# Individual and contextual factors associated with the survival of patients with severe acute respiratory syndrome by COVID-19 in Brazil

## TL;DR

This study examines how individual and hospital/municipal factors affect survival rates of severe COVID-19 patients in Brazil.

## Contribution

It identifies the combined impact of individual and contextual factors on hospital survival in a large Brazilian cohort.

## Key findings

- Hospital lethality was 30.4% for severe COVID-19 patients.
- Elderly patients on invasive ventilation in low-tax cities had lower survival rates.
- Contextual factors like hospital and municipal characteristics significantly influence survival.

## Abstract

To analyze the influence of individual and contextual factors of the hospital
and the municipality of care on the survival of patients with Severe Acute
Respiratory Syndrome due to COVID-19.

Hospital cohort study with data from 159,948 adults and elderly with Severe
Acute Respiratory Syndrome due to COVID-19 hospitalized from January 1 to
December 31, 2022 and reported in the Influenza Epidemiological Surveillance
Information System. The contextual variables were related to the structure,
professionals and equipment of the hospital establishments and socioeconomic
and health indicators of the municipalities. The outcome was hospital
survival up to 90 days. Survival tree and Kaplan-Meier curves were used for
survival analysis.

Hospital lethality was 30.4%. Elderly patients who underwent invasive
mechanical ventilation and were hospitalized in cities with low tax
collection rates had lower survival rates compared to other groups
identified in the survival tree (p<0.001).

The study indicated the interaction of contextual factors with the individual
ones, and it shows that hospital and municipal characteristics increase the
risk of death, highlighting the attention to the organization, operation,
and performance of the hospital network.