Changing Severity and Epidemiology of Adults Hospitalized with Coronavirus Disease 2019 (COVID-19) in the United States after Introduction of COVID-19 Vaccines, March 2021-August 2022

Noah Kojima; Katherine Adams; Wesley H. Self; Manjusha Gaglani; Tresa McNeal; Shekhar Ghamande; Jay S. Steingrub; Nathan I. Shapiro; Abhijit Duggal; Laurence W. Busse; Matthew E. Prekker; Ithan D. Peltan; Samuel M. Brown; David N. Hager; Harith Ali; Michelle N. Gong; Amira Mohamed; Matthew C. Exline; Akram Khan; Jennifer G. Wilson; Nida Qadir; Steven Y. Chang; Adit A. Ginde; Cori A. Withers; Nicholas M. Mohr; Christopher Mallow; Emily T. Martin; Adam S. Lauring; Nicholas J. Johnson; Jonathan D. Casey; William B. Stubblefield; Kevin W. Gibbs; Jennie H. Kwon; Adrienne Baughman; James D. Chappell; Kimberly W. Hart; Ian D. Jones; Jillian P. Rhoads; Sydney A. Swan; Kelsey N. Womack; Yuwei Zhu; Diya Surie; Meredith L. McMorrow; Manish M. Patel; Mark W. Tenforde

doi:10.1093/cid/ciad276

Changing Severity and Epidemiology of Adults Hospitalized with Coronavirus Disease 2019 (COVID-19) in the United States after Introduction of COVID-19 Vaccines, March 2021-August 2022

Noah Kojima, Katherine Adams, Wesley H. Self, Manjusha Gaglani, Tresa McNeal, Shekhar Ghamande, Jay S. Steingrub, Nathan I. Shapiro, Abhijit Duggal, Laurence W. Busse, Matthew E. Prekker, Ithan D. Peltan, Samuel M. Brown, David N. Hager, Harith Ali, Michelle N. Gong, Amira Mohamed, Matthew C. Exline, Akram Khan, Jennifer G. WilsonNida Qadir, Steven Y. Chang, Adit A. Ginde, Cori A. Withers, Nicholas M. Mohr, Christopher Mallow, Emily T. Martin, Adam S. Lauring, Nicholas J. Johnson, Jonathan D. Casey, William B. Stubblefield, Kevin W. Gibbs, Jennie H. Kwon, Adrienne Baughman, James D. Chappell, Kimberly W. Hart, Ian D. Jones, Jillian P. Rhoads, Sydney A. Swan, Kelsey N. Womack, Yuwei Zhu, Diya Surie, Meredith L. McMorrow, Manish M. Patel, Mark W. Tenforde

Pulmonary and Critical Care Medicine

Research output: Contribution to journal › Article › peer-review

14 Scopus citations

Abstract

Introduction: Understanding the changing epidemiology of adults hospitalized with coronavirus disease 2019 (COVID-19) informs research priorities and public health policies. Methods: Among adults (≥18 years) hospitalized with laboratory-confirmed, acute COVID-19 between 11 March 2021, and 31 August 2022 at 21 hospitals in 18 states, those hospitalized during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron-predominant period (BA.1, BA.2, BA.4/BA.5) were compared to those from earlier Alpha- and Delta-predominant periods. Demographic characteristics, biomarkers within 24 hours of admission, and outcomes, including oxygen support and death, were assessed. Results: Among 9825 patients, median (interquartile range [IQR]) age was 60 years (47-72), 47% were women, and 21% non-Hispanic Black. From the Alpha-predominant period (Mar-Jul 2021; N = 1312) to the Omicron BA.4/BA.5 sublineage-predominant period (Jun-Aug 2022; N = 1307): the percentage of patients who had ≥4 categories of underlying medical conditions increased from 11% to 21%; those vaccinated with at least a primary COVID-19 vaccine series increased from 7% to 67%; those ≥75 years old increased from 11% to 33%; those who did not receive any supplemental oxygen increased from 18% to 42%. Median (IQR) highest C-reactive protein and D-dimer concentration decreased from 42.0 mg/L (9.9-122.0) to 11.5 mg/L (2.7-42.8) and 3.1 mcg/mL (0.8-640.0) to 1.0 mcg/mL (0.5-2.2), respectively. In-hospital death peaked at 12% in the Delta-predominant period and declined to 4% during the BA.4/BA.5-predominant period. Conclusions: Compared to adults hospitalized during early COVID-19 variant periods, those hospitalized during Omicron-variant COVID-19 were older, had multiple co-morbidities, were more likely to be vaccinated, and less likely to experience severe respiratory disease, systemic inflammation, coagulopathy, and death.

