One-year mortality and associated factors in older hospitalized COVID-19 survivors: a Nationwide Cohort Study in Korea
Eunji Kim, Jeong-Yeon Kim, Kyoung Min Moon, Tae Wan Kim, Won-Young Kim, Sun‑young Jung, Moon Seong Baek
Scientific Reports, doi:10.1038/s41598-024-76871-3
This study aimed to evaluate the 1-year mortality rate among older patients with COVID-19 discharged from hospital and to identify risk factors associated with this outcome. Using a COVID-19 dataset from the Korean National Health Insurance System, this study's evaluation period spanned from October 8, 2020, through December 31, 2021. The primary outcome was the 1-year mortality rate following hospital discharge. A logistic regression model was employed for multivariable analysis to estimate the odds ratios for the outcomes, and the Kaplan-Meier method was used to analyze differences in 1-year survival rates. Among the 66,810 COVID-19 patients aged 60 years or older who were hospitalized during the study period, the in-hospital mortality rate was 4.8% (n = 3219). Among the survivors (n = 63,369), the 1-year mortality rate was 4.9% (n = 3093). Non-survivors, compared to survivors, were significantly older (79.2 ± 9.5 vs. 68.9 ± 7.8, P < 0.001) and exhibited a lower rate of COVID-19 vaccination (63.0% vs. 91.7%, P < 0.001). Additionally, non-survivors experienced a higher incidence of organ dysfunction, along with a greater proportion of required mechanical ventilation (14.6% vs. 1.0%, P < 0.001) and extracorporeal membrane oxygenation (4.0% vs. 0.1%, P < 0.001). Multivariable logistic regression analysis identified older age, male sex, cardiovascular disease, immunosuppression, organ dysfunction, illness severity, and corticosteroid use during hospitalization as factors associated with death within 1 year after hospital discharge. However, vaccination was found to have a long-term protective effect against death among COVID-19 survivors. The 1-year mortality rate after hospital discharge for older COVID-19 patients was comparable to the in-hospital mortality rate for these patients in Korea. The long-term mortality rate among hospitalized older COVID-19 patients was influenced by demographic factors and the severity of illness experienced during hospitalization.
Author contributions MSB and SYJ conceived and designed the study. EK, JYK, SYJ, and MSB collected the primary data and conducted data analyses. EK, KMM, TWK, WYK, SYJ, and MSB interpreted the results and prepared the first draft. All the authors revised the draft for important intellectual content and approved the final manuscript submitted for publication.
Declarations Competing interests The authors declare no competing interests.
Ethics approval and consent to participate The study protocol was approved by the Institutional Review Board of Chung-Ang University (1041078-20221111-BR-010). Informed consent was waived because data analyses were performed retrospectively using anonymized data from the South Korean NHIS database. All procedures in this study were performed according to the relevant guidelines and regulations.
Consent for publication Not applicable.
Additional information
Supplementary Information The online version contains supplementary material available at https://doi. org/10.1038/s41598-024-76871-3 .
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