COVID-19: Spatial analysis of hospital case-fatality rate in France

When the population risk factors and reporting systems are similar, the assessment of the case-fatality (or lethality) rate (ratio of cases to deaths) represents a perfect tool for analyzing, understanding and improving the overall efficiency of the health system. The objective of this article is to estimate the influence of the hospital care system on lethality in metropolitan France during the inception of the COVID-19 epidemic, by analyzing the spatial variability of the hospital case-fatality rate (CFR) between French districts. In theory, the hospital age-standardized CFR should not display significant differences between districts, since hospital lethality depends on the virulence of the pathogen (the SARS-CoV-2 virus), the vulnerability of the population (mainly age-related), the healthcare system quality, and cases and deaths definition and the recording accuracy. We analyzed hospital data on COVID-19 hospitalizations, severity (admission to intensive care units for reanimation or endotracheal intubation) and mortality, from March 19 to May 8 corresponding to the first French lockdown. All rates were age-standardized to eliminate differences in districts age structure. The results show that the higher case-fatality rates observed by districts are mostly related to the level of morbidity. Time analysis shows that the case-fatality rate has decreased over time, globally and in almost all districts, showing an improvement in the management of severe patients during the epidemic. In conclusion, it appears that during the first critical phase of COVID-19 ramping epidemic in metropolitan France, the higher case-fatality rates were generally related to the higher level of hospitalization, then potentially related to the overload of healthcare system. Also, low hospitalization with high case-fatality rates were mostly found in districts with low population density, and could due to some limitation of the local healthcare access. However, the magnitude of this increase of case-fatality rate represents less than 10 per cent of the average case-fatality rate, and this variation is small compared to much greater variation across countries reported in the literature.

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COVID-19: Spatial Analysis of Hospital Case-Fatality Rate in France

10.1101/2020.05.16.20104026 ◽

2020 ◽

Author(s):

Marc SOURIS ◽

Jean-Paul Gonzalez

Keyword(s):

International Organizations ◽

Rate Ratio ◽

Case Fatality Rate ◽

Case Fatality ◽

Healthcare Systems ◽

Fatality Rate ◽

Average Case ◽

Hospital Case ◽

Reporting Systems ◽

Overall Efficiency

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Declining Trend in the In-Hospital Case-Fatality Rate From Acute Myocardial Infarction in Miyagi Prefecture From 1980 to 1999

Japanese Circulation Journal ◽

10.1253/jcj.65.941 ◽

2001 ◽

Vol 65 (11) ◽

pp. 941-946 ◽

Cited By ~ 17

Author(s):

Jun Watanabe ◽

Kaoru Iwabuchi ◽

Yoshito Koseki ◽

Mitsumasa Fukuchi ◽

Tsuyoshi Shinozaki ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Case Fatality Rate ◽

Case Fatality ◽

Fatality Rate ◽

Hospital Case ◽

Miyagi Prefecture

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Impact of Vena Cava Filters on In-hospital Case Fatality Rate from Pulmonary Embolism

The American Journal of Medicine ◽

10.1016/j.amjmed.2011.05.025 ◽

2012 ◽

Vol 125 (5) ◽

pp. 478-484 ◽

Cited By ~ 119

Author(s):

Paul D. Stein ◽

Fadi Matta ◽

Daniel C. Keyes ◽

Gary L. Willyerd

Keyword(s):

Pulmonary Embolism ◽

Case Fatality Rate ◽

Vena Cava ◽

Case Fatality ◽

Fatality Rate ◽

Hospital Case ◽

Vena Cava Filters

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COVID-19 Healthcare Planning: Predicting Mortality and the Role of the Herd Immunity Barrier in the General Population

Sustainability ◽

10.3390/su12135228 ◽

2020 ◽

Vol 12 (13) ◽

pp. 5228

Author(s):

Julio Emilio Marco-Franco ◽

Natividad Guadalajara-Olmeda ◽

Silvia González-de Julián ◽

David Vivas-Consuelo

Keyword(s):

