Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 153 No. 5 (2023)

Burden of disease in patients hospitalised with COVID-19 during the first and second pandemic wave in Switzerland: a nationwide cohort study

  • Claudia Gregoriano
  • Kris Rafaisz
  • Philipp Schuetz
  • Beat Mueller
  • Christoph A. Fux
  • Anna Conen
  • Alexander Kutz
DOI
https://doi.org/10.57187/smw.2023.40068
Cite this as:
Swiss Med Wkly. 2023;153:40068
Published
03.05.2023

Summary

AIM OF THE STUDY: The first and second waves of the COVID-19 pandemic led to a tremendous burden of disease and influenced several policy directives, prevention and treatment strategies as well as lifestyle and social behaviours. We aimed to describe trends of hospitalisations with COVID-19 and hospital-associated outcomes in these patients during the first two pandemic waves in Switzerland.

METHODS: In this nationwide retrospective cohort study, we used in-hospital claims data of patients hospitalised with COVID-19 in Switzerland between January 1st and December 31st, 2020. First, stratified by wave (first wave: January to May, second wave: June to December), we estimated incidence rates (IR) and rate differences (RD) per 10,000 person-years of COVID-19-related hospitalisations across different age groups (0–9, 10–19, 20–49, 50–69, and ≥70 years). IR was calculated by counting the number of COVID-19 hospitalisations for each patient age stratum paired with the number of persons living in Switzerland during the specific wave period. Second, adjusted odds ratios (aOR) of outcomes among COVID-19 hospitalisations were calculated to assess the association between COVID-19 wave and outcomes, adjusted for potential confounders.

RESULTS: Of 36,517 hospitalisations with COVID-19, 8,862 (24.3%) were identified during the first and 27,655 (75.7%) during the second wave. IR for hospitalisations with COVID-19 was highest during the second wave and among patients above 50 years (50–69 years: first wave: 31.49 per 10,000 person-years; second wave: 62.81 per 10,000 person-years; RD 31.32 [95% confidence interval [CI]: 29.56 to 33.08] per 10,000 person-years; IRR 1.99 [95% CI: 1.91 to 2.08]; ≥70 years: first wave: 88.59 per 10,000 person-years; second wave: 228.41 per 10,000 person-years; RD 139.83 [95% CI: 135.42 to 144.23] per 10,000 person-years; IRR 2.58 [95% CI: 2.49 to 2.67]). While there was no difference in hospital readmission, when compared with the first wave, patients hospitalised during the second wave had a lower probability of death (aOR 0.88 [95% CI: 0.81 to 0.95], ARDS (aOR 0.56 [95% CI: 0.51 to 0.61]), ICU admission (aOR 0.66 [95% CI: 0.61 to 0.70]), and need for ECMO (aOR 0.60 [95% CI: 0.38 to 0.92]). LOS was –16.1 % (95% CI: –17.8 to –14.2) shorter during the second wave.

CONCLUSION: In this nationwide cohort study, rates of hospitalisations with COVID-19 were highest among adults older than 50 years and during the second wave. Except for hospital readmission, the likelihood of adverse outcomes was lower during the second pandemic wave, which may be explained by advances in the understanding of the disease and improved treatment options.

