Prevalencia y factores asociados a la muerte de personas mayores hospitalizadas por Covid-19 en el estado de Paraná

Inoue, Luiz Hiroshi; Baccon, Wanessa Cristina; Pesce, Giovanna Brichi; Pereira, Natan David; Silva, Isabela Vanessa Tavares Cordeiro; Salci, Maria Aparecida; Vissoci, João Ricardo Nickenig; Facchini, Luiz Augusto; Carreira, Lígia

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 57 • 2023 • https://doi.org/10.1590/1980-220X-REEUSP-2023-0036en copiar

Prevalencia y factores asociados a la muerte de personas mayores hospitalizadas por Covid-19 en el estado de Paraná

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

Prevalencia y factores asociados a la muerte de personas mayores hospitalizadas por Covid-19 en el estado de Paraná*

Método:

Estudio transversal realizado con datos secundarios de personas mayores con diagnóstico positivo de Covid-19 residentes en el Estado de Paraná, recolectados del 1 de marzo de 2020 al 31 de agosto de 2021. Las razones de prevalencia se obtuvieron ajustando el modelo de regresión.

Resultados:

Se analizaron 16.153 muertes de personas mayores hospitalizadas en el Estado de Paraná. El modelo ajustado reveló asociación entre la muerte y algunos factores como: pertenecer al grupo etario de 75 a 84 años (RP = 1,28; IC_95% = 1,24–1,32) y 85 años o más (RP = 1,52; IC_95% = 1,45–1,59); masculino (RP = 1,17; IC_95% = 1,13–1,21); obesidad (RP = 1,23; IC_95% = 1,16–1,29); otras morbilidades (RP = 1,25; IC_95% = 1,20–1,30); y haber utilizado soporte ventilatorio (RP = 2,60; IC_95% = 2,33–2,86). Las personas mayores vacunadas contra la influenza tuvieron una probabilidad de muerte reducida en un 11% (RP = 0,89; IC_95% = 0,86–0,93).

Conclusión:

Se identificó la asociación de la edad, el sexo y el diagnóstico de comorbilidades previas con resultados desfavorables por Covid-19. Haber recibido la vacuna contra la gripe brindó protección a las personas mayores que contrajeron el SARS-CoV-2.

DESCRIPTORES
Anciano; Hospitalización; Mortalidad; Coronavirus; Enfermería

Variables	Case Progression						p-value
	Hospitalized (n = 35,580)		Hospital discharge (n = 19,427)		Deaths (n = 16,153)
	n	%	n	%	n	%
*Sociodemographic*
Age range							<0.0001
60 to 74	22,621	63.6	13,543	59.9	9,078	40.1
75 a 84	9,192	25.8	4,424	48.1	4,768	51.9
85 or over	3,767	10.6	1,460	38.8	2,307	61.2
Sex							<0.0001
Female	16.582	46.6	9.595	57.9	6.987	42.1
Male	18.998	53.4	9.832	51.8	9.166	48.2
Race/color							<0.0001
White	29.804	83.8	16.381	55.0	13.423	45.0
Black	5.281	14.8	2.785	52.7	2.496	47.3
Indigenous/Yellow	495	1.4	261	52.7	234	47.3
Lives in the city of hospitalization							<0.0001
Yes	23.412	65.8	13.221	56.5	10.191	43.5
No	12.168	34.2	6.206	51.0	5.962	49.0
*Clinical*
Flu vaccine							<0.0001
Yes	5.840	16.4	3.531	60.5	2.309	39.5
No	29.740	83.6	15.896	53.4	13.844	46.6
Diabetes
Yes	11.125	31.3	5.681	51.1	5.444	48.9	<0.0001
No	24.455	68.7	13.746	56.2	10.709	43.8	<0.0001
Heart diseases
Yes	17.012	47.8	8.739	51.4	8.273	48.6	<0.0001
No	18.568	52.2	10.688	57.6	7.880	42.4	<0.0001
Obesity
Yes	2.862	8.0	1.307	45.7	1.555	54.3	<0.0001
No	32.718	92.0	18.120	55.4	14.598	44.6	<0.0001
Other Morbidities^* *Immunodeficiency; asthma; other chronic lung disease; chronic neurological disease; chronic kidney disease. †Cough; sore throat; abdominal pain; fatigue; loss of smell; loss of taste. ‡Fever; O2 saturation <95%; diarrhea; vomiting; dyspnea; respiratory discomfort.
Yes	6.837	19.2	2.880	42.1	3.957	57.9	<0.0001
No	28.743	80.8	16.547	57.6	12.196	42.4	<0.0001
Symptoms
Common/Mild^† *Immunodeficiency; asthma; other chronic lung disease; chronic neurological disease; chronic kidney disease. †Cough; sore throat; abdominal pain; fatigue; loss of smell; loss of taste. ‡Fever; O2 saturation <95%; diarrhea; vomiting; dyspnea; respiratory discomfort.	1.378	3.9	921	66.8	457	33.2	<0.0001
Moderate/Severe^‡ *Immunodeficiency; asthma; other chronic lung disease; chronic neurological disease; chronic kidney disease. †Cough; sore throat; abdominal pain; fatigue; loss of smell; loss of taste. ‡Fever; O2 saturation <95%; diarrhea; vomiting; dyspnea; respiratory discomfort.	34.202	96.1	18.506	54.1	15.696	45.9	<0.0001
Use of Ventilatory Support
Yes	29.337	82.5	14.366	49.0	14.971	51.0	<0.0001
No	6,243	17.5	5,061	81.1	1,182	18.9	<0.0001

