The first 20 months of the COVID-19 pandemic: Mortality, intubation and ICU rates among 104,590 patients hospitalized at 21 United States health systems

Michael C. Fiore, Stevens S. Smith, Robert T. Adsit, Daniel M. Bolt, Karen L. Conner, Steven L. Bernstein, Oliver D. Eng, David Lazuk, Alec Gonzalez, Douglas E. Jorenby, Heather D’Angelo, Julie A. Kirsch, Brian Williams, Margaret B. Nolan, Todd Hayes-Birchler, Sean Kent, Hanna Kim, Thomas M. Piasecki, Wendy S. Slutske, Stan LubanskiMenggang Yu, Youmi Suk, Yuxin Cai, Nitu Kashyap, Jomol P. Mathew, Gabriel McMahan, Betsy Rolland, Hilary A. Tindle, Graham W. Warren, Lawrence C. An, Andrew D. Boyd, Darlene H. Brunzell, Victor Carrillo, Li Shiun Chen, James M. Davis, Deepika Dilip, Edward F. Ellerbeck, Eduardo Iturrate, Thulasee Jose, Niharika Khanna, Andrea King, Elizabeth Klass, Michael Newman, Kimberly A. Shoenbill, Elisa Tong, Janice Y. Tsoh, Karen M. Wilson, Wendy E. Theobald, Timothy B. Baker

Research output: Contribution to journalArticlepeer-review


Main objective There is limited information on how patient outcomes have changed during the COVID-19 pandemic. This study characterizes changes in mortality, intubation, and ICU admission rates during the first 20 months of the pandemic. Study design and methods University of Wisconsin researchers collected and harmonized electronic health record data from 1.1 million COVID-19 patients across 21 United States health systems from February 2020 through September 2021. The analysis comprised data from 104,590 adult hospitalized COVID-19 patients. Inclusion criteria for the analysis were: (1) age 18 years or older; (2) COVID-19 ICD-10 diagnosis during hospitalization and/or a positive COVID-19 PCR test in a 14-day window (+/- 7 days of hospital admission); and (3) health system contact prior to COVID-19 hospitalization. Outcomes assessed were: (1) mortality (primary), (2) endotracheal intubation, and (3) ICU admission. Results and significance The 104,590 hospitalized participants had a mean age of 61.7 years and were 50.4% female, 24% Black, and 56.8% White. Overall risk-standardized mortality (adjusted for age, sex, race, ethnicity, body mass index, insurance status and medical comorbidities) declined from 16% of hospitalized COVID-19 patients (95% CI: 16% to 17%) early in the pandemic (February-April 2020) to 9% (CI: 9% to 10%) later (July-September 2021). Among subpopulations, males (vs. females), those on Medicare (vs. those on commercial insurance), the severely obese (vs. normal weight), and those aged 60 and older (vs. younger individuals) had especially high mortality rates both early and late in the pandemic. ICU admission and intubation rates also declined across these 20 months. Conclusions Mortality, intubation, and ICU admission rates improved markedly over the first 20 months of the pandemic among adult hospitalized COVID-19 patients although gains varied by sub-population. These data provide important information on the course of COVID-19 and identify hospitalized patient groups at heightened risk for negative outcomes. Trial registration Identifier: NCT04506528 ( NCT04506528).

Original languageEnglish (US)
Article numbere0274571
JournalPloS one
Issue number9 September
StatePublished - Sep 2022
Externally publishedYes

ASJC Scopus subject areas

  • General


Dive into the research topics of 'The first 20 months of the COVID-19 pandemic: Mortality, intubation and ICU rates among 104,590 patients hospitalized at 21 United States health systems'. Together they form a unique fingerprint.

Cite this