Impact of ceiling of care on mortality across four COVID-19 epidemic waves in Catalonia

Researchers from the Biostatistics Unit at the Germans Trias i Pujol Research Institute (IGTP) have led a study, published in BMJ Open, which analyses how in-hospital mortality evolved during four waves of the COVID-19 pandemic in Catalonia, taking into account the patients' ceiling of care.

The study included 5,813 patients hospitalised with COVID-19 in five tertiary hospitals in Catalonia over the course of the first four pandemic waves. The ceiling of care-defined as the highest level of medical treatment a patient will receive-was assessed upon admission for all patients.

The results show that, among patients without a ceiling of care, those admitted during the first wave had a higher risk of in-hospital death compared to those admitted in subsequent waves. The adjusted models confirmed a significant decrease in mortality over time, likely due to improvements in clinical knowledge, treatment and patient management.

As expected, mortality was higher among patients with a ceiling of care. In this group, no significant differences in mortality were observed between the first three waves. However, in the fourth wave, adjusted analyses showed a reduction in mortality comparable to that of patients without a ceiling of care. This improvement may be associated with the higher vaccination coverage among this group.

"Understanding how mortality patterns evolve differently in patients with and without a ceiling of care could help inform clinical strategies in future public health emergencies," explains Natàlia Pallarès, first author of the study and researcher at IGTP at the unit led by Cristian Tebé.