Variables	Death (n = 16,153)		Raw Model		p-value
Variables	n	%	PR	CI 95%	p-value
*Sociodemographic*
Age range
60 to 74	9,078	40.1	Reference	–	–
75 a 84	4,768	51.9	1.29	1.26–1.33	<0.0001
85 or over	2,307	61.2	1.53	1.48–1.57	0.0010
Sex
Female	6,987	42.1	Reference	–	–
Male	9,166	48.2	1.15	1.12–1.17	<0.0001
Race/color
White	13,423	45.0	Reference	–	–
Black	2,496	47.3	1.05	1.02–1.08	0.0027
Indigenous/Yellow	234	47.3	1.05	0.96–1.15	0.3215
Lives in the city of hospitalization
Yes	10,191	43.5	Reference	–	–
No	5,962	49.0	1.13	1.10–1.15	<0.0001
*Clinical*
Flu vaccine
No	13,844	46.6	Reference	–	–
Yes	2,309	39.5	0.85	0.82–0.88	<0.0001
Diabetes
No	10,709	43.8	Reference	–	–
Yes	5,444	48.9	1.12	1.09–1.14	<0.0001
Heart diseases
No	7,880	42.4	Reference	–	–
Yes	8,273	48.6	1.15	1.12–1.17	<0.0001
Obesity
No	14,598	44.6	Reference	–	–
Yes	1,555	54.3	1.21	1.18–1.26	<0.0001
Other Morbidities^* *Immunodeficiency; asthma; other chronic lung disease; chronic neurological disease; chronic kidney disease. †Cough; sore throat; abdominal pain; fatigue; loss of smell; loss of taste. ‡Fever; O2 saturation <95%; diarrhea; vomiting; dyspnea; respiratory discomfort.
No	12,196	42.4	Reference	–	–
Sim	3,957	57.9	1.36	1.33–1.40	<0.0001
Symptoms
Common/Mild^† *Immunodeficiency; asthma; other chronic lung disease; chronic neurological disease; chronic kidney disease. †Cough; sore throat; abdominal pain; fatigue; loss of smell; loss of taste. ‡Fever; O2 saturation <95%; diarrhea; vomiting; dyspnea; respiratory discomfort.	457	33.2	Reference	–	–
Moderate/Severe^‡ *Immunodeficiency; asthma; other chronic lung disease; chronic neurological disease; chronic kidney disease. †Cough; sore throat; abdominal pain; fatigue; loss of smell; loss of taste. ‡Fever; O2 saturation <95%; diarrhea; vomiting; dyspnea; respiratory discomfort.	15,696	45.9	1.38	1.28–1.49	<0.0001
Use of Ventilatory Support
No	1,182	18.9	Reference	–	–
Yes	14,971	51.0	2.70	2.56–2.84	<0.0001

Variables	Death (n = 16,153)		Adjusted Model		p-value
Variables	n	%	PR	CI 95%	p-value
*Sociodemographic*
Age range
60 to 74	9,078	40.1	Reference	–	–
75 a 84	4,768	51.9	1.28	1.24–1.32	<0.0001
85 or over	2,307	61.2	1.52	1.45–1.59	<0.0001
Sex
Female	6,987	42.1	Reference	–	–
Male	9,166	48.2	1.17	1.13–1.21	<0.0001
*Clinical*
Flu vaccine
No	13,844	46.6	Reference	–	–
Yes	2,309	39.5	0.89	0.86–0.93	<0.0001
Diabetes
No	10,709	43.8	Reference	–	–
Yes	5,444	48.9	1.09	1.06–1.13	<0.0001
Obesity
No	14,598	44.6	Reference	–	–
Yes	1,555	54.3	1.23	1.16–1.29	<0.0001
*Other Morbidities^ Immunodeficiency; asthma; other chronic lung disease; chronic neurological disease; chronic kidney disease.*
No	12,196	42.4	Reference	–	–
Yes	3,957	57.9	1.25	1.20–1.30	<0.0001
Use of Ventilatory Support
No	1,182	18.9	Reference	–	–
Yes	14,971	51.0	2.60	2.33–2.86	<0.0001

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E-mail: reeusp@usp.br

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[1] Corresponding author: Luiz Hiroshi Inoue, Rua João Fregadolli, 161, Jardim Dias I, 87025-756, Maringá, PR, Brazil, lhinoue17@gmail.com