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Trends in COVID-19 hospital outcomes in England before and after vaccine introduction, a cohort study.

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Charlett, Andre 
Elgohari, Suzanne 
Hope, Russell 


Widespread vaccination campaigns have changed the landscape for COVID-19, vastly altering symptoms and reducing morbidity and mortality. We estimate trends in mortality by month of admission and vaccination status among those hospitalised with COVID-19 in England between March 2020 to September 2021, controlling for demographic factors and hospital load. Among 259,727 hospitalised COVID-19 cases, 51,948 (20.0%) experienced mortality in hospital. Hospitalised fatality risk ranged from 40.3% (95% confidence interval 39.4-41.3%) in March 2020 to 8.1% (7.2-9.0%) in June 2021. Older individuals and those with multiple co-morbidities were more likely to die or else experienced longer stays prior to discharge. Compared to unvaccinated people, the hazard of hospitalised mortality was 0.71 (0.67-0.77) with a first vaccine dose, and 0.56 (0.52-0.61) with a second vaccine dose. Compared to hospital load at 0-20% of the busiest week, the hazard of hospitalised mortality during periods of peak load (90-100%), was 1.23 (1.12-1.34). The prognosis for people hospitalised with COVID-19 in England has varied substantially throughout the pandemic and according to case-mix, vaccination, and hospital load. Our estimates provide an indication for demands on hospital resources, and the relationship between hospital burden and outcomes.


Funder: MRC UKRI/DHSC NIHR COVID-19 rapid response call (grant ref: MC_PC_19074) and NIHR Health Protection Research Unit in Behavioural Science and Evaluation.


Article, /692/308/174, /692/699/255, /692/700/478, /631/326/596/4130, /141, article

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Nat Commun

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Springer Science and Business Media LLC
RCUK | Medical Research Council (MRC) (MC_UU_00002/11, MC_UU_00002/11)
DH | National Institute for Health Research (NIHR) (OD-1017-20006, OD-1017-20006)