• Gregory A Roth, Sophia Emmons-Bell, Heather M Alger, Steven M Bradley, Sandeep R Das, James A de Lemos, Emmanuela Gakidou, ElkindMitchell S VMSVDepartment of Neurology, Vagelos College of Physicians and Surgeons, New York, New York.Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York., Simon Hay, Jennifer L Hall, Catherine O Johnson, David A Morrow, Fatima Rodriguez, Christine Rutan, Saate Shakil, Reed Sorensen, Laura Stevens, Tracy Y Wang, Jason Walchok, Joseph Williams, and Christopher Murray.
• Division of Cardiology, Department of Medicine, University of Washington, Seattle.
• JAMA Netw Open. 2021 May 3; 4 (5): e218828.

ImportanceIn-hospital mortality rates from COVID-19 are high but appear to be decreasing for selected locations in the United States. It is not known whether this is because of changes in the characteristics of patients being admitted.ObjectiveTo describe changing in-hospital mortality rates over time after accounting for individual patient characteristics.Design, Setting, And ParticipantsThis was a retrospective cohort study of 20 736 adults with a diagnosis of COVID-19 who were included in the US American Heart Association COVID-19 Cardiovascular Disease Registry and admitted to 107 acute care hospitals in 31 states from March through November 2020. A multiple mixed-effects logistic regression was then used to estimate the odds of in-hospital death adjusted for patient age, sex, body mass index, and medical history as well as vital signs, use of supplemental oxygen, presence of pulmonary infiltrates at admission, and hospital site.Main Outcomes And MeasuresIn-hospital death adjusted for exposures for 4 periods in 2020.ResultsThe registry included 20 736 patients hospitalized with COVID-19 from March through November 2020 (9524 women [45.9%]; mean [SD] age, 61.2 [17.9] years); 3271 patients (15.8%) died in the hospital. Mortality rates were 19.1% in March and April, 11.9% in May and June, 11.0% in July and August, and 10.8% in September through November. Compared with March and April, the adjusted odds ratios for in-hospital death were significantly lower in May and June (odds ratio, 0.66; 95% CI, 0.58-0.76; P < .001), July and August (odds ratio, 0.58; 95% CI, 0.49-0.69; P < .001), and September through November (odds ratio, 0.59; 95% CI, 0.47-0.73).Conclusions And RelevanceIn this cohort study, high rates of in-hospital COVID-19 mortality among registry patients in March and April 2020 decreased by more than one-third by June and remained near that rate through November. This difference in mortality rates between the months of March and April and later months persisted even after adjusting for age, sex, medical history, and COVID-19 disease severity and did not appear to be associated with changes in the characteristics of patients being admitted.

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