References

  1. Verelst F , Kuylen E , Beutels P . Indications for healthcare surge capacity in European countries facing an exponential increase in coronavirus disease (COVID-19) cases, March 2020. Euro Surveill. 2020 Apr;25(13):2000323. https://doi.org/10.2807/1560-7917.ES.2020.25.13.2000323 DOI: https://doi.org/10.2807/1560-7917.ES.2020.25.13.2000323
  2. Winkelmann J , Webb E , Williams GA , Hernández-Quevedo C , Maier CB , Panteli D . European countries’ responses in ensuring sufficient physical infrastructure and workforce capacity during the first COVID-19 wave. Health Policy. 2022 May;126(5):362–72. https://doi.org/10.1016/j.healthpol.2021.06.015 DOI: https://doi.org/10.1016/j.healthpol.2021.06.015
  3. Webb E , Hernández-Quevedo C , Williams G , Scarpetti G , Reed S , Panteli D . Providing health services effectively during the first wave of COVID-19: A cross-country comparison on planning services, managing cases, and maintaining essential services. Health Policy. 2022 May;126(5):382–90. https://doi.org/10.1016/j.healthpol.2021.04.016 DOI: https://doi.org/10.1016/j.healthpol.2021.04.016
  4. Zimmermann BM , Fiske A , McLennan S , Sierawska A , Hangel N , Buyx A . Motivations and Limits for COVID-19 Policy Compliance in Germany and Switzerland. Int J Health Policy Manag. 2021 Apr;11(8):1342–53. https://doi.org/10.34172/ijhpm.2021.30 DOI: https://doi.org/10.34172/ijhpm.2021.30
  5. Salathé M , Althaus CL , Neher R , Stringhini S , Hodcroft E , Fellay J , et al. COVID-19 epidemic in Switzerland: on the importance of testing, contact tracing and isolation. Swiss Med Wkly. 2020 Mar;150:w20225. https://doi.org/10.4414/smw.2020.20225 DOI: https://doi.org/10.4414/smw.2020.20225
  6. Flaxman S , Mishra S , Gandy A , Unwin HJ , Mellan TA , Coupland H , et al.; Imperial College COVID-19 Response Team . Estimating the effects of non-pharmaceutical interventions on COVID-19 in Europe. Nature. 2020 Aug;584(7820):257–61. https://doi.org/10.1038/s41586-020-2405-7 DOI: https://doi.org/10.1038/s41586-020-2405-7
  7. Cao B , Wang Y , Wen D , Liu W , Wang J , Fan G , et al. A Trial of Lopinavir-Ritonavir in Adults Hospitalized with Severe Covid-19. N Engl J Med. 2020 May;382(19):1787–99. https://doi.org/10.1056/NEJMoa2001282 DOI: https://doi.org/10.1056/NEJMc2008043
  8. Boulware DR , Pullen MF , Bangdiwala AS , Pastick KA , Lofgren SM , Okafor EC , et al. A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19. N Engl J Med. 2020 Aug;383(6):517–25. https://doi.org/10.1056/NEJMoa2016638 DOI: https://doi.org/10.1056/NEJMoa2016638
  9. Wang Y , Zhang D , Du G , Du R , Zhao J , Jin Y , et al. Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet. 2020 May;395(10236):1569–78. https://doi.org/10.1016/S0140-6736(20)31022-9 DOI: https://doi.org/10.1016/S0140-6736(20)31022-9
  10. Horby P , Lim WS , Emberson JR , Mafham M , Bell JL , Linsell L , et al.; RECOVERY Collaborative Group . Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med. 2021 Feb;384(8):693–704. https://doi.org/10.1056/NEJMoa2021436 DOI: https://doi.org/10.1056/NEJMoa2021436
  11. Biswas M , Rahaman S , Biswas TK , Haque Z , Ibrahim B . Association of Sex, Age, and Comorbidities with Mortality in COVID-19 Patients: A Systematic Review and Meta-Analysis. Intervirology. 2020 Dec;1–12. DOI: https://doi.org/10.1159/000512592
  12. Bundesamt für Statistik . Auswirkungen der Covid-19-Pandemie auf die Gesundheitsversorgung im Jahr 2020. 2021.
  13. von Elm E , Altman DG , Egger M , Pocock SJ , Gøtzsche PC , Vandenbroucke JP ; STROBE Initiative . Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007 Oct;335(7624):806–8. https://doi.org/10.1136/bmj.39335.541782.AD DOI: https://doi.org/10.1136/bmj.39335.541782.AD
  14. Elixhauser A , Steiner C , Harris DR , Coffey RM . Comorbidity measures for use with administrative data. Med Care. 1998 Jan;36(1):8–27. https://doi.org/10.1097/00005650-199801000-00004 DOI: https://doi.org/10.1097/00005650-199801000-00004
  15. Gilbert T , Neuburger J , Kraindler J , Keeble E , Smith P , Ariti C , et al. Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study. Lancet. 2018 May;391(10132):1775–82. https://doi.org/10.1016/S0140-6736(18)30668-8 DOI: https://doi.org/10.1016/S0140-6736(18)30668-8
  16. Bundesamt für Gesundheit (BAG) . Coronavirus: Monitoring [Available from: https://www.bag.admin.ch/bag/de/home/krankheiten/ausbrueche-epidemien-pandemien/aktuelle-ausbrueche-epidemien/novel-cov/situation-schweiz-und-international/monitoring.html#19385953 ], last access: 23.12.2022.
  17. Bundesamt für Statistik . Permanent resident population by age, sex and category of citizenship, 2010-2021 2010-2021 [Available from: https://www.bfs.admin.ch/bfs/de/home/statistiken/bevoelkerung/stand-entwicklung/alter-zivilstand-staatsangehoerigkeit.assetdetail.23064709.html ], last access: 23.12.2022.
