Modelling factors associated with covid-19 mortality among patients admitted to Dr. Sumait Hospital in Mogadishu Somalia : implementing parametric AFT models

Abstract

Background: The coronavirus disease of 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first case of COVID-19 in Somalia was confirmed on March 16, 2020. The World Health Organization declared COVID-19 a pandemic on March 11, 2020. From March 2020 to September 2021, WHO reported 27,207 confirmed cases and 1,361 deaths in Somalia, resulting in a case fatality rate (CFR) of 5%. However, there is limited data on factors associated with COVID-19 related mortality among 293 admitted patients and time-to-death of in-patients in DR. Sumait Hospital in Mogadishu, Somalia. Therefore this study aimed to assess individual and clinical factors of COVID-19 mortality and determining time-to-death among patients admitted to DR. Sumait Hospital in Mogadishu Somalia. Methods: This retrospective cohort study examined 293 COVID-19 patients admitted to Dr. Sumait Hospital in Mogadishu from March 16, 2020, to November 16, 2021. Descriptive analysis of inpatient socio-demographic characteristics was conducted using mean and standard deviation for continuous variables and frequency and percentage for categorical variables. Accelerated Failure Time (AFT) models, rather than Cox proportional hazards models, were used to assess factors associated with survival time. Time Ratios (TR) with 95% confidence intervals (CI) were determined as measures of association for AFT models. Model goodness of fit was assessed using Cox-Snell residuals, Deviance residuals, AIC, and BIC. The proportional hazards (PH) assumption was tested with categorical variables. Data analysis was performed using Stata 14. Results: Among the 293 COVID-19 patients admitted to Dr. Sumait Hospital, 93 (32.1%) died, and 199 (67.9%) were discharged. The incidence rate of deaths was 14.05 deaths per 100,000 person-days, while discharge incidence was 0.84 or 84%. Of the patients, 137 (46.9%) were females, including 6 (4%) pregnant, and 155 (53.1%) were males. Most patients, 265 (90.8%), did not have hypertension, while 27 (9.2%) had hypertension. Diabetes was present in 218 patients (74.7%), and 74 (25.3%) were non-diabetic. Severe COVID-19 occurred in 77% of patients, with 23% having mild cases. Survival time increased by 1% for each additional year of age (adjusted.TR = 1.01; 95% CI: 1.00–1.01). Male patients had 6% lower survival time than females (adjusted.TR = 0.94; 95% CI: 0.88–0.99). Patients with hypertension had 33% lower survival time (adjusted.TR = 0.67; 95% CI: 0.63–0.71). Severe cases reduced survival time by 11% (adjusted.TR = 0.89; 95% CI: 0.81–0.90), while diabetes lowered survival by 1% (adjusted.TR = 0.99; 95% CI: 0.91–1.07). Conclusion: The study findings reveals that incidence rate of Covid-19 death in Dr. Sumait was 14.05 deaths per 100,000 person also indicated that individual factors such as age and urban residence significantly influenced survival while clinical factors like hypertension and severe disease status were associated with lower survival times and male patients’ also demonstrated reduced survival compared to females.