Study finds regional disparities in quality of Covid-19 care

A study has found the mortality of severely ill Covid-19 patients in Greek hospitals is negatively affected by the high numbers of patients in hospital, as well as by regional differences in the quality of care.

The study, authored by Sotiris Tsiodras, the head of infectious diseases of the National Public Health Organization, and epidemiologist Theodoros Lytras, professor of public health at the European University of Cyprus, found that “that in-hospital mortality of severely ill Covid-19 patients is adversely affected by high patient load even without exceeding capacity, as well as by regional disparities.”

“This highlights the need for more substantial strengthening of healthcare services, focusing on equity and quality of care besides just expanding capacity,” the experts state in their conclusion to the paper, which was published in the Scandinavian Journal of Public Health.

The study finds that although public health services in Greece increased significantly during the pandemic, the quality of health under the pressure of increased hospital admissions has received less attention.

By looking at data on all intubated Covid-19 patients in the country from September 1, 2020 to May 6, 2021, the two scientists concluded that the increased pressure on hospitals led to a higher mortality rate among intubated patients.

The risk of death gradually increased for every hundred patients intubated in the health system. When more than 400 patients were intubated at the same time, their risk of death increased on average by 1.25 times compared when there were fewer than 400 on ventilators. When the number of intubated went above 800, the risk of death was 1.57 times greater.

“This represents a major preventable factor to limit avoidable deaths from COVID-19, and highlights the need for more extensive investment in healthcare beyond the minimum to meet peak demand during the pandemic, thereby ensuring adequate quality of care,” the authors state.

The study notes that in Thessaloniki, although the age of the Covid victims examined was lower than in Athens, the mortality rate was 35% higher. In the rest of Greece, except for Attica, mortality was 40% higher.

“This highlights the chronically uneven regional distribution of healthcare resources in Greece, with beds, equipment and trained healthcare workers concentrated in metropolitan areas,” the scientists state.

Regarding deaths outside of intensive care units, the two authors note that intubation outside ICU has a mortality rate of 87%.

However, they emphasize that the data must be interpreted with care as the sample was small (5% of all intubated patients) and may concern the screening of the most seriously ill patients.

Tsiodras and Lytras conclude that out of the 3,988 deaths examined, 1,535 were “attributable” to the high load of intubated Covid-19 patients, to being outside an ICU and to being hospitalized outside of from Attica.