In-hospital mortality among older patients in France (2018–2024): Analysis of death predictors before and after COVID-19
Year: 2026
Type: article
Study design: Observational Study
Abstract: Introduction The world's ageing population is increasingly affected by comorbidities, placing pressure on already strained healthcare systems. The indirect impact of the COVID-19 pandemic remains unclear, especially for those aged 65 years and older. This study provides an overview of the health status of hospitalised elderly patients following the COVID-19 period by describing evolutions in in-hospital mortality trends and investigating how predictors of mortality have evolved from the pre-COVID-19 to the post-COVID-19 period. Methods We conducted a retrospective and observational study leveraging the French hospital database, involving all hospitalisations of patients aged 65 years and older between 2018 and 2024. Crude and standardised mortality rates were calculated and multivariable logistic regression models, including interaction terms, were used to identify mortality predictors and assess changes before (2018-2019) and after (2023-2024) the pandemic. Results Among 30 506 467 hospitalisations, 1 747 712 inhospital deaths occurred, resulting in an overall mortality rate of 5.73%. Crude in-hospital mortality rates increased post-COVID-19 (2023: 5.68%, 2024: 5.62%) compared with pre-pandemic levels (2018: 5.15%, 2019: 5.22%). However, age-and sex-standardised analyses showed a decline in mortality across most age-sex strata in the post-COVID-19 period. Several predictors of mortality became more strongly associated with death in the post-pandemic period, including dementia, palliative care, medical type of hospitalisation and the type of hospital with a widening disparity between public and private. Conversely, older age (80 years and older), admission to an acute geriatric unit or critical care unit, high severity levels and positive Elixhauser comorbidity score were associated with attenuated mortality post-pandemic. Conclusions Post-pandemic in-hospital mortality patterns among older patients should be interpreted considering both demographic ageing and possible indirect effects of the COVID-19 period on healthcare dynamics and patient vulnerability, underscoring the need for targeted public health strategies to address persistent vulnerabilities in elderly care and strengthen health system resilience.
Source: BMJ Public Health
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7225385168