Original language	English (US)
Pages (from-to)	547-557
Number of pages	11
Journal	Clinical Infectious Diseases
Volume	77
Issue number	4
DOIs	https://doi.org/10.1093/cid/ciad276
State	Published - Aug 15 2023

Keywords

COVID-19
SARS-CoV-2
death
hospitalization
severe disease

ASJC Scopus subject areas

Microbiology (medical)
Infectious Diseases

Access to Document

10.1093/cid/ciad276

Cite this

Kojima, N., Adams, K., Self, W. H., Gaglani, M., McNeal, T., Ghamande, S., Steingrub, J. S., Shapiro, N. I., Duggal, A., Busse, L. W., Prekker, M. E., Peltan, I. D., Brown, S. M., Hager, D. N., Ali, H., Gong, M. N., Mohamed, A., Exline, M. C., Khan, A., ... Tenforde, M. W. (2023). Changing Severity and Epidemiology of Adults Hospitalized with Coronavirus Disease 2019 (COVID-19) in the United States after Introduction of COVID-19 Vaccines, March 2021-August 2022. Clinical Infectious Diseases, 77(4), 547-557. https://doi.org/10.1093/cid/ciad276

Changing Severity and Epidemiology of Adults Hospitalized with Coronavirus Disease 2019 (COVID-19) in the United States after Introduction of COVID-19 Vaccines, March 2021-August 2022. / Kojima, Noah; Adams, Katherine; Self, Wesley H. et al.
In: Clinical Infectious Diseases, Vol. 77, No. 4, 15.08.2023, p. 547-557.

Research output: Contribution to journal › Article › peer-review

Kojima, N, Adams, K, Self, WH, Gaglani, M, McNeal, T, Ghamande, S, Steingrub, JS, Shapiro, NI, Duggal, A, Busse, LW, Prekker, ME, Peltan, ID, Brown, SM, Hager, DN, Ali, H, Gong, MN, Mohamed, A, Exline, MC, Khan, A, Wilson, JG, Qadir, N, Chang, SY, Ginde, AA, Withers, CA, Mohr, NM, Mallow, C, Martin, ET, Lauring, AS, Johnson, NJ, Casey, JD, Stubblefield, WB, Gibbs, KW, Kwon, JH, Baughman, A, Chappell, JD, Hart, KW, Jones, ID, Rhoads, JP, Swan, SA, Womack, KN, Zhu, Y, Surie, D, McMorrow, ML, Patel, MM & Tenforde, MW 2023, 'Changing Severity and Epidemiology of Adults Hospitalized with Coronavirus Disease 2019 (COVID-19) in the United States after Introduction of COVID-19 Vaccines, March 2021-August 2022', Clinical Infectious Diseases, vol. 77, no. 4, pp. 547-557. https://doi.org/10.1093/cid/ciad276

@article{6aa891fd4f984c25a977c2f4f3d32502,

title = "Changing Severity and Epidemiology of Adults Hospitalized with Coronavirus Disease 2019 (COVID-19) in the United States after Introduction of COVID-19 Vaccines, March 2021-August 2022",

abstract = "Introduction: Understanding the changing epidemiology of adults hospitalized with coronavirus disease 2019 (COVID-19) informs research priorities and public health policies. Methods: Among adults (≥18 years) hospitalized with laboratory-confirmed, acute COVID-19 between 11 March 2021, and 31 August 2022 at 21 hospitals in 18 states, those hospitalized during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron-predominant period (BA.1, BA.2, BA.4/BA.5) were compared to those from earlier Alpha- and Delta-predominant periods. Demographic characteristics, biomarkers within 24 hours of admission, and outcomes, including oxygen support and death, were assessed. Results: Among 9825 patients, median (interquartile range [IQR]) age was 60 years (47-72), 47% were women, and 21% non-Hispanic Black. From the Alpha-predominant period (Mar-Jul 2021; N = 1312) to the Omicron BA.4/BA.5 sublineage-predominant period (Jun-Aug 2022; N = 1307): the percentage of patients who had ≥4 categories of underlying medical conditions increased from 11% to 21%; those vaccinated with at least a primary COVID-19 vaccine series increased from 7% to 67%; those ≥75 years old increased from 11% to 33%; those who did not receive any supplemental oxygen increased from 18% to 42%. Median (IQR) highest C-reactive protein and D-dimer concentration decreased from 42.0 mg/L (9.9-122.0) to 11.5 mg/L (2.7-42.8) and 3.1 mcg/mL (0.8-640.0) to 1.0 mcg/mL (0.5-2.2), respectively. In-hospital death peaked at 12% in the Delta-predominant period and declined to 4% during the BA.4/BA.5-predominant period. Conclusions: Compared to adults hospitalized during early COVID-19 variant periods, those hospitalized during Omicron-variant COVID-19 were older, had multiple co-morbidities, were more likely to be vaccinated, and less likely to experience severe respiratory disease, systemic inflammation, coagulopathy, and death.",

