Early Death Among COVID-19 Patients: A Cross-sectional Analysis of the First 10,000 COVID-19 Deaths from the Indian State of Tamil Nadu

Abstract Background Tamil Nadu state reported the second highest number of confirmed COVID-19 cases in India. In this study, we aimed to describe and determine the risk factors for early death among the first 10,000 COVID-19 deaths in the state. Methods We conducted a cross sectional analysis of state government administrative data to describe deaths, examine the differences between early deaths and non-early deaths, and calculate the risks of early death for several independent variables. All p -values < 0.05 were considered statistically significant. Results In total, 4147 early deaths (41.5%) were recorded; the median age of patients who suffered from early death was significantly lower [64 years; interquartile range (IQR): 55–72] when compared with patients who did not suffer from early death (65 years; IQR: 56–73). After adjusting for comorbidities, age, and the time elapsed from the onset of symptoms to hospitalization; we found that the risk of early death was significantly lower for males [adjusted odds ratio (aOR): 0.82; 95% confidence interval (CI): 0.72, 0.93; p = 0.002], among rich individuals (aOR: 0.76; 95% CI: 0.63, 0.92; p = 0.004), in the richest districts (aOR: 0.70; 95% CI: 0.59, 0.84; p < 0.001) and for those who received treatment in private facilities (aOR: 0.45; 95% CI: 0.40, 0.51; p < 0.001. Conclusions The risk of early deaths among the first 10,000 reported COVID deaths in the Tamil Nadu state of India was higher in patients treated in government hospitals especially in the poorest districts probably indicating a lack of infrastructure in government facilities or the overburdening of government facilities at least in the early phase of the pandemic.