LAUSR

Objectives We aimed to investigate possible differences in aggregated hospital-fatality rate from COVID-19 in France at the early phase of the outbreak, and to determine whether factors related to population or healthcare supply before the pandemic could be associated with outcome differences. Study design Nationwide observational study including all French hospitals from January 24, 2020 to April 11, 2020. Methods We analysed aggregated hospital-fatality rate. A Poisson regression was performed to investigate associations between characteristics pertaining to populational health, socioeconomic context and local healthcare supply at baseline, and the chosen outcome. Results On April 11, 2020, a total number of 30 960 patients were hospitalized among the 3 046 French healthcare facilities, including 6 832 patients in intensive care unit (ICU). A total of 8 581 deaths due to Covid-19 had been recorded, with a median mortality rate per 10 000 people per department of 0.53 (IQR: 0.29-1.90). There were significant variations between the 95 French departments even after adjusting on outbreak inception (p<0.001). After multivariable analysis, four factors were independently associated with a significantly higher aggregated hospital-fatality rate: a higher ICU capacity at baseline (estimate=1.47; p=0.00791), a lower density of general practitioners (estimate=0.95; p=0.0205), a higher fraction of activity from the for-profit private sector (estimate=0.99; p<0.001), and the ratio of people over 75 (estimate=0.91; p=0.0023). Conclusions Aggregated hospital-fatality rate from COVID-19 in France seems to vary among geographic areas, with some factors pertaining to local healthcare supply being associated with outcome.