keywords = "COVID-19, SARS-CoV-2, death, hospitalization, severe disease",

author = "Noah Kojima and Katherine Adams and Self, {Wesley H.} and Manjusha Gaglani and Tresa McNeal and Shekhar Ghamande and Steingrub, {Jay S.} and Shapiro, {Nathan I.} and Abhijit Duggal and Busse, {Laurence W.} and Prekker, {Matthew E.} and Peltan, {Ithan D.} and Brown, {Samuel M.} and Hager, {David N.} and Harith Ali and Gong, {Michelle N.} and Amira Mohamed and Exline, {Matthew C.} and Akram Khan and Wilson, {Jennifer G.} and Nida Qadir and Chang, {Steven Y.} and Ginde, {Adit A.} and Withers, {Cori A.} and Mohr, {Nicholas M.} and Christopher Mallow and Martin, {Emily T.} and Lauring, {Adam S.} and Johnson, {Nicholas J.} and Casey, {Jonathan D.} and Stubblefield, {William B.} and Gibbs, {Kevin W.} and Kwon, {Jennie H.} and Adrienne Baughman and Chappell, {James D.} and Hart, {Kimberly W.} and Jones, {Ian D.} and Rhoads, {Jillian P.} and Swan, {Sydney A.} and Womack, {Kelsey N.} and Yuwei Zhu and Diya Surie and McMorrow, {Meredith L.} and Patel, {Manish M.} and Tenforde, {Mark W.}",

note = "Publisher Copyright: {\textcopyright} 2023 Published by Oxford University Press on behalf of Infectious Diseases Society of America.",

year = "2023",

month = aug,

day = "15",

doi = "10.1093/cid/ciad276",

language = "English (US)",

volume = "77",

pages = "547--557",

journal = "Clinical Infectious Diseases",

issn = "1058-4838",

publisher = "Oxford University Press",

number = "4",

}

TY - JOUR

T1 - Changing Severity and Epidemiology of Adults Hospitalized with Coronavirus Disease 2019 (COVID-19) in the United States after Introduction of COVID-19 Vaccines, March 2021-August 2022

AU - Kojima, Noah

AU - Adams, Katherine

AU - Self, Wesley H.

AU - Gaglani, Manjusha

AU - McNeal, Tresa

AU - Ghamande, Shekhar

AU - Steingrub, Jay S.

AU - Shapiro, Nathan I.

AU - Duggal, Abhijit

AU - Busse, Laurence W.

AU - Prekker, Matthew E.

AU - Peltan, Ithan D.

AU - Brown, Samuel M.

AU - Hager, David N.

AU - Ali, Harith

AU - Gong, Michelle N.

AU - Mohamed, Amira

AU - Exline, Matthew C.

AU - Khan, Akram

AU - Wilson, Jennifer G.

AU - Qadir, Nida

AU - Chang, Steven Y.

AU - Ginde, Adit A.

AU - Withers, Cori A.

AU - Mohr, Nicholas M.

AU - Mallow, Christopher

AU - Martin, Emily T.

AU - Lauring, Adam S.

AU - Johnson, Nicholas J.

AU - Casey, Jonathan D.

AU - Stubblefield, William B.

AU - Gibbs, Kevin W.

AU - Kwon, Jennie H.

AU - Baughman, Adrienne

AU - Chappell, James D.

AU - Hart, Kimberly W.

AU - Jones, Ian D.

AU - Rhoads, Jillian P.

AU - Swan, Sydney A.

AU - Womack, Kelsey N.

AU - Zhu, Yuwei

AU - Surie, Diya

AU - McMorrow, Meredith L.

AU - Patel, Manish M.

AU - Tenforde, Mark W.

