Hospital Characteristics Associated With COVID-19 Mortality: Data From the Multicenter Cohort Brazilian COVID-19 Registry

Background:The COVID-19 pandemic caused unprecedented pressure over health care systems, but hospital-level data that may influence the prognosis are not well-studied. Therefore, this study analyzed regional socioeconomic, hospital, and intensive care units (ICU) characteristics associated with mortality in COVID-19 patients admitted to Brazilian institutions.Methods:This is a multicenter retrospective cohort. Patients with COVID-19 admitted from March to September 2020, were enrolled. Data were collected through hospital records, forms, and open databases. Generalized linear mixed models with logit link function were used to assess association between hospital characteristics and mortality. Two models were built, one testing hospital general characteristics and another testing ICU factors. All analysis were adjusted for the proportion of high-risk patients at admission.Findings:Thirty-one hospitals were included. Mortality ranged from 9·0% to 48·0%. In the first model, hospitals with private funding (β=-0·37; 95%CI: -0·71 to -0·04; p=0·029) and in municipalities with high gross domestic product (GDP) per capita (β=-0·40; 95%CI: -0·72 to -0·08; p=0·014) were independently associated with lower mortality. The second model included 23 hospitals and showed that ICUs with a work shift composed of less than 10% of medical residents (β=-0·40; 95%CI: -0·68 to -0·11; p=0.006) and those with more than 50% of intensivists (β=-0·59; 95%CI: -0·98 to -0·20; p=0·003) were independently associated with lower mortality.Interpretation: Funding, city-level GDP and the experience of the critical care medical team were independently associated with COVID-19 in-hospital mortality. Funding Information: Minas Gerais State Agency for Research and Development (FAPEMIG), Institute for Health Technology Assessment (IATS/CNPq) and CAPES Foundation.Declaration of Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.Ethics Approval Statement: This study followed the STROBE guidelines for reporting observational studies, and it is in accordance with the Declaration of Helsinki. The study protocol was approved by the Brazilian National Commission for Research Ethics (CAAE: 30350820·5·1001·0008). Individual informed consent was waived due to the severity of the pandemic situation and the use of deidentified data, based on medical chart review only.