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Causes of death amongst medical schemes patients diagnosed with COVID-19, COVID-19 suspected and other diagnoses, South Africa

Background: The COVID-19 epidemic has adversely affected health systems globally, with some on the verge of collapse as countries experienced subsequent waves. By 24 October 2021, nearly five million people globally have succumbed to the pandemic. Hardly hit are the elderly and those with comorbidities. Objectives: The primary objective of this study was to invstigate demographic characteristics of COVID-19 related deaths of private patients privately funded by medical schemes. The secondary objective of this research was to analyse and compare the causes of deaths related to COVID-19 diagnosis and other diagnoses amongst medical scheme patients. Methods: The study design was a retrospective study on medical schemes patients’ mortality data, mainly the private sector data in South Africa. The study included secondary data from fifty-two medical schemes and was collected at an aggregated level as the researcher did not access the complete patient database. The analysis included hospital mortality data collected from medical schemes between March 2020 and August 2021. The schemes accounted for 8,1 million people ( lives or beneficiaries of medical schemes ). ICD-10 discharge diagnoses were grouped into three categories; mainly COVID-19 confirmed related deaths, COVID-19 suspected cases and other conditions. A laboratory-confirmed (RT-PCR assay) and Antigen tests conducted in private hospitals were used to identify COVID-19 deaths as per the World Health Organisation’s (WHO) guidelines. Results: The incidence rate was 1,664 per million beneficiaries, and the case fatality rate was 2,6 percent. The median age of female patients who died after hospital admission was higher than males at 65 (54-77) and 63 (54-73) years, respectively. The median length of stay in hospital was 11 (5-23) days for females, slightly higher than for male patients at 10 (4-20) days. Over two-thirds of the deaths were COVID-19, and under ten percent were COVID- 19 suspected, 35 percent and 8 percent, respectively. Those dependent on respirators accounted for 3,6 percent of the patients who died. Three percent of patients were in isolation, and the other three percent had pneumonia, unspecified. Just under a third of COVID-19 related deaths were treated in ICU, compared to the 43 percent treated in the General Ward, just under 13 percent from High Care and just under 10 percent were treated in other facilities, including other step-down rehabilitation centres. Conclusion: This study highlighted a more significant proportion of males in COVID-19 confirmed and suspected, but a more significant proportion of female deaths in other diagnoses. This study also found the risk of mortality amongst COVID-19 suspected patients who were 70 years and older