Thread by @COVKIDProject

The COVKID team has a new research study out today in @AMJPublicHealth, as part of a special issue called "When Dying Really Counts:"

Out-of-Hospital COVID-19 Deaths: Consequences for Quality of Medical Care and Accuracy of Cause of Death Coding

1/16
ajph.aphapublications.org/doi/abs/10.210…

We found that 🇺🇸children (younger than 18 years) were most likely (30.5%) and elders aged 64 to 74 years were least likely (10.4%) to die out of hospital or in the emergency department from #COVID19.

2/16

ajph.aphapublications.org/doi/abs/10.210…

Why does dying from #COVID19 in the ED matter? Isn't that technically "in the hospital?"

No, it's not. Patients who die in the ED were critically ill before they arrived. They accessed medical care too late!

Some thoughts on possible reasons at the end of this thread.

3/16

We don't have a cure for #COVID19. But supportive care by trained providers in the inpatient hospital setting can **save lives** while patients' immune systems struggle to fight off the virus.

4/16

Case fatality for #COVID19 is low among children. So when we see kids who died outside of the hospital or in the ED, those were lives that potentially could have been saved by high-quality, timely hospital care.

5/16

We also found that during 2020, the % of #COVID19 deaths out of hospital/ED was higher during the surge months for all ages except 75+ years.

This suggests that hospital capacity may have played a role. (**hypothesis, not proof!**)

6/16

Out of hospital/emergency department deaths are a problem for another reason - deaths that occur without medical witness lead to problems with cause-of-death coding on the death certificate.

7/16

Deaths for which insufficient info is available can be assigned a "catch-all" cause of death:

"symptoms, signs, and ill-defined conditions" (SSID)

Deaths that happen outside a hospital are more likely to end up with this non-specific coding, instead of a known disease.

8/16

In a separate dataset (without place of death info), we looked at the % of all non-injury deaths which were coded to SSID, for 2019 vs. 2020.

We guessed that SSID codes ⬆️in 2020.

We looked by age and race/ethnicity.

9/16

We found that child decedents 0-14 years had the highest % coded to SSID. Black children were most likely to have their deaths coded to SSID.

Teens/young adults 15-24 showed the sharpest ⬆️ from 2019-2020.

10/16

The limited tabulation dataset we analyzed did not report out-of-hospital/ED #COVID19 deaths by race/ethnicity or metro/rural residence.

There's more research to be done - when more detailed mortality datasets are released!

11/16

Nonetheless, it is compelling to note the strong effect modification by age of the association between race/ethnicity & #COVID19 death.

<50 yrs, 75% of decedents were Hispanic, Black, or other racial/ethnic minorities.

>84 yrs, 75% of decedents were non-Hispanic white.

12/16

Numerous barriers can stand between severely/critically ill patients and the hospital care they need. There are previous (pre-pandemic) studies on access issues, but we need much more research to understand what happened with #COVID19 in 2020-21.

13/16

We are very grateful to the indomitable Dr. Vickie Mays of @UCLAFSPH for her expert guidance/editing of our paper & the entire special issue "When Dying Really Counts" out today in @AMJPublicHealth

14/16

Many important papers here, please take a look:
ajph.aphapublications.org/toc/ajph/111/S2

Special 🙏 to the great folks @NCHStats who have worked so hard to get #COVID19 mortality data out to the public as fast as possible.

Their work depends on myriad state & local PH professionals - we see & appreciate you!

15/16

#epitwitter @astho @CSTEnews @NACCHOalerts

Please share our new #COVID19 research with your followers - thank you!

16/16

#epitwitter #PedsICU @Cleavon_MD @DrEricDing @DrLindaMD @EricTopol @SapnaKmd @drkomanduri @Arrianna_Planey @gradydoctor @tarahaelle @futuredocs @JenArnoldMD

ajph.aphapublications.org/doi/10.2105/AJ…