Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc
Journal website https://jocmr.elmerjournals.com

Original Article

Volume 000, Number 000, March 2025, pages 000-000


Comparative Evaluation of Risk of Death in Mechanically Ventilated Patients With COVID-19 and Influenza: A Population-Based Cohort Study

Figure

Figure 1.
Figure 1. Subgroup analysis of comparative short-term mortality among mechanically ventilated hospitalizations with COVID-19 and influenza. Analyses were conducted using overlap propensity score weighting. Adjusted risk ratio represents the risk of short-term mortality among mechanically ventilated hospitalizations with COVID-19 compared to those with influenza. Adjusted risk difference represents the absolute difference in short-term mortality among mechanically ventilated hospitalizations with COVID-19 compared to those with influenza, expressed as percentage. Non-parametric bootstrap 95% confidence intervals (CIs) were determined using 10,000 bootstrap samples and the percentile method. The width of the CIs was not adjusted for multiplicity and should not be used to infer definite effects. COVID-19: coronavirus disease 2019.

Tables

Table 1. The Characteristics and Outcomes of Mechanically Ventilated Hospitalizations With COVID-19 and Influenza
 
VariablesCOVID-19aInfluenzaaP value
N = 19,659N = 2,536
aThe parenthesized figures represent percents, except for the Deyo comorbidity index and number of organ dysfunctions; percentage figures may not add to 100 due to rounding. bThe State of Texas suppresses gender data of hospitalizations with HIV infection, alcohol use, and substance use. cMean (standard deviation). dPost-acute care facilities include long-term acute care hospitals, inpatient rehabilitation, skilled nursing facilities, and nursing homes. COVID-19: coronavirus disease 2019; HIV: human immunodeficiency virus; ECMO: extracorporeal membrane oxygenation; Do-not-resuscitate: a do-not-resuscitate state.
Age, years0.9212
  18 - 442,252 (11.5)285 (11.2)
  45 - 646,612 (33.6)861 (34.0)
  ≥ 6510,795 (54.9)1,390 (54.8)
Gender
  Female8,189 (41.7)1,220 (48.1)< 0.0001
  Male10,036 (51.1)1,026 (40.6)
  Suppressedb1,434 (7.3)290 (11.4)
Race/ethnicity< 0.0001
  White9,974 (50.7)1,308 (51.6)
  Hispanic5,413 (27.5)557 (22.0)
  Black2,755 (14.0)504 (19.9)
  Other1,517 (7.7)167 (6.6)
Health insurance< 0.0001
  Private8,597 (43.7)1,085 (42.8)
  Medicare6,909 (35.1)846 (33.4)
  Medicaid1,383 (7.0)238 (9.4)
  Uninsured1,688 (8.6)297 (11.7)
  Other869 (4.4)57 (2.2)
  Missing213 (1.1)13 (0.5)
Deyo comorbidity indexc2.04 (2.03)2.53 (1.91)< 0.0001
Comorbid conditions
  Diabetes8,341 (42.4)990 (39.0)0.0011
  Liver disease1,125 (5.7)136 (5.4)0.5386
  Malignancy1,272 (6.5)145 (5.7)0.1216
  Congestive heart failure6,639 (33.8)1,231 (48.5)< 0.0001
  Chronic lung disease5,597 (28.5)1,463 (57.7)< 0.0001
  Myocardial infarction2,998 (15.3)475 (18.7)< 0.0001
  Peripheral vascular disease715 (3.6)107 (4.2)0.1304
  Dementia1,509 (7.7)163 (6.4)0.0197
  Peptic ulcer disease303 (1.5)33 (1.3)0.4320
  Hemiplegia/paraplegia535 92.7)46 (1.8)0.0073
  HIV99 (0.5)18 (0.7)0.1882
  Cerebrovascular disease1,684 (8.6)161 (6.3)0.0001
  Chronic renal disease4,994 (25.4)588 (23.2)0.0163
  Rheumatological disease614 (3.1)101 (4.0)0.0154
  Obesity6,605 (33.6)781 (30.8)0.0049
  Tobacco use1,938 (9.9)564 (22.2)< 0.0001
  Alcohol use745 (3.8)121 (4.8)0.0145
  Substance use767 (3.9)176 (6.9)< 0.0001
Number of organ dysfunctionsc2.60 (1.37)2.13 (1.27)< 0.0001
Hemodialysis1,493 (7.6)114 (4.5)< 0.0001
ECMO63 (0.3)2 (0.07)0.0369
Do-not-resuscitate6,513 (33.1)483 (19.0)< 0.0001
Palliative care4,348 (22.1)318 (12.5)< 0.0001
Teaching hospital5,093 (25.9)684 (27.0)0.2348
Hospital admission period
  Fourth quarter 20215,646 (28.7)137 (5.4)< 0.0001
  First quarter 20227,792 (39.6)305 (12.0)< 0.0001
  Second quarter 2022716 (3.6)261 (10.3)< 0.0001
  Third quarter 20222,267 (11.5)101 (4.0)< 0.0001
  Fourth quarter 20221,281 (6.5)1,230 (48.5)< 0.0001
  First quarter 20231,957 (10.0)502 (19.8)< 0.0001
Hospital disposition
  In- hospital mortality7,968 (40.5)342 (13.5)< 0.0001
  Hospice1,675 (8.5)182 (7.2)0.0259
  Home5,837 (29.7)1,459 (57.5)< 0.0001
  Post-acute care facilityd3,892 (19.8)488 (19.2)0.4749
  Leave against medical advice287 (1.5)65 (2.6)< 0.0001

 

Table 2. Adjusted Analyses of the Comparative Short-Term Mortalitya Among Mechanically Ventilated Hospitalizations With COVID-19 Versus Influenza
 
ModelbaRR (95% CI)caRDd (95% CI)c
aShort-term mortality is the composite of in-hospital death or discharge to hospice. bAll models were adjusted for patients’ sociodemographic characteristics, coexisting conditions, measures of severity of illness, organ support, use of palliative care, do-not-resuscitate status, hospitals’ teaching status, and year and calendar quarter of hospitalization. cNon-parametric bootstrap 95% CIs were determined using 10,000 bootstrap samples. dThe risk difference represents the absolute difference in risk of short-term mortality between mechanically ventilated hospitalizations with COVID-19 vs. those with influenza, expressed as percentage. COVID-19: coronavirus disease 2019; aRR: adjusted risk ratio; CI: confidence interval; aRD: adjusted risk difference.
Overlap propensity score weighting1.24 (1.18 - 1.30)8.8 (6.7 - 10.4)
Alternative analyses
  Entropy balance1.25 (1.19 - 1.33)9.3 (7.4 - 11.7)
  Hierarchical multivariable logistic regression1.23 (1.22 - 1.34)8.8 (8.3 - 12.0)