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BMC Public Health
Published in: BMC Public Health 1/2022

Open Access 01-12-2022 | COVID-19 | Research

National geographical pattern of COVID-19 hospitalization, case fatalities, and associated factors in patients covered by Iran Health Insurance Organization

Authors: Soheila Damiri, Ali Shojaee, Mohsen Dehghani, Zahra Shahali, Sadrollah Abbasi, Rajabali Daroudi

Published in: BMC Public Health | Issue 1/2022

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Abstract

Background

Understanding the Spatio-temporal distribution and interpersonal comparisons are important tools in etiological studies. This study was conducted to investigate the temporal and geographical distribution of COVID-19 hospitalized patients in the Iran Health Insurance Organization (IHIO) insured population (the second largest social health insurance organization) and the factors affecting their case fatality rate (CFR).

Methods

In this descriptive-analytical cross-sectional study, the demographic and clinical data of all insured of the IHIO who were hospitalized with COVID-19 in hospitals across the country until March 2021 was extracted from the comprehensive system of handling the inpatient documents of this organization. The Excel 2019 and GeoDA software were used for descriptive reporting and geographical distribution of variables. A multiple logistic regression model was used to estimate the Odds Ratio (OR) of death in patients with COVID-19 using STATA 14 software.

Results

During the first 14 months of the COVID-19 outbreak in Iran, 0.72% of the IHIO insured (303,887 individuals) were hospitalized with COVID-19. Hospitalization per 100,000 people varied from 192.51 in East Azerbaijan to 1,277.49 in Yazd province. The overall CFR in hospitalized patients was 14%. Tehran and Kohgiluyeh & BoyerAhmad provinces had the highest and lowest CFR with 19.39% and 5.19%, respectively. The highest odds of death were in those over 80 years old people (OR = 9.65), ICU-admitted (OR = 7.49), Hospitalized in governmental hospitals (OR = 2.08), Being a foreign national (OR = 1.45), hospitalized in November (OR = 1.47) and Residence in provinces such as Sistan & Baluchestan (OR = 1.47) and Razavi Khorasan (OR = 1.66) respectively. Furthermore, the odds of death were lower in females (OR = 0.81) than in males.

