Predictors of survival among hospitalized COVID-19 patients in the Gambia, 2020–2022

Advanced age and several chronic conditions were independently associated with higher mortality among 705 laboratory-confirmed COVID-19 patients hospitalized in The Gambia from March 2020 through December 2022, according to a retrospective cohort study summarized in the article abstract. Overall, 235 patients died in hospital, an in-hospital mortality proportion of 33.3%. The study estimated time to in-hospital death while treating medical discharge as a competing event.

The cohort included patients admitted to Edward Francis Small Teaching Hospital and the Medical Research Council Clinic. The investigators used Fine-Gray competing-risks regression to estimate sub-distribution hazard ratios, or SHRs, for mortality with 95% confidence intervals. Advanced age was the strongest observed predictor: compared with the study’s reference group, adjusted SHRs were 3.54 for patients aged 50–59 years and 6.96 for those aged 70 years or older. These are adjusted associations in the competing-risks model, not evidence that age directly caused the deaths.

Chronic liver disease, cardiac failure, chronic kidney disease and diabetes mellitus were also independently associated with increased mortality. Their adjusted SHRs were 3.20, 2.15, 1.91 and 1.78, respectively. Hypertension was not independently associated with mortality after multivariable adjustment, with an SHR of 0.92. The incidence rate of in-hospital death was 40.1 per 1,000 person-days, and most deaths occurred within the first 21 days after admission.

COVID-19 vaccination was associated with a lower mortality hazard in the model, but the adjusted estimate did not meet the conventional statistical significance threshold: SHR 0.58, 95% CI 0.32–1.06, p = 0.079. The abstract notes that only 11 vaccinated patients died, which may have limited statistical power, and that sensitivity analyses were directionally consistent. Vaccination coverage in the cohort was 8.2%. The authors also reported that the recorded annual in-hospital mortality proportion increased from 28.2% in 2020 to 48.4% in 2022, describing this as an in-hospital measure among admitted patients rather than a population-level case-fatality rate. The study was retrospective, relied on clinical data from two facilities and identified an age–comorbidity interaction that requires further investigation.

Subject of Research: Competing-risks predictors of in-hospital mortality among hospitalized COVID-19 patients in The Gambia

Article Title: Predictors of survival among hospitalized COVID-19 patients in the Gambia, 2020–2022

Article References: Manjang, L. F., Bandoh, D., Bobb, M., Kijera, B., Jarjusey, S., Ocansey, G. A., Afagbedzi, S. K., & Anto, F. (2026). Predictors of survival among hospitalized COVID-19 patients in the Gambia, 2020–2022. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14467-0

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14467-0

Keywords: COVID-19, Gambia, in-hospital mortality, competing risks, older adults, chronic disease, vaccination, retrospective cohort, Predictors, survival, hospitalized, patients