue case classification was 1.09% with 95% CI of 0.77–1.55%; and for eight studies with WHO 2009 was 1.62% with 95% CI of 0.64–4.02%. The unadjusted and adjusted odds ratio of case fatality using WHO 2009 dengue case classification was 1.49 (95% CI: 0.52, 4.24) and 0.83 (95% CI: 0.26, 2.63) respectively, compared to WHO 1997 dengue case classification. There was an apparent increase in trend of case fatality rate from the year 1992–2016. Neither was statistically significant. ConclusionsThe WHO 2009 dengue case classification might have no effect towards the case fatality rate although the adjusted results indicated a lower case fatality rate. Future studies are required for an update in the meta-regression analysis to confirm the findings.

Mixed-location cerebral hemorrhage/microbleeds: Underlying microangiopathy and recurrence risk.

To assess the predominant type of cerebral small vessel disease (SVD) and recurrence risk in patients who present with a combination of lobar and deep intracerebral hemorrhage (ICH)/microbleed locations (mixed ICH). Of 391 consecutive patients with primary ICH enrolled in a prospective registry, 75 (19%) had mixed ICH. Their demographics, clinical/laboratory features, and SVD neuroimaging markers were compared to those of 191 patients with probable cerebral amyloid angiopathy (CAA-ICH) and 125 with hypertensive strictly deep microbleeds and ICH (HTN-ICH). ICH recurrence and case fatality were also analyzed. Patients with mixed ICH showed a higher burden of vascular risk factors reflected by a higher rate of left ventricular hypertrophy, higher creatinine values, and more lacunes and severe basal ganglia (BG) enlarged perivascular spaces (EPVS) than patients with CAA-ICH (all p < 0.05). In multivariable models mixed ICH diagnosis was associated with higher creatinine levels (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.2-5.0, p = 0.010), more lacunes (OR 3.4, 95% CI 1.7-6.8), and more severe BG EPVS (OR 5.8, 95% CI 1.7-19.7) than patients with CAA-ICH. Conversely, when patients with mixed ICH were compared to patients with HTN-ICH, they were independently associated with older age (OR 1.03, 95% CI 1.02-1.1), more lacunes (OR 2.4, 95% CI 1.1-5.3), and higher microbleed count (OR 1.6, 95% CI 1.3-2.0). Among 90-day survivors, adjusted case fatality rates were similar for all 3 categories. Annual risk of ICH recurrence was 5.1% for mixed ICH, higher than for HTN-ICH but lower than for CAA-ICH (1.6% and 10.4%, respectively). Mixed ICH, commonly seen on MRI obtained during etiologic workup, appears to be driven mostly by vascular risk factors similar to HTN-ICH but demonstrates more severe parenchymal damage and higher ICH recurrence risk.

Incidence and case-fatality from spontaneous intracerebral hemorrhage in a southern region of Portugal

BackgroundThere is scarce information on incidence and case fatality of spontaneous intracerebral hemorrhage (SICH) in certain regions of the world, including in Europe. There is no community-based data on SICH in Southern Portugal. AimTo determine the incidence and early case-fatality from SICH in Algarve, the southernmost region of Portugal. MethodsThe recommended criteria for stroke incidence studies was used to identify cases of incident first-ever SICH from January 1st to December 31st 2015 in a subregion with 280,081 inhabitants. Crude incidence rates per age group and gender; standardized rates to the European population; and age adjusted case fatality rates were calculated. ResultsEighty-two first-ever cases of SICH (64.6% men) occurred. The mean age was 72.3 years (SD±12.1); women were 3 years older than men on average and had more frequently lobar SICH. The crude annual incidence rate was 29.2/100,000 (95% CI 23.4- 38.6; p<0.001); higher in men (39.7/100,000) than women (19.8/100,000). The standardized to the European population incidence was 15.1/100,000 (95% CI 3.6–18.9; p<0.05); 26.9 and 10.9/100,000 for men and women respectively. The 30-day case-fatality was 40 % (95% CI 29–51) and increased steeply with age ConclusionThe incidence of SICH in Southern Portugal was high, but within the figures found in some parts of Europe. However, a marked predominance of males was found and the case-fatality rate was amongst the highest reported in western countries.