Conclusions

A sound understanding of the primary causes of COVID-19 death and severity in different groups can be the basis for developing programs focused on more vulnerable groups in order to manage the crisis more effectively and benefit from resources more efficiently.
Appendix
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Literature
1.
2.
3.
4.
Sachs J, Kroll C, Lafortune G, Fuller G, Woelm F. Sustainable Development Report 2021. Cambridge University Press; 2021. p. 1-7.
5.
6.
Rezaeian M, Dunn G, St Leger S, Appleby L. Geographical epidemiology, spatial analysis and geographical information systems: a multidisciplinary glossary. J Epidemiol Community Health. 2007;61(2):98–102.PubMedPubMedCentralCrossRef
7.
Nicodemo C, Barzin S, Lasserson D, Moscone F, Redding S, Shaikh M. Measuring geographical disparities in England at the time of COVID-19: results using a composite indicator of population vulnerability. BMJ Open. 2020;10(9): e039749.PubMedPubMedCentralCrossRef
8.
Jackson SL, Derakhshan S, Blackwood L, Lee L, Huang Q, Habets M, Cutter SL. Spatial disparities of COVID-19 Cases and fatalities in United States Counties. Int J Environ Res Public Health. 2021;18(16):8259.PubMedPubMedCentralCrossRef
9.
10.
Sun F, Matthews SA, Yang T-C, Hu M-H. A spatial analysis of the COVID-19 period prevalence in US counties through June 28, 2020: where geography matters? Ann Epidemiol. 2020;52(54–59): e51.
11.
Zhang CH, Schwartz GG. Spatial disparities in coronavirus incidence and mortality in the United States: an ecological analysis as of May 2020. J Rural Health. 2020;36(3):433–45.PubMedPubMedCentralCrossRef
12.
Bertuzzo E, Mari L, Pasetto D, Miccoli S, Casagrandi R, Gatto M, Rinaldo A. The geography of COVID-19 spread in Italy and implications for the relaxation of confinement measures. Nat Commun. 2020;11(1):1–11.CrossRef
13.
14.
Holmager TL, Lynge E, Kann CE, St-Martin G. Geography of COVID-19 in Denmark. Scand J Public Health. 2021;49(1):88–95.PubMedCrossRef
15.
Florida R, Mellander C. The geography of COVID-19 in Sweden. Ann Reg Sci. 2022;68(1):125-50.
16.
Lima EECd, Gayawan E, Baptista EA, Queiroz BL. Spatial pattern of COVID-19 deaths and infections in small areas of Brazil. Plos One. 2021;16(2):e0246808.PubMedPubMedCentralCrossRef
17.
Jalili M, Payandemehr P, Saghaei A, Sari HN, Safikhani H, Kolivand P. Characteristics and mortality of hospitalized patients with COVID-19 in Iran: a National Retrospective Cohort Study. Ann Intern Med. 2021;174(1):125–7.PubMedCrossRef
18.
Yoosefi Lebni J, Abbas J, Moradi F, Salahshoor MR, Chaboksavar F, Irandoost SF, Nezhaddadgar N, Ziapour A. How the COVID-19 pandemic effected economic, social, political, and cultural factors: a lesson from Iran. Int J Soc Psychiatry. 2021;67(3):298–300.PubMedCrossRef
19.
Sari AA, Rezaei S, Rad EH, Dehghanian N, Chavehpour Y. Regional disparity in physical resources in the health sector in Iran: a comparison of two time periods. Iran J Public Health. 2015;44(6):848.
20.
21.
Kiadaliri AA, Najafi B, Haghparast-Bidgoli H. Geographic distribution of need and access to health care in rural population: an ecological study in Iran. Int J Equity Health. 2011;10(1):1–7.
22.
23.
Moradi-Lakeh M, Bijari B, Namiranian N, Olyaeemanesh A-R, Khosravi A. Geographical disparities in child mortality in the rural areas of Iran: 16-years trend. J Epidemiol Community Health. 2013;67(4):346–9.PubMedCrossRef
24.
Hazbavi Z, Mostfazadeh R, Alaei N, Azizi E. Spatial and temporal analysis of the COVID-19 incidence pattern in Iran. Environ Sci Pollut Res. 2021;28(11):13605–15.CrossRef
25.
Bazargan M, Amirfakhriyan M. Geographical Analysis of COVID-19 Epidemiology in Iran with Exploratory Spatial Data Analysis Approach (ESDA). J Milit Med. 2020;22(6):542–52 (in persian).
26.
Saberian P, Rafiemanesh H, Sadeghi M, Hasani-Sharamin P, Dadashi F, Baratloo A. The Geographical Distribution of Probable COVID-19 Patients Transferred by Tehran Emergency Medical Services; a Cross Sectional Study. Arch Acad Emerg Med. 2021;9(1):e25. https://​doi.​org/​10.​22037/​aaem.​v9i1.​1177.
27.