  18. World Health Organization (WHO) . Clinical management of COVID-19: Living guideline, 23 June 2022 2022 [Available from: WHO-2019-nCoV-Clinical-2022.1-eng.pdf.], last access, 23.12.2022.
  19. van Paassen J , Vos JS , Hoekstra EM , Neumann KM , Boot PC , Arbous SM . Corticosteroid use in COVID-19 patients: a systematic review and meta-analysis on clinical outcomes. Crit Care. 2020 Dec;24(1):696. https://doi.org/10.1186/s13054-020-03400-9 DOI: https://doi.org/10.1186/s13054-020-03400-9
  20. Oladunjoye O , Gallagher M , Wasser T , Oladunjoye A , Paladugu S , Donato A . Mortality due to COVID-19 infection: A comparison of first and second waves. J Community Hosp Intern Med Perspect. 2021 Nov;11(6):747–52. https://doi.org/10.1080/20009666.2021.1978154 DOI: https://doi.org/10.1080/20009666.2021.1978154
  21. Saito S , Asai Y , Matsunaga N , Hayakawa K , Terada M , Ohtsu H , et al. First and second COVID-19 waves in Japan: A comparison of disease severity and characteristics. J Infect. 2021 Apr;82(4):84–123. https://doi.org/10.1016/j.jinf.2020.10.033 DOI: https://doi.org/10.1016/j.jinf.2020.10.033
  22. Di Fusco M , Shea KM , Lin J , Nguyen JL , Angulo FJ , Benigno M , et al. Health outcomes and economic burden of hospitalized COVID-19 patients in the United States. J Med Econ. 2021;24(1):308–17. https://doi.org/10.1080/13696998.2021.1886109 DOI: https://doi.org/10.1080/13696998.2021.1886109
  23. Mallow PJ , Belk KW , Topmiller M , Hooker EA . Outcomes of Hospitalized COVID-19 Patients by Risk Factors: Results from a United States Hospital Claims Database. J Health Econ Outcomes Res. 2020 Sep;7(2):165–74. https://doi.org/10.36469/jheor.2020.17331 DOI: https://doi.org/10.36469/jheor.2020.17331
  24. Iftimie S , López-Azcona AF , Vallverdú I , Hernández-Flix S , de Febrer G , Parra S , et al. First and second waves of coronavirus disease-19: A comparative study in hospitalized patients in Reus, Spain. PLoS One. 2021 Mar;16(3):e0248029. https://doi.org/10.1371/journal.pone.0248029 DOI: https://doi.org/10.1101/2020.12.10.20246959
  25. Hothorn T , Bopp M , Günthard H , Keiser O , Roelens M , Weibull CE , et al. Assessing relative COVID-19 mortality: a Swiss population-based study. BMJ Open. 2021 Mar;11(3):e042387. https://doi.org/10.1136/bmjopen-2020-042387 DOI: https://doi.org/10.1136/bmjopen-2020-042387
  26. Williamson EJ , Walker AJ , Bhaskaran K , Bacon S , Bates C , Morton CE , et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020 Aug;584(7821):430–6. https://doi.org/10.1038/s41586-020-2521-4 DOI: https://doi.org/10.1038/s41586-020-2521-4
  27. Bravi F , Flacco ME , Carradori T , Volta CA , Cosenza G , De Togni A , et al. Predictors of severe or lethal COVID-19, including Angiotensin Converting Enzyme inhibitors and Angiotensin II Receptor Blockers, in a sample of infected Italian citizens. PLoS One. 2020 Jun;15(6):e0235248. https://doi.org/10.1371/journal.pone.0235248 DOI: https://doi.org/10.1371/journal.pone.0235248
  28. Maximiano Sousa F , Roelens M , Fricker B , Thiabaud A , Iten A , Cusini A , et al.; Ch-Sur Study Group . Risk factors for severe outcomes for COVID-19 patients hospitalised in Switzerland during the first pandemic wave, February to August 2020: prospective observational cohort study. Swiss Med Wkly. 2021 Jul;151(2930):w20547. https://doi.org/10.4414/smw.2021.20547 DOI: https://doi.org/10.4414/smw.2021.20547
  29. Ye Z , Wang Y , Colunga-Lozano LE , Prasad M , Tangamornsuksan W , Rochwerg B , et al. Efficacy and safety of corticosteroids in COVID-19 based on evidence for COVID-19, other coronavirus infections, influenza, community-acquired pneumonia and acute respiratory distress syndrome: a systematic review and meta-analysis. CMAJ. 2020 Jul;192(27):E756–67. https://doi.org/10.1503/cmaj.200645 DOI: https://doi.org/10.1503/cmaj.200645
  30. Liebl ME , Gutenbrunner C , Glaesener JJ , Schwarzkopf S , Best N , Lichti G , et al. Early Rehabilitation in COVID-19 – Best Practice Recommendations for the Early Rehabilitation of COVID-19 Patients. Phys Med Rehabilmed Kurortmed. 2020 Jun;30(3):129–34. https://doi.org/10.1055/a-1162-4919 DOI: https://doi.org/10.1055/a-1162-4919
  31. Brown CA , Londhe AA , He F , Cheng A , Ma J , Zhang J , et al. Development and Validation of Algorithms to Identify COVID-19 Patients Using a US Electronic Health Records Database: A Retrospective Cohort Study. Clin Epidemiol. 2022 May;14:699–709. https://doi.org/10.2147/CLEP.S355086 DOI: https://doi.org/10.2147/CLEP.S355086

Most read articles by the same author(s)

<< < 1 2 3 4 > >>