Consultant input in acute medical admissions and patient outcomes in hospitals in England: a multivariate analysis.

Recent recommendations for physicians in the UK outline key aspects of care that should improve patient outcomes and experience in acute hospital care. Included in these recommendations are Consultant patterns of work to improve timeliness of clinical review and improve continuity of care. This study used a contemporaneous validated survey compared with clinical outcomes derived from Hospital Episode Statistics, between April 2009 and March 2010 from 91 acute hospital sites in England to evaluate systems of consultant cover for acute medical admissions. Clinical outcomes studied included adjusted case fatality rates (aCFR), including the ratio of weekend to weekday mortality, length of stay and readmission rates. Hospitals that had an admitting Consultant presence within the Acute Medicine Unit (AMU, or equivalent) for a minimum of 4 hours per day (65% of study group) had a lower aCFR compared with hospitals that had Consultant presence for less than 4 hours per day (p<0.01) and also had a lower 28 day re-admission rate (p<0.01). An ‘all inclusive’ pattern of Consultant working, incorporating all the guideline recommendations and which included the minimum Consultant presence of 4 hours per day (29%) was associated with reduced excess weekend mortality (p<0.05). Hospitals with >40 acute medical admissions per day had a lower aCFR compared to hospitals with fewer than 40 admissions per day (p<0.03) and had a lower 7 day re-admission rate (p<0.02). This study is the first large study to explore the potential relationships between systems of providing acute medical care and clinical outcomes. The results show an association between well-designed systems of Consultant working practices, which promote increased patient contact, and improved patient outcomes in the acute hospital setting.

Stroke Incidence and Survival Among Middle-Aged Adults

Although stroke mortality rates in the United States are well documented, assessment of incidence rates and case fatality are less well studied. A cohort of 15 792 men and women aged 45 to 64 years from a population sample of households in 4 US communities was followed from 1987 to 1995, an average of 7. 2 years. Incident strokes were identified through annual phone contacts and hospital record searching and were then validated. Of the 267 incident definite or probable strokes, 83% (n=221) were categorized as ischemic strokes, 10% (n=27) were intracerebral hemorrhages, and 7% (n=19) were subarachnoid hemorrhages. The age-adjusted incidence rate (per 1000 person-years) of total strokes was highest among black men (4.44), followed by black women (3.10), white men (1.78), and white women (1.24). The black versus white age-adjusted rate ratio (RR) for ischemic stroke was 2.41 (95% CI, 1.85 to 3.15), which was attenuated to 1.38 (95% CI, 1.01 to 1.89) after adjustment for baseline hypertension, diabetes, education level, smoking status, and prevalent coronary heart disease. There was a tendency for the adjusted case fatality rates to be higher among blacks and men, although none of the case fatality comparisons across sex or race was statistically significant. After accounting for established baseline risk factors, blacks still had a 38% greater risk of incident ischemic stroke compared with whites. Identification of new individual and community-level risk factors accounting for the elevated incidence of stroke requires further investigation and incorporation into intervention planning.

Outbreak of cholera in Ibadan, Nigeria.

The changing epidemiology of cholera in Ibadan, Nigeria, has become a public health challenge, and outbreaks of the disease have been occurring with increasing frequency since the first outbreak in modern times in 1970. In this outbreak, 1384 persons were seen, diagnosed and treated for the disease at the cholera unit, Ibadan from January to December 1996. The outbreak lasted for a whole year. No child under one year was seen. The age adjusted case fatality rate was 5.3%. Diarrhoea and vomiting were the most common combination of symptoms present in 97.3% of all cases, followed by diarrhoea, vomiting and dehydration (84.3%). The median number of days spent on admission was only 2 days. Cholera cases were clustered within the densely populated and poorly planned areas of the city. Though significantly more cases were seen during the rainy season than during the dry season (p<0.01), the deaths were not seasonally related (p = 0.67). Contamination of otherwise potable sources of water, late presentation to the cholera treatment unit and low levels of knowledge about diseases need to be addressed in order to effectively control this disease in the community. Progress should also be made towards developing a suitable vaccine for the control of this internationally important public health disease so that the responsibility of its control is not left entirely to individuals and communities, particularly in developing countries.