Estimating COVID-19 Hospitalizations in the United States With Surveillance Data Using a Bayesian Hierarchical Model: Modeling Study

• Type of Material: Article
• Authors: Carrie Reed, Emory University; Alexia Couture, Centers for Disease Control and Prevention, Atlanta; AD Iuliano, Centers for Disease Control and Prevention, Atlanta; Howard Chang, Emory University; Neha N Patel, Centers for Disease Control and Prevention, Atlanta; Matthew Gilmer, Centers for Disease Control and Prevention, Atlanta; Molly Steele, Centers for Disease Control and Prevention, Atlanta; Fiona Havers, Emory University; Michael Whitaker, Centers for Disease Control and Prevention, Atlanta
• Language: English
• Date: 2022-06-01
• Publisher: JMIR PUBLICATIONS, INC
• Publication Version: Final Published Version
• Copyright Statement: ©Alexia Couture, A Danielle Iuliano, Howard H Chang, Neha N Patel, Matthew Gilmer, Molly Steele, Fiona P Havers, Michael Whitaker, Carrie Reed. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 02.06.2022.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.2196/34296
• Title of Journal or Parent Work: JMIR PUBLIC HEALTH AND SURVEILLANCE
• Volume: 8
• Issue: 6
• Start Page: e34296
• End Page: e34296
• Grant/Funding Information: Funding for this work was supported by the Centers for Disease Control and Prevention (CDC; Atlanta, GA). The authors received no financial support for the research, authorship, or publication of these data.
• Keywords: Science & Technology; rate; prediction; modeling; Public, Environmental & Occupational Health; data; novel; surveillance; extrapolation; COVID-19; hospital; SARS-CoV-2; estimation; framework; hierarchical; monitoring; United States; Life Sciences & Biomedicine; SELECTION; model; Bayesian; COVID-NET; hospitalization
• Research Categories: Health Sciences, Public Health; Biology, Biostatistics

Abstract

Background: In the United States, COVID-19 is a nationally notifiable disease, meaning cases and hospitalizations are reported by states to the Centers for Disease Control and Prevention (CDC). Identifying and reporting every case from every facility in the United States may not be feasible in the long term. Creating sustainable methods for estimating the burden of COVID-19 from established sentinel surveillance systems is becoming more important. Objective: We aimed to provide a method leveraging surveillance data to create a long-term solution to estimate monthly rates of hospitalizations for COVID-19. Methods: We estimated monthly hospitalization rates for COVID-19 from May 2020 through April 2021 for the 50 states using surveillance data from the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) and a Bayesian hierarchical model for extrapolation. Hospitalization rates were calculated from patients hospitalized with a lab-confirmed SARS-CoV-2 test during or within 14 days before admission. We created a model for 6 age groups (0-17, 18-49, 50-64, 65-74, 75-84, and ≥85 years) separately. We identified covariates from multiple data sources that varied by age, state, and month and performed covariate selection for each age group based on 2 methods, Least Absolute Shrinkage and Selection Operator (LASSO) and spike and slab selection methods. We validated our method by checking the sensitivity of model estimates to covariate selection and model extrapolation as well as comparing our results to external data. Results: We estimated 3,583,100 (90% credible interval [CrI] 3,250,500-3,945,400) hospitalizations for a cumulative incidence of 1093.9 (992.4-1204.6) hospitalizations per 100,000 population with COVID-19 in the United States from May 2020 through April 2021. Cumulative incidence varied from 359 to 1856 per 100,000 between states. The age group with the highest cumulative incidence was those aged ≥85 years (5575.6; 90% CrI 5066.4-6133.7). The monthly hospitalization rate was highest in December (183.7; 90% CrI 154.3-217.4). Our monthly estimates by state showed variations in magnitudes of peak rates, number of peaks, and timing of peaks between states. Conclusions: Our novel approach to estimate hospitalizations for COVID-19 has potential to provide sustainable estimates for monitoring COVID-19 burden as well as a flexible framework leveraging surveillance data.