Hospital Deaths in the Pre COVID-19 Era: A 5-year Trend Analysis of Mortality related to Viral Pneumonia and Acute Respiratory-related Events in Malaysian Public Hospitals

Introduction: Pneumonia has been reported as one of the leading causes of death in Malaysia. The number of hospital admissions and in-hospital deaths associated with pneumonia and acute respiratory-related events is also expected to increase during the current COVID-19 pandemic. However, understanding is still sparse on the trend of in-hospital mortality associated with those conditions in Malaysian public hospitals before the pandemic. Methodology: We conducted a cross-sectional analysis on administrative discharge data obtained from Malaysian Health Data Warehouse (MyHDW) and mortality data from National Registry Department (NRD) involving 135 public hospitals between year 2012 and 2016, to determine the 5-year trend of in hospital mortality associated with viral pneumonia. We also explored the demographic distribution and the mortality trend associated with those conditions by hospital category (State, Major Specialist, and acute respiratory-related events. Minor Specialist, Non-Specialist). Results: Within the 5-year study period, a total of 29844 in-patients died of viral pneumonia and acute respiratory-related events, with a preponderance to male, those of age 61-80 years old and Bumiputera. The annual (age-sex-adjusted) hospital case-fatality rates ranged from 3.66% to 10% but were consistently highest for the State (7.49% - 10%) and Major Specialist (7.31% - 9.56%). In addition, the rates showed an increasing trend for all hospital categories, with an average rate of change between 0.8% and 6.5%. Discussion: Mortality burden due to pneumonia in Malaysia remains high. The highest mortality burden of these diagnoses were observed in State and Major Specialist Hospitals, potentially linked to their status as referral hospitals, thus higher likelihood of receiving more severe cases. Older age groups are vulnerable to these conditions due to multiple comorbidities. Readmission were common in more than a third of those who died within the study interval, suggesting the co-occurrence of underlying chronic respiratory diseases. Study Limitation: Only public hospital data, no severity of illness variables, non-availability of viral vs non-viral attributes for some data (2016: Malaysia 8745 vs Canada 6011 vs Italy 10837). Conclusion: Epidemiological data on mortality during the pre-pandemic years is crucial to help gauge the impact of the COVID-19 pandemic on population health. Findings from this study can set the baseline against which future surveillance of mortality related to viral pneumonia and acute respiratory-related events can be benchmarked. [Disclaimer: Abstract text might vary slightly from what is displayed in the e-poster]