Short- and longer-term all-cause mortality among SARS-CoV-2- infected individuals and the pull-forward phenomenon in Qatar: a national cohort study

• Published in: International journal of infectious diseases Vol. 136; pp. 81 - 90
• Main Authors: Chemaitelly, Hiam, Faust, Jeremy Samuel, Krumholz, Harlan M., Ayoub, Houssein H., Tang, Patrick, Coyle, Peter, Yassine, Hadi M., Al Thani, Asmaa A., Al-Khatib, Hebah A., Hasan, Mohammad R., Al-Kanaani, Zaina, Al-Kuwari, Einas, Jeremijenko, Andrew, Kaleeckal, Anvar Hassan, Latif, Ali Nizar, Shaik, Riyazuddin Mohammad, Abdul-Rahim, Hanan F., Nasrallah, Gheyath K., Al-Kuwari, Mohamed Ghaith, Butt, Adeel A., Al-Romaihi, Hamad Eid, Al-Thani, Mohamed H., Al-Khal, Abdullatif, Bertollini, Roberto, Abu-Raddad, Laith J.
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.11.2023; Elsevier
• Subjects: Acute infection; Cohort study; COVID-19; Death; Epidemiology; Immunity; Long COVID; COVID-19; Acute infection; Cohort study; Death; Long COVID; Immunity; Epidemiology
• ISSN: 1201-9712; 1878-3511
• DOI: 10.1016/j.ijid.2023.09.005

•Qatar's COVID-19 mortality was driven by infection among vulnerable persons.•There was excess mortality in short-term and deficit mortality in medium-term.•Observed pattern was particularly evident in clinically vulnerable individuals.•Vaccination prevented early deaths, regardless of vulnerability status. We assessed short-, medium-, and long-term all-cause mortality risks after a primary SARS-CoV-2 infection. A national, matched, retrospective cohort study was conducted in Qatar to assess risk of all-cause mortality in the national SARS-CoV-2 primary infection cohort compared with the national infection-naïve cohort. Associations were estimated using Cox proportional-hazards regression models. Analyses were stratified by vaccination status and clinical vulnerability status. Among unvaccinated persons, within 90 days after primary infection, the adjusted hazard ratio (aHR) comparing mortality incidence in the primary-infection cohort with the infection-naïve cohort was 1.19 (95% confidence interval 1.02-1.39). aHR was 1.34 (1.11-1.63) in persons more clinically vulnerable to severe COVID-19 and 0.94 (0.72-1.24) in those less clinically vulnerable. Beyond 90 days after primary infection, aHR was 0.50 (0.37-0.68); aHR was 0.41 (0.28-0.58) at 3-7 months and 0.76 (0.46-1.26) at ≥8 months. The aHR was 0.37 (0.25-0.54) in more clinically vulnerable persons and 0.77 (0.48-1.24) in less clinically vulnerable persons. Among vaccinated persons, mortality incidence was comparable in the primary-infection versus infection-naïve cohorts, regardless of clinical vulnerability status. COVID-19 mortality was primarily driven by an accelerated onset of death among individuals who were already vulnerable to all-cause mortality, but vaccination prevented these accelerated deaths.