Clinical management of COVID-19 in hospitals and the community: A snapshot from a medical insurance database in South Africa.

BACKGROUND

Little is known about the clinical care, use of medicines, and risk factors associated with mortality among the population with private health insurance with COVID-19 in South Africa.

METHODS

This was a retrospective cross-sectional study using claims data of patients with confirmed COVID-19. Sociodemographics, comorbidities, severity, concurrent/progressive comorbidity, drug treatment, and outcomes were extracted from administrative data. Univariate and multivariate logistic regression models were used to explore the risk factors associated with in-hospital death.

RESULTS

This study included 154,519 patients with COVID-19; only 24% were categorized as severe because they received in-hospital care. Antibiotic (42.8%) and steroid (30%) use was high in this population. After adjusting for known comorbidities, concurrent/progressive diagnosis of the following conditions were associated with higher in-hospital death odds: acute respiratory distress syndrome (aOR = 1.55; 95% CI = 1.44-1.68), septic shock (aOR = 1.55; 95% CI = 2.00-4.12), pneumonia (aOR = 1.35; 95% CI = 1.24-1.47), acute renal failure (aOR = 2.30; 95% CI = 2.09-2.5), and stroke (aOR = 2.09; 95% CI = 1.75-2.49). The use of antivirals (aOR = 0.47; 95% CI= 0.40-0.54), and/or steroids (aOR = 0.46; 95% CI = 0.43-0.50) were associated with decreased death odds. The use of antibiotics in-hospital was not associated with increased survival (aOR = 0.97; 95% CI = 0.91-1.04).

CONCLUSIONS

Comorbidities remain significant risk factors for death mediated by organ failure. The use of antibiotics did not change the odds of death, suggesting inappropriate use.