Latent heterogeneity in COVID-19 hospitalisations: a cluster-weighted approach to analyse mortality

Abstract

The COVID-19 pandemic caused an unprecedented excess mortality. Since 2020, many studies have focussed on the characteristics of COVID-19 patients who did not survive. From the statistical point of view, what seems to dominate is the large heterogeneity of the populations affected by COVID-19 and the extreme difficulty in identifying subpopulations who died affected by a plurality of contemporary characteristics. In this paper, we propose an extremely flexible approach based on a cluster-weighted model, which allows us to identify latent groups of patients sharing similar characteristics at the moment of hospitalisation as well as a similar mortality. We focus on one of the hardest hit areas in Italy and study the heterogeneity in the population of patients affected by COVID-19 using administrative data on hospitalisations in the first wave of the pandemic. Results highlighted that a model-based clustering approach is essential to understand the complexity of the COVID-19 patients treated by hospitals and who die during hospitalisation.