PY - 2023/8/15

Y1 - 2023/8/15

N2 - Introduction: Understanding the changing epidemiology of adults hospitalized with coronavirus disease 2019 (COVID-19) informs research priorities and public health policies. Methods: Among adults (≥18 years) hospitalized with laboratory-confirmed, acute COVID-19 between 11 March 2021, and 31 August 2022 at 21 hospitals in 18 states, those hospitalized during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron-predominant period (BA.1, BA.2, BA.4/BA.5) were compared to those from earlier Alpha- and Delta-predominant periods. Demographic characteristics, biomarkers within 24 hours of admission, and outcomes, including oxygen support and death, were assessed. Results: Among 9825 patients, median (interquartile range [IQR]) age was 60 years (47-72), 47% were women, and 21% non-Hispanic Black. From the Alpha-predominant period (Mar-Jul 2021; N = 1312) to the Omicron BA.4/BA.5 sublineage-predominant period (Jun-Aug 2022; N = 1307): the percentage of patients who had ≥4 categories of underlying medical conditions increased from 11% to 21%; those vaccinated with at least a primary COVID-19 vaccine series increased from 7% to 67%; those ≥75 years old increased from 11% to 33%; those who did not receive any supplemental oxygen increased from 18% to 42%. Median (IQR) highest C-reactive protein and D-dimer concentration decreased from 42.0 mg/L (9.9-122.0) to 11.5 mg/L (2.7-42.8) and 3.1 mcg/mL (0.8-640.0) to 1.0 mcg/mL (0.5-2.2), respectively. In-hospital death peaked at 12% in the Delta-predominant period and declined to 4% during the BA.4/BA.5-predominant period. Conclusions: Compared to adults hospitalized during early COVID-19 variant periods, those hospitalized during Omicron-variant COVID-19 were older, had multiple co-morbidities, were more likely to be vaccinated, and less likely to experience severe respiratory disease, systemic inflammation, coagulopathy, and death.

AB - Introduction: Understanding the changing epidemiology of adults hospitalized with coronavirus disease 2019 (COVID-19) informs research priorities and public health policies. Methods: Among adults (≥18 years) hospitalized with laboratory-confirmed, acute COVID-19 between 11 March 2021, and 31 August 2022 at 21 hospitals in 18 states, those hospitalized during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron-predominant period (BA.1, BA.2, BA.4/BA.5) were compared to those from earlier Alpha- and Delta-predominant periods. Demographic characteristics, biomarkers within 24 hours of admission, and outcomes, including oxygen support and death, were assessed. Results: Among 9825 patients, median (interquartile range [IQR]) age was 60 years (47-72), 47% were women, and 21% non-Hispanic Black. From the Alpha-predominant period (Mar-Jul 2021; N = 1312) to the Omicron BA.4/BA.5 sublineage-predominant period (Jun-Aug 2022; N = 1307): the percentage of patients who had ≥4 categories of underlying medical conditions increased from 11% to 21%; those vaccinated with at least a primary COVID-19 vaccine series increased from 7% to 67%; those ≥75 years old increased from 11% to 33%; those who did not receive any supplemental oxygen increased from 18% to 42%. Median (IQR) highest C-reactive protein and D-dimer concentration decreased from 42.0 mg/L (9.9-122.0) to 11.5 mg/L (2.7-42.8) and 3.1 mcg/mL (0.8-640.0) to 1.0 mcg/mL (0.5-2.2), respectively. In-hospital death peaked at 12% in the Delta-predominant period and declined to 4% during the BA.4/BA.5-predominant period. Conclusions: Compared to adults hospitalized during early COVID-19 variant periods, those hospitalized during Omicron-variant COVID-19 were older, had multiple co-morbidities, were more likely to be vaccinated, and less likely to experience severe respiratory disease, systemic inflammation, coagulopathy, and death.

KW - COVID-19

KW - SARS-CoV-2

KW - death

KW - hospitalization

KW - severe disease

UR - http://www.scopus.com/inward/record.url?scp=85165209486&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85165209486&partnerID=8YFLogxK

U2 - 10.1093/cid/ciad276

DO - 10.1093/cid/ciad276

M3 - Article

C2 - 37255285

AN - SCOPUS:85165209486

SN - 1058-4838

VL - 77

SP - 547

EP - 557

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

IS - 4

ER -

Changing Severity and Epidemiology of Adults Hospitalized with Coronavirus Disease 2019 (COVID-19) in the United States after Introduction of COVID-19 Vaccines, March 2021-August 2022

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this