General Population ◽

Case Fatality Rate ◽

Meta Analysis ◽

Herd Immunity ◽

Case Fatality ◽

Fatality Rate ◽

Daily Monitoring ◽

Age Related ◽

The Impact ◽

Carlos Iii

Using a mathematical model for COVID-19 incorporating data on excess of mortality compared to the corresponding period of the previous year obtained from the daily monitoring of mortality in Spain (MoMo), the prediction of total number of casualties in Spain for the first outbreak has been computed. From this figure, and following a stepwise meta-analysis of available reports, the case fatality rate (CFR) and the infectious case fatality rate (IFR) for the outbreak have been estimated. As the impact of age on these rates is notable, it is proposed to include an age-related adjusted fatality ratio in future comparative analyses between studies, calculated by adjusting the results by risk ratio to a reference age band (e.g., 60–69). From the casualty figures, and the corresponding CFR and IFR ratios, the forecast of serologically positive cases in the general Spanish population has been estimated at approximately 1% (0.87–1.3%) of the samples. If the data are confirmed by the ongoing study of the Carlos III Institute, until a vaccine is found, the immunity acquired in the general population after the infectious outbreak is far from the 65–70% herd immunity required as a barrier for COVID-19.

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Incidence of shock complicating acute MI has remained constant, but the in-hospital case fatality rate has improved

Evidence-based Cardiovascular Medicine ◽

10.1054/ebcm.1999.0225 ◽

1999 ◽

Vol 3 (3) ◽

pp. 78

Author(s):

Judith S. Hochman ◽

Venu Menon

Keyword(s):

Case Fatality Rate ◽

Case Fatality ◽

Fatality Rate ◽

Hospital Case ◽

Acute Mi

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Time trends and case fatality rate of in-hospital treated pulmonary embolism during 11 years of observation in Northwestern Italy

Thrombosis and Haemostasis ◽

10.1160/th15-02-0172 ◽

2016 ◽

Vol 115 (02) ◽

pp. 399-405 ◽

Cited By ~ 41

Author(s):

Walter Ageno ◽

Fulvio Pomero ◽

Luigi Fenoglio ◽

Alessandro Squizzato ◽

Matteo Bonzini ◽

...

Keyword(s):

Pulmonary Embolism ◽

Incidence Rate ◽

Time Trends ◽

Case Fatality Rate ◽

Case Fatality ◽

Population Based ◽

Fatality Rate ◽

Entire Study ◽

Mortality And Morbidity ◽

Hospital Case

SummaryPulmonary embolism (PE) is a common disorder with high mortality and morbidity rates. However, population-based information on its incidence and prognosis remains limited. We conducted a large epidemiology study collecting data on hospitalisation for PE (from 2002 to 2012) in a population of about 13 million people in Northwestern Italy. Patients were identified using the ICD-9-CM codes: 415.11, 415.19; gender and age specific incidence rate of PE during the study period were estimated using the resident population for each year of the study. Furthermore, time trends in the in-hospital PE-related mortality and case fatality rate were calculated. Results were adjusted for possible confounders. A total of 60,853 patients (mean age 72.8 years, ± 14.1, 59.6 % females) with PE were included; the overall crude incidence rate for the entire study period was 55.4 and 40.6 events per year per 100,000 inhabitants for women and men, respectively (p < 0.001). However, this difference was completely lost after standardisation for age. The incidence of PE significantly increased in both genders during the study period. In-hospital case fatality rate significantly decreased throughout the study period (p < 0.001) in women (from 15.6 % to 10.2 %) and in men (from 17.6 % to 10.1 %). The observed decrease of the in-hospital case-fatality throughout the study period remained significant also after adjustment for possible confounders. In conclusion, time trends over an 11-year period show an increasing incidence of PE, but a significant reduction in mortality during hospitalisation. Reduction in the case fatality rate remained significant after adjustment for these possible confounders.Supplementary Material to this article is available online at www.thrombosis-online.com.

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Impact of Vena Cava Filters on In-hospital Case Fatality Rate from Pulmonary Embolism

The American Journal of Medicine ◽

10.1016/j.amjmed.2012.05.035 ◽

2013 ◽

Vol 126 (1) ◽

pp. e21

Author(s):

Sandeep Ravi ◽

Hima bindu Yalamanchili ◽

Stuart Zarich

Keyword(s):

Pulmonary Embolism ◽

Case Fatality Rate ◽

Vena Cava ◽

Case Fatality ◽

Fatality Rate ◽

Hospital Case ◽

Vena Cava Filters

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Vena Cava Filters and In-Hospital Case Fatality Among Patients With Pulmonary Embolism: Results From a Large Population-Based Study

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029619888022 ◽

2019 ◽

Vol 25 ◽

pp. 107602961988802 ◽

Cited By ~ 1

Author(s):

Fulvio Pomero ◽

Walter Ageno ◽

Francesco Dentali ◽

Luigi Fenoglio ◽

Alessandro Squizzato ◽

...

