Trends in COVID-19–Attributable Hospitalizations Among Adults With Laboratory-Confirmed SARS-CoV-2—COVID-NET, June 2020 to September 2023

Abstract

Background

Screening for SARS-CoV-2 infection among hospital admissions made interpretation of COVID-19 hospitalization data challenging as SARS-CoV-2–positive persons with mild or asymptomatic infection may be incorrectly identified as COVID-19–associated hospitalizations. The study objective is to estimate the proportion of hospitalizations likely attributable to COVID-19 among SARS-CoV-2–positive hospitalized patients.

Methods

A sample of laboratory-confirmed SARS-CoV-2–positive hospitalizations from the COVID-19–Associated Hospitalization Surveillance Network (COVID-NET) from June 2020 to September 2023 was analyzed, with a focus on July 2022 to September 2023. Likely COVID-19–attributable hospitalizations were defined as hospitalizations among SARS-CoV-2–positive non-pregnant adults ages ≥ 18 years with COVID-19–related presenting complaint, treatment, or discharge diagnosis.

Results

Among 44,816 sampled hospitalizations, 90% met the definition of likely COVID-19–attributable. Among the 9866 admissions occurring during July 2022 to September 2023, 86% were likely COVID-19–attributable; 87% had a COVID-19–related presenting complaint, 64% received steroids or COVID-19–related treatment, 47% had respiratory- and 10% had coagulopathy-related discharge diagnoses, and 39% had COVID-19 as the principal discharge diagnosis code. More than 70% met ≥ 2 criteria. Compared with likely COVID-19–attributable hospitalizations, SARS-CoV-2–positive patients who did not meet the case definition were more likely to be ages 18–49 years (27% vs. 13%), have no underlying medical conditions (14% vs. 4%), or be asymptomatic for COVID-19 upon admission (46% vs. 10%) (all p < 0.05).

Conclusions

Most hospitalizations among SARS-CoV-2–positive adults in a recent period were likely attributable to COVID-19. COVID-19–attributable hospitalizations are less common among younger SARS-CoV-2–positive hospitalized adults but still account for nearly three quarters of all admissions among SARS-CoV-2–positive adults in this age group.