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Temporal trends in hospitalizations and 30-day mortality in older patients during the COVID pandemic from March 2020 to July 2021

Importance: Previous reports have suggested reductions in mortality risk from COVID-19 throughout the first wave of the COVID-19 pandemic. Mortality changes later in the pandemic and pandemic effects on other types of geriatric hospitalizations are less studied. Objectives: To describe the changes in hospitalizations and 30-day mortality in Stockholm for patients 70+ receiving inpatient geriatric care for COVID-19 and other causes. Design: Observational study. For patients 70 or older, we present the incidence of 30-day mortality from COVID-19 in the Stockholm region, in relationship to geriatric hospitalizations and 30-day mortality after admission for COVID-19 and other causes. Setting: Hospitalizations for patients 70+ from geriatric clinics in Stockholm, Sweden hospitalized for COVID-19 or other causes between March 2020 and July 31, 2021, were included. Participants: The total number of geriatric hospitalizations for patients 70+ was 5,320 for COVID-19 and 32,243 for non-COVID-19 causes, corresponding to 4,565 individual COVID-19 patients and 19,308 non-COVID-19 patients. Exposure(s): The date of hospital admission to a geriatric clinic. Main Outcome(s) and Measure(s): 30-day mortality after admission. Results: In patients with COVID-19, the 30-day mortality rate was highest at the beginning of the first wave (29% in March-April 2020), decreased as the first wave subsided (7% July-August), increased again in the second wave (17% November-December), but failed to increase as much in the third wave (11-13% March-July 2021). In non-COVID-19 geriatric patients during the same period, the 30-day mortality presented a similar trend, but with a smaller magnitude of variation (5 to 10%). The number of persons 70 or older testing positive for COVID-19 in Stockholm reached two peaks in 2020 (April and December), fell in January 2021 and then increased again in March-April 2021. Conclusions and Relevance: During the first and second waves, hospital admissions and 30-day mortality after geriatric hospitalization for COVID-19 increased in periods of high community transmission, although the mortality peak was lower in wave 2 than in wave 1. The mortality for non-COVID geriatric cases was lower and more stable but also showed an increase with the pandemic peaks.