Lak A, Zali A, Badr S, Mostafavi E, Baradaran HR, Hanani K, Toomanian A, Khalili D. A description of spatial-temporal patterns of the novel COVID-19 outbreak in the neighbourhoods’ scale in Tehran. Iran Med J The Islam Repub Iran. 2021;35(1):954–61.
28.
Dastjerdi HK, Nasrabadi NH. Exploring the role of place on COVID-19 spatial distribution in 22 districts of Tehran, Iran. Spat Inf Res. 2021;29(6):871-86.
29.
Rahnama MR, Bazargan M. Analysis of spatio-temporal patterns of Covid-19 virus pandemic and its hazards in Iran. Environ Manag Hazards. 2020;7(2):113-27.
30.
Gray WK, Navaratnam AV, Day J, Babu P, Mackinnon S, Adelaja I, Bartlett-Pestell S, Moulton C, Mann C, Batchelor A. Variability in COVID-19 in-hospital mortality rates between national health service trusts and regions in England: a national observational study for the getting it right first time programme. EClinicalMedicine. 2021;35: 100859.PubMedPubMedCentralCrossRef
31.
32.
Doshmangir L, Bazyar M, Rashidian A, Gordeev VS. Iran health insurance system in transition: equity concerns and steps to achieve universal health coverage. Int J Equity Health. 2021;20(1):1–14.CrossRef
33.
34.
35.
36.
Review and payment of bills of medical records of medical institutions that are parties to the contract with the Health Insurance Organization. https://​ihio.​gov.​ir. Accessed 17 Oct 2021. [in persian].
37.
38.
39.
Khoshnood RJ, Ommi D, Zali A, Ashrafi F, Vahidi M, Azhide A, Shirini D, Sanadgol G, Khave LJ, Nohesara S. Epidemiological characteristics, clinical features, and outcome of COVID-19 patients in northern Tehran, Iran; a cross-sectional study. Adv J Emerg Med. 2020;5(1):e11.
40.
Zali A, Gholamzadeh S, Mohammadi G, Looha MA, Akrami F, Zarean E, Vafaee R, Maher A, Khodadoost M. Baseline characteristics and associated factors of mortality in COVID-19 Patients; an analysis of 16000 cases in Tehran, Iran. Arch Acad Emerg Med. 2020;8(1):e70.
41.
Bellan M, Patti G, Hayden E, Azzolina D, Pirisi M, Acquaviva A, Aimaretti G, Valletti PA, Angilletta R, Arioli R. Fatality rate and predictors of mortality in an Italian cohort of hospitalized COVID-19 patients. Sci Rep. 2020;10(1):1–10.CrossRef
42.
Navaratnam AV, Gray WK, Day J, Wendon J, Briggs TW. Patient factors and temporal trends associated with COVID-19 in-hospital mortality in England: an observational study using administrative data. Lancet Respir Med. 2021;9(4):397–406.PubMedPubMedCentralCrossRef
43.
Bertsimas D, Lukin G, Mingardi L, Nohadani O, Orfanoudaki A, Stellato B, Wiberg H, Gonzalez-Garcia S, Parra-Calderon CL, Robinson K. COVID-19 mortality risk assessment: an international multi-center study. Plos One. 2020;15(12): e0243262.PubMedPubMedCentralCrossRef
44.
Asch DA, Sheils NE, Islam MN, Chen Y, Werner RM, Buresh J, Doshi JA. Variation in US hospital mortality rates for patients admitted with COVID-19 during the first 6 months of the pandemic. JAMA Intern Med. 2021;181(4):471–8.PubMedCrossRef
45.
Liang L-L, Tseng C-H, Ho HJ, Wu C-Y. Covid-19 mortality is negatively associated with test number and government effectiveness. Sci Rep. 2020;10(1):1–7.CrossRef
46.
47.
Raza HA, Sen P, Bhatti OA, Gupta L. Sex hormones, autoimmunity and gender disparity in COVID-19. Rheumatol Int. 2021;41(8):1375-86.
48.
Biswas M, Rahaman S, Biswas TK, Haque Z, Ibrahim B. Association of sex, age, and comorbidities with mortality in COVID-19 patients: a systematic review and meta-analysis. Intervirology. 2021;64(1):36–47.CrossRef
49.
Ahrenfeldt LJ, Otavova M, Christensen K, Lindahl-Jacobsen R. Sex and age differences in COVID-19 mortality in Europe. Wien Klin Wochenschr. 2021;133(7):393–8.PubMedCrossRef
50.
Nikpouraghdam M, Farahani AJ, Alishiri G, Heydari S, Ebrahimnia M, Samadinia H, Sepandi M, Jafari NJ, Izadi M, Qazvini A. Epidemiological characteristics of coronavirus disease 2019 (COVID-19) patients in IRAN: A single center study. J Clin Virol. 2020;127: 104378.PubMedPubMedCentralCrossRef
51.
52.
Channappanavar R, Fett C, Mack M, Ten Eyck PP, Meyerholz DK, Perlman S. Sex-based differences in susceptibility to severe acute respiratory syndrome coronavirus infection. J Immunol. 2017;198(10):4046–53.PubMedCrossRef
53.
Lloyd-Sherlock P, Sempe L, McKee M, Guntupalli A. Problems of data availability and quality for COVID-19 and older people in low-and middle-income countries. Gerontologist. 2021;61(2):141–4.PubMedCrossRef
