Clinical characteristics and risk factors for severe disease among hospitalized patients with COVID-19 in Japan after cessation of public funding: A single-center retrospective study in 2024-2025.

Although the mortality rate of COVID-19 is declining, disease threats remain, particularly in older individuals and those with underlying conditions. Furthermore, there are concerns about the decrease in antiviral prescriptions following public funding cessation for COVID-19 treatment in Japan. In this study, we aimed to investigate patient characteristics, pre-admission COVID-19 diagnosis, treatment status, severity, and risk factors for severe disease and mortality among hospitalized patients with COVID-19 after ending public funding. This single-center retrospective study, conducted at the Kyoto Prefectural University of Medicine Hospital, included 186 SARS-CoV-2-positive patients hospitalized from April 1, 2024, to March 31, 2025. The patients' median age was 75 years; 76.9 % were admitted owing to COVID-19 symptoms. Additionally, 47.3 % (88/186) of the patients visited a medical facility prior to admission: 75.9 % (65/88) of those were diagnosed with COVID-19; among them, 61.5 % (40/65) did not receive antivirals. Antiviral agents were prescribed to 25 patients, accounting for 28.4 % of the 88 patients who had a history of accessing medical facility prior to admission. Moreover, 56.4 % of all patients progressed to moderate II or higher disease severity; the in-hospital all-cause mortality rate was 7.0 %. Multivariate analysis revealed that interstitial pneumonia was a significant risk factor for in-hospital mortality (odds ratio, 8.0; 95 % confidence interval, 1.5-43.2; p = 0.016). This suggests a potential inadequacy in the early administration of antiviral agents to patients at risk of severe COVID-19. A multifaceted intervention, including patient education, healthcare provider awareness, and reconsideration of the medical system (e.g., antiviral agents pricing), is needed.