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2030-12-31
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THE IMPACT OF VACCINATION ON THE LENGTH OF STAY OF HOSPITALIZED COVID-19 PATIENTS IN BRAZIL
Hospitalization
Length of stay
Breakthrough infections
Competing risks
Survival analysis
Multi-state model
Author
Affilliation
Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Departamento de Epidemiologia. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST e AIDS. Rio de Janeiro, RJ, Brasil.
University of Oxford. Department of Paediatrics. Oxford, England, United Kingdom / Universidade Federal Fluminense. Faculdade de Medicina. Programa de Pós-Graduação em Ciências Médicas. Niterói, RJ, Brasil.
Fundação Getúlio Vargas. Escola de Matemática Aplicada. Rio de Janeiro, RJ, Brasil.
Fundação Getúlio Vargas. Escola de Matemática Aplicada. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST e AIDS. Rio de Janeiro, RJ, Brasil.
Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Departamento de Epidemiologia. Rio de Janeiro, RJ, Brasil / Universidade Federal do Rio de Janeiro. Instituto de Estudos em Saúde Coletiva. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Presidência. Programa de Computação Científica. Rio de Janeiro, RJ, Brasil.
Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Departamento de Epidemiologia. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST e AIDS. Rio de Janeiro, RJ, Brasil.
University of Oxford. Department of Paediatrics. Oxford, England, United Kingdom / Universidade Federal Fluminense. Faculdade de Medicina. Programa de Pós-Graduação em Ciências Médicas. Niterói, RJ, Brasil.
Fundação Getúlio Vargas. Escola de Matemática Aplicada. Rio de Janeiro, RJ, Brasil.
Fundação Getúlio Vargas. Escola de Matemática Aplicada. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST e AIDS. Rio de Janeiro, RJ, Brasil.
Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Departamento de Epidemiologia. Rio de Janeiro, RJ, Brasil / Universidade Federal do Rio de Janeiro. Instituto de Estudos em Saúde Coletiva. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Presidência. Programa de Computação Científica. Rio de Janeiro, RJ, Brasil.
Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Departamento de Epidemiologia. Rio de Janeiro, RJ, Brasil.
Abstract
Background: The length of hospital stays for severe COVID-19 cases significantly impacts the overall burden on the health system. Current COVID-19 vaccines have proven effective at reducing severe cases. However, the influence of vaccination status on the progression of COVID-19 after hospitalization is not well understood. Here, we estimated the impact of vaccination on the length of stay of hospitalized COVID-19 cases in Brazil. Methods: We utilized nationwide data from hospital stays due to COVID-19 and the vaccination status of over 1.6 million individuals who tested positive for COVID-19 between January 17, 2021, and January 31, 2022. A competing-risk survival analysis was conducted to assess the COVID-19 in-hospital progression. We considered the hospital pathway according to four states: ward, ICU, discharge and death and measuring the length of stay accordingly. Findings: Over half of hospital patients were unvaccinated. For patients aged 50-69-year-olds, the average length of stay for those discharged directly from the hospital ward (ward-to-discharge) ranged from 12.51 days (95 % CI, 12.39-12.63) in the unvaccinated to 11.02 days (95 % CI, 10.98-11.07) in booster recipients. Similar results were observed in the 20-49 and 70 or + age groups. For all age groups, the average time between hospital admission and ICU entrance was shorter in the unvaccinated. In the 50-69 age group, the average interval between ICU and discharge was 19.29 days (95 % CI, 18.95-19.64) in the unvaccinated and 16.92 days (95 % CI, 16.78-17.07) in the booster recipients, with a similar trend in other age groups. A higher discharge probability was observed among vaccinated individuals including hospital-to-discharge and ICU-to-discharge pathways. Interpretation: Vaccination reduced hospital admissions and length-of-stay across the hospital-to-discharge and ICU-to-discharge pathways, contributing to a reduced health system burden. Our results demonstrate that even when vaccines do not prevent severe cases leading to hospitalizations, they significantly shorten the duration of hospital stays.
Keywords
COVID-19Hospitalization
Length of stay
Breakthrough infections
Competing risks
Survival analysis
Multi-state model
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