Elsevier

Annals of Epidemiology

Volume 72, August 2022, Pages 57-64
Annals of Epidemiology

Original article
Declining COVID-19 case-fatality in Georgia, USA, March 2020 to March 2021: a sign of real improvement or a broadening epidemic?

https://doi.org/10.1016/j.annepidem.2022.05.008Get rights and content
Under a Creative Commons license
open access

Abstract

Purpose

To examine whether declines in the crude U.S. COVID-19 case fatality ratio is due to improved clinical care and/or other factors.

Methods

We used multivariable logistic regression, adjusted for age and other individual-level characteristics, to examine associations between report month and mortality among confirmed and probable COVID-19 cases and hospitalized cases in Georgia reported March 2, 2020 to March 31, 2021.

Results

Compared to August 2020, mortality risk among cases was lowest in November 2020 (OR = 0.84; 95% CI: 0.78–0.91) and remained lower until March 2021 (OR = 0.86; 95% CI: 0.77–0.95). Among hospitalized cases, mortality risk increased in December 2020 (OR = 1.16, 95% CI: 1.07–1.27) and January 2021 (OR = 1.25; 95% CI: 1.14–1.36), before declining until March 2021 (OR = 0.90, 95% CI: 0.78–1.04).

Conclusions

After adjusting for other factors, including the shift to a younger age distribution of cases, we observed lower mortality risk from November 2020 to March 2021 compared to August 2020 among cases. This suggests that improved clinical management may have contributed to lower mortality risk. Among hospitalized cases, mortality risk increased again in December 2020 and January 2021, but then decreased to a risk similar to that among all cases by March 2021.

Keywords

Covid-19
Sars-cov-2
Mortality
Case fatality
Risk factors

Cited by (0)

Carly Adams reports financial support was provided by Agency for Healthcare Research and Quality. Benjamin A. Lopman reports financial support was provided by Agency for Healthcare Research and Quality. Carly Adams reports financial support was provided by National Science Foundation. Benjamin A. Lopman reports financial support was provided by National Science Foundation. Carly Adams reports financial support was provided by The Emory Covid-19 Response Collaborative, which is funded by a grant from the Robert W. Woodruff Foundation. Benjamin A. Lopman reports financial support was provided by The Emory Covid-19 Response Collaborative, which is funded by a grant from the Robert W. Woodruff Foundation. Allison Chamberlain reports financial support was provided by The Emory Covid-19 Response Collaborative, which is funded by a grant from the Robert W. Woodruff Foundation. Benjamin A. Lopman reports a relationship with Takeda Pharmaceuticals USA Inc that includes: consulting or advisory and funding grants. Benjamin A. Lopman reports a relationship with World Health Organization that includes: consulting or advisory. Allison Chamberlain reports a relationship with Fulton County Board of Health that includes: consulting or advisory.

Benjamin A. Lopman reports grants and personal fees from Takeda Pharmaceuticals and personal fees from the World Health Organization, outside the submitted work. Allison Chamberlain is a consultant with the Fulton County Board of Health.