54.
MohammadEbrahimi S, Mohammadi A, Bergquist R, Dolatkhah F, Olia M, Tavakolian A, Pishgar E, Kiani B. Epidemiological characteristics and initial spatiotemporal visualisation of COVID-19 in a major city in the Middle East. BMC Public Health. 2021;21(1):1–18.CrossRef
55.
Thakur B, Dubey P, Benitez J, Torres JP, Reddy S, Shokar N, Aung K, Mukherjee D, Dwivedi AK. A systematic review and meta-analysis of geographic differences in comorbidities and associated severity and mortality among individuals with COVID-19. Sci Rep. 2021;11(1):1–13.CrossRef
56.
57.
58.
Salmani I, Seddighi H, Nikfard M. Access to health care services for Afghan refugees in Iran in the COVID-19 pandemic. Disaster Med Public Health Prep. 2020;14(4):e13–4.PubMedCrossRef
59.
WH Organization. Mapping health systems’ responsiveness to refugee and migrant health needs. 2021.
60.
61.
Secretariat of the Supreme Council of Health Insurance. Cabinet approval Annual health servivces tariff. 2020. p. 2020.
62.
Grasselli G, Greco M, Zanella A, Albano G, Antonelli M, Bellani G, Bonanomi E, Cabrini L, Carlesso E, Castelli G. Risk factors associated with mortality among patients with COVID-19 in intensive care units in Lombardy Italy. JAMA IntMed. 2020;180(10):1345–55.CrossRef
63.
Armstrong R, Kane A, Cook T. Outcomes from intensive care in patients with COVID-19: a systematic review and meta-analysis of observational studies. Anaesthesia. 2020;75(10):1340–9.PubMedCrossRef
64.
65.
Murgante B, Borruso G, Balletto G, Castiglia P, Dettori M. Why Italy first? Health, geographical and planning aspects of the COVID-19 outbreak. Sustainability. 2020;12(12):5064.CrossRef
66.
Ramírez-Aldana R, Gomez-Verjan JC, Bello-Chavolla OY. Spatial analysis of COVID-19 spread in Iran: Insights into geographical and structural transmission determinants at a province level. Plos Negl Trop Dis. 2020;14(11): e0008875.PubMedPubMedCentralCrossRef
67.
Khalagi K, Gharibzadeh S, Khalili D, Mansournia MA, Samiee SM, Aghamohamadi S, Roodaki MM-M-A, Hashemi SM, Tayeri K, Tabar HN. Prevalence of COVID-19 in Iran: results of the first survey of the Iranian COVID-19 Serological Surveillance programme. Clin Microbiol Infect. 2021;27(11):1666–71.PubMedPubMedCentralCrossRef
68.
Zarabi A, Shahivandi A. An Analysis of distribution of economic development indices in Iran provinces. Geography Environ Plan. 2010;21(2):17–32.
69.
Sharifzadeh A, Abdollahzade G. Classifying regional development in Iran (Application of Composite Index Approach). J Urban Reg Stud Res. 2012;4(13):41–62.
70.
Mirfallah Nasiri SN, Asghari S, Sabaghi S. A Look at the developments of aging in iran and the coverage of social support for the elderly (Provincial Adaptation). Iran J Official Stat Stud. 2019;30(1):173–92 (in perian).
71.
Fattahi N, Azadnajafabad S, Mohammadi E, Aminorroaya A, Rezaei S, Ghasemi E, Rezaei N, Naderimagham S, Larijani B, Farzadfar F. Geographical, gender and age inequalities in non-communicable diseases both at national and provincial levels in Iran. J Diabet Metab Dis. 2021:1-7.
72.
Lotfi F, Bayati M, Yusefi AR, Ghaderi S, Barati O. Inequality in distribution of health care resources in Iran: human resources, health centers and hospital beds. Shiraz E-Med J. 2018;19(6): e63700.CrossRef
73.
Roshanaei G, Safari M, Faradmal J, Kouselo Z. Ranking and clustering Iranian provinces based on important health indicators of vital horoscope in rural areas by using multivariate methods. Koomesh. 2016;17(2):277–87.
74.
Yazdani MH, Montazer F. Analysis of indicators of health status in provinces and ten regions of Iran. Health Dev J. 2018;6(4):290–301.
75.
Metadata
Title
National geographical pattern of COVID-19 hospitalization, case fatalities, and associated factors in patients covered by Iran Health Insurance Organization
Authors
Soheila Damiri
Ali Shojaee
Mohsen Dehghani
Zahra Shahali
Sadrollah Abbasi
Rajabali Daroudi
Publication date
01-12-2022
Publisher
BioMed Central
Keyword
COVID-19
Published in
BMC Public Health / Issue 1/2022
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-022-13649-0

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