Non-COVID hospital deaths rose over the first two years of the pandemic and varied by urban or rural settings, according to a study published in JAMA Network Open.
Researchers “compared the odds of in-hospital death among adults with non-COVID-related heart attack, hip fracture, gastrointestinal bleeding, pneumonia, sepsis, and stroke at 3,813 US hospitals from March 2020 to December 2021 compared with January 2017 to March 2020.”
The team found that “the chances of in-hospital death among sepsis patients rose 27% from before to during the pandemic at urban hospitals…and 35% at rural hospitals.” Pneumonia patients also saw a rise in in-hospital death over the same period. Additionally, risk of death among heart attack patients increased in urban hospitals, among hip fracture patients in rural hospitals, and among gastrointestinal bleeding patients at urban locations.
The authors of the study largely attribute these rising death rates to “delayed care, resource constraints, and emergency department crowding by COVID-19 patients.” They also wrote that “mobilizing strategies tailored to the different needs of urban and rural hospitals may help reduce the likelihood of excess deaths during future public health crises.”
A commentary in the same journal written by John Westfall, MD, MPH, of the DARTNet Institute in Colorado, cautioned that the analysis of rural hospitals may be incomplete “because the researchers didn’t account for patient transfers from rural hospitals, which are a common treatment decision and can result in bias against these hospitals if not considered.” He also said that data show that “patients transferred from rural hospitals tend to be younger and healthier than those who remain.”
Specifically addressing the higher rate of death from sepsis in rural hospitals, Westfall theorizes that “rural hospitals may have had more constrained resources and a much smaller workforce without the capacity to expand as quickly as urban hospitals.”
CIDRAP’s website has the release.
