Risk factors for in-hospital related COVID-19 deaths in Mpumalanga province - June 2020 – June 2022

Abstract

Background: South Africa was among the African countries heavily impacted by COVID-19, reporting significant case numbers and deaths. This study aimed to assess the demographic and clinical characteristics of hospitalized COVID-19 patients in Mpumalanga Province. We also analysed the factors associated with COVID-19 deaths in Mpumalanga Province. Methods: We performed a retrospective cohort study using surveillance data of COVID-19 hospitalisations from Mpumalanga Province between June 2020 and June 2022, extracted from the DATCOV Surveillance System. Clinical severity was defined by the need for oxygen therapy, ventilation, or admission to High Care or Intensive Care Units. Kaplan-Meier survival analysis and Cox regression were used to estimate survival probabilities and identify risk factors for in-hospital mortality. Adjusted Hazard Ratios (aHR) with 95% Confidence Intervals (CI) were reported. Results: Of the 20,960 hospitalized COVID-19 patients, 4,467 (21.6%) died. The majority were female (56%), and females accounted for 51.6% of the deaths. The median time to death was 25 days (IQR: 11–66). The overall mortality rate for this cohort was 21.6%. After adjusting for age, sex, comorbidities, and clinical severity, factors significantly associated with increased risk of in-hospital mortality included admission in Ehlanzeni [aHR 1.10; 95% CI 1.01–1.19] and Gert Sibande [aHR 1.20; 95% CI 1.10–1.30] districts, and during the second wave [aHR 1.09; 95% CI 1.02– 1.18]. Protective factors included admission during the fourth wave [aHR 0.80; 95% CI 0.70–0.92], clinical severity [aHR 0.74; 95% CI 0.69–0.80], and private healthcare admission, which reduced mortality risk by 87%. Conclusion: In-hospital mortality was significantly higher for patients admitted to hospitals located in Ehlanzeni and Gert Sibande districts, and during the second wave of the pandemic. Admission during the fourth wave, in private hospitals, and in clinically severe cases were associated with decreased mortality risk. Strenghtening the province’s healthcare system, such as early identification of vulnerable groups to target vaccination campaigns, and improving healthcare infrastructure and access to underserved districts, low-density areas and in public hospitals could reduce in- hospital mortality in similar future pandemics.