Filling the gaps in the characterization of the clinical management of COVID-19: 30-day hospital admission and fatality rates in a cohort of 118 150 cases diagnosed in outpatient settings in Spain

• DOI: 10.1093/ije/dyaa190
• Publication Date: 2020-09-03T11:10:39Z
• Authors: Daniel Prieto-Alh...; Elisabet Balló; Ermengol Coma; Núria Mora; María Aragón; Albert Prats-Uribe; Francesc Fina; Mència Benítez; Carolina Guiriguet; Mireia Fàbregas; Manuel Medina-Per...; Talita Duarte-Salles
• Keywords: Adult; Male; Time Factors; Adolescent; Epidemiology; Cohort Studies; Young Adult; 03 medical and health sciences; Patient Admission; 0302 clinical medicine; Ambulatory Care; Humans; Aged; Aged, 80 and over; SARS-CoV-2; COVID-19; General Medicine; Middle Aged; 3. Good health; Spain; COVID-19 Nucleic Acid Testing; Population Surveillance; Female; Covid-19

Abstract

Background Currently, there is a missing link in the natural history of COVID-19, from first (usually milder) symptoms to hospitalization and/or death. To fill in this gap, we characterized COVID-19 patients at the time at which they were diagnosed in outpatient settings and estimated 30-day hospital admission and fatality rates.

Methods This was a population-based cohort study.

Data were obtained from Information System for Research in Primary Care (SIDIAP)—a primary-care records database covering >6 million people (>80% of the population of Catalonia), linked to COVID-19 reverse transcriptase polymerase chain reaction (RT-PCR) tests and hospital emergency, inpatient and mortality registers. We included all patients in the database who were ≥15 years old and diagnosed with COVID-19 in outpatient settings between 15 March and 24 April 2020 (10 April for outcome studies). Baseline characteristics included socio-demographics, co-morbidity and previous drug use at the time of diagnosis, and polymerase chain reaction (PCR) testing and results.

Study outcomes included 30-day hospitalization for COVID-19 and all-cause fatality.

Results We identified 118 150 and 95 467 COVID-19 patients for characterization and outcome studies, respectively. Most were women (58.7%) and young-to-middle-aged (e.g. 21.1% were 45–54 years old). Of the 44 575 who were tested with PCR, 32 723 (73.4%) tested positive. In the month after diagnosis, 14.8% (14.6–15.0) were hospitalized, with a greater proportion of men and older people, peaking at age 75–84 years. Thirty-day fatality was 3.5% (95% confidence interval: 3.4% to 3.6%), higher in men, increasing with age and highest in those residing in nursing homes [24.5% (23.4% to 25.6%)].

Conclusion COVID-19 infections were widespread in the community, including all age–sex strata. However, severe forms of the disease clustered in older men and nursing-home residents. Although initially managed in outpatient settings, 15% of cases required hospitalization and 4% died within a month of first symptoms. These data are instrumental for designing deconfinement strategies and will inform healthcare planning and hospital-bed allocation in current and future COVID-19 outbreaks.