# Survival, mortality and epidemic risk status of COVID-19: a population-based Study in Golestan province, Iran

## TL;DR

This study examines how the epidemic risk status of COVID-19 in Iran's Golestan province relates to patient survival and hospital outcomes.

## Contribution

The study introduces a novel approach to assess how epidemic risk levels correlate with mortality and hospitalization outcomes in a specific region.

## Key findings

- Patients in higher epidemic risk areas had significantly increased mortality rates compared to low-risk areas.
- Hospital stay duration varied significantly with factors like age, gender, and epidemic risk status.
- The study highlights the importance of preparedness and backup healthcare capacities to reduce deaths during health crises.

## Abstract

Appreciating the various dimensions of the coronavirus disease 2019 (COVID-19) pandemic can improve health systems and prepare them to deal better with future pandemics and public health events. This study was conducted to investigate the association between the survival of hospitalized patients with COVID-19 and the epidemic risk stratification of the disease in Golestan province, Iran.

In this study, all patients with COVID-19 who were hospitalized in the hospitals of Golestan province of Iran from February 20, 2020, to December 19, 2022, and were registered in the Medical Care Monitoring Center (MCMC) system (85,885 individuals) were examined.The community's epidemic risk status (ERS) was determined based on the daily incidence statistics of COVID-19. The survival distribution and compare Survival in different subgroups was investigated using Kaplan–Meier and log-rank test and association between the survival and ERS by multiple Cox regression modeling.

Out of 68,983 individuals whose data were correctly recorded, the mean age was 49 (SD = 23.98) years, and 52.8% were women. In total, 11.1% eventually died. The length of hospital stay was varying significantly with age, gender, ERS, underlying diseases, and COVID-19 severity (P < 0.001 for all). The adjusted hazard ratio of death for the ERS at medium, high, and very high-risk status compared to the low-risk status increased by 19%, 26%, and 56%, respectively (P < 0.001 for all).

Enhancing preparedness, facilitating rapid rises in hospital capacities, and developing backup healthcare capacities can prevent excessive hospital referrals during health crises and further deaths.