Keyword(s):

Pulmonary Embolism ◽

Case Fatality Rate ◽

Large Population ◽

Vena Cava ◽

Case Fatality ◽

First Episode ◽

Fatality Rate ◽

Hospital Case ◽

Vena Cava Filters ◽

Acute Pe

In patients with venous thromboembolism (VTE), vena cava filters (VCFs) are currently only recommended when anticoagulant treatment is contraindicated or if VTE has recurred despite adequate anticoagulation. However, evidence on the efficacy of filter in patients with VTE is not compelling. We evaluated potential efficacy of VCF in reducing in-hospital mortality in a large population of patients presenting with a first episode of pulmonary embolism (PE). Patients were collected using regional hospital-discharge databases covering a population of more than 13 million of inhabitants in Northern Italy. For each year of observation, we calculated the proportion of cases with VCF among all PE incident cases. The temporal trend of VCF application during the study period was also derived. The effect of VCF use on in-hospital case-fatality rate was evaluated with a multivariate regression model and with the use of propensity score matching. During the study period (2002-2012), 60 813 patients were hospitalized for a first episode of acute PE. In-hospital case-fatality rate for PE was 13.3%. Vena cava filters were used in 745 (1.22%) patients. The annual use of VCF remained stable from 2002 to 2008, while it progressively decreased afterward. After adjustment for available confounders, case-fatality rate remained significantly lower in patients who received VCF compared to the one registered in patients who did not (odds ratio [OR] 0.46; 95% confidence interval [CI]: 0.34-0.62). Propensity score matching gave similar results (OR: 0.42; 95% CI: 0.30-0.61). Vena cava filters were infrequently used in patients with acute PE. Insertion of VCF appeared to sensibly reduce all-cause in-hospital mortality in this subgroup of patients.

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COVID-19 is an emergent disease of aging

10.1101/2020.04.15.20060095 ◽

2020 ◽

Cited By ~ 9

Author(s):

Didac Santesmasses ◽

José Pedro Castro ◽

Aleksandr A. Zenin ◽

Anastasia V. Shindyapina ◽

Maxim V. Gerashchenko ◽

...

Keyword(s):

Case Fatality Rate ◽

Aging Process ◽

Respiratory Diseases ◽

Doubling Time ◽

Case Fatality ◽

The Elderly ◽

Fatality Rate ◽

Age Dependence ◽

Therapeutic Approaches ◽

Age Related

AbstractCOVID-19 is an ongoing pandemic caused by the SARS-CoV-2 coronavirus that poses one of the greatest challenges to public health in recent years. SARS-CoV-2 is highly contagious and often leads to severe viral pneumonia with respiratory failure and death in the elderly and subjects with pre-existing conditions, but the reason for this age dependence is unclear. Here, we found that the case fatality rate for COVID-19 grows exponentially with age in Italy, Spain, South Korea, and China, with the doubling time approaching that of all-cause human mortality. In addition, men and those with multiple age-related diseases are characterized by increased mortality. Moreover, similar mortality patterns were found for all-cause pneumonia. We further report that the gene expression of ACE2, the SARS-CoV-2 receptor, grows in the lung with age, except for subjects on a ventilator. Together, our findings establish COVID-19 as an emergent disease of aging, and age and age-related diseases as its major risk factors. In turn, this suggests that COVID-19, and deadly respiratory diseases in general, may be targeted, in addition to therapeutic approaches that affect specific pathways, by approaches that target the aging process.

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We Have the Solution: Now What's the Problem?

PEDIATRICS ◽

10.1542/peds.90.1.113 ◽

1992 ◽

Vol 90 (1) ◽

pp. 113-115 ◽

Cited By ~ 1

Author(s):

RONALD E. KLEINMAN

Keyword(s):

Replacement Therapy ◽

Case Fatality Rate ◽

Case Fatality ◽

Western Hemisphere ◽

Watery Diarrhea ◽

Fatality Rate ◽

Years Of Experience ◽

Average Case ◽

Electrolyte Replacement

The largest outbreak of the current cholera pandemic and the first to strike the Western hemisphere in this century began in Peru in January of 1991. Two hundred seventy-four thousand, seven hundred sixty-eight cases were reported as of August 7, 1991, with an average case-fatality rate of just over 1%.1 For more than 30 years cholera has served as the paradigm for watery diarrhea, fully treatable by fluid and electrolyte replacement therapy. More than 20 years of experience, including this most recent epidemic in our own hemisphere, has proven the effectiveness of this therapy when given by mouth. It is hard to imagine a more impressive benefit from a cheap and simple therapy.

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