Surveillance Open Access
Like 0



In early 2020, the I-MOVE-COVID-19 hospital surveillance system was adapted from an existing influenza surveillance system to include hospitalised COVID-19 cases.


To describe trends in the demographic and clinical characteristics of hospitalised COVID-19 cases across Europe during the first 2 years of the pandemic, and to identify associations between sex, age and chronic conditions with admission to intensive care or high dependency units (ICU/HDU) and in-hospital mortality.


We pooled pseudonymised data from all hospitalised COVID-19 cases in 11 surveillance sites in nine European countries, collected between 1 February 2020 and 31 December 2021. Associations between sex, age and chronic conditions, with ICU/HDU admission and in-hospital mortality were examined using Pearson’s chi-squared test, and crude odds ratio (OR) estimates with respective 95% confidence intervals (CI).


Of 25,971 hospitalised COVID-19 cases, 55% were male, 35% were 75 years or older and 90% had a chronic underlying condition. Patients with two or more chronic underlying conditions were significantly more likely to die in-hospital from COVID-19 (OR: 10.84; 95% CI: 8.30–14.16) than those without a chronic condition.


The surveillance demonstrated that males, those 75 years or older and those with chronic conditions were at greater risk of in-hospital death. Over the surveillance period, outcomes tended to improve, likely because of vaccinations. This surveillance has laid the groundwork for further research studies investigating the risk factors of hospitalised COVID-19 cases and vaccine effectiveness.


Article metrics loading...

Loading full text...

Full text loading...



  1. Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Biomed. 2020;91(1):157-60. https://doi.org/10.23750/abm.v91i1.9397  PMID: 32191675 
  2. World Health Organization Regional Office for Europe (WHO/Europe). Coronavirus disease (COVID-19) pandemic, updated 24 May 2023. Copenhagen: WHO/Europe; 2023. Available from: https://www.who.int/europe/emergencies/situations/covid-19
  3. Nsubuga P, White ME, Thacker SB, Anderson MA, Blount SB, Broome CV, et al. Public health surveillance: A tool for targeting and monitoring interventions. In: Disease control priorities in developing countries. 2nd ed. Washington DC: World Bank; 2006.
  4. European Centre for Disease Prevention and Control (ECDC). Strategies for the surveillance of COVID-19. Stockholm: ECDC; 2020. Available from: https://www.ecdc.europa.eu/en/publications-data/strategies-surveillance-covid-19
  5. Influenza - Monitoring Vaccine Effectiveness in Europe (I-MOVE). I-MOVE-COVID-19 European primary care and hospital networks. Paris: Epiconcept. [Accessed: 31 Mar 2022]. Available from: https://www.imoveflu.org/i-move-covid-19
  6. Public Health Scotland. COVID-19 European hospital surveillance: Draft generic protocol. Glasgow: Public Health Scotland; 2020. Available from: https://www.imoveflu.org/wp-content/uploads/2021/03/14jun2020_draft_generic_protocol-I-MOVE-