Characteristics and Risk Factors for Mortality by Coronavirus Disease 2019 Pandemic Waves in Fulton County, Georgia: A Cohort Study March 2020-February 2021

• Authors: Nathaniel Chishinga, Fulton County Board of Health; Sasha Smith, Fulton County Board of Health; Neel Gandhi, Emory University; Udodirim N Onwubiko, Fulton County Board of Health; Carson Telford, Fulton County Board of Health; Juliana Prieto, Fulton County Board of Health; Allison Chamberlain, Emory University; Shamimul Khan, Fulton County Board of Health; Steve Williams, Fulton County Government; Fazle Khan, Fulton County Board of Health; Sarita Shah, Emory University
• Journal Title: OPEN FORUM INFECTIOUS DISEASES
• Volume: Volume 9, Number 4
• Publisher: OXFORD UNIV PRESS INC | 2022-04-01, Pages ofac101-ofac101
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1093/ofid/ofac101
• Subjects: Health Sciences, Epidemiology; Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Immunology; Infectious Diseases; Microbiology; case fatality rate; cohort; COVID-19; mortality; risk factors; OUTCOMES

Abstract

Background: We examined differences in mortality among coronavirus disease 2019 (COVID-19) cases in the first, second, and third waves of the COVID-19 pandemic. Methods: A retrospective cohort study of COVID-19 cases in Fulton County, Georgia, USA, reported to a public health surveillance from March 2020 through February 2021. We estimated case-fatality rates (CFR) by wave and used Cox proportional hazards random-effects models in each wave, with random effects at individual and long-term-care-facility level, to determine risk factors associated with rates of mortality. Results: Of 75 289 confirmed cases, 4490 (6%) were diagnosed in wave 1 (CFR 31 deaths/100 000 person days [pd]), 24 293 (32%) in wave 2 (CFR 7 deaths/100 000 pd), and 46 506 (62%) in wave 3 (CFR 9 deaths/100 000 pd). Compared with females, males were more likely to die in each wave: Wave 1 (adjusted hazard ratio [aHR], 1.5; 95% confidence interval [CI], 1.2-1.8), wave 2 (aHR 1.5, 95% CI, 1.2-1.8), and wave 3 (aHR 1.7, 95% CI, 1.5-2.0). Compared with non-Hispanic whites, non-Hispanic blacks were more likely to die in each wave: Wave 1 (aHR, 1.4; 95% CI, 1.1-1.8), wave 2 (aHR, 1.5; 95% CI, 1.2-1.9), and wave 3 (aHR, 1.7; 95% CI, 1.4-2.0). Cases with any disability, chronic renal disease, and cardiovascular disease were more likely to die in each wave compared with those without these comorbidities. Conclusions: Our study found gender and racial/ethnic disparities in COVID-19 mortality and certain comorbidities associated with COVID-19 mortality. These factors have persisted throughout the COVID-19 pandemic waves, despite improvements in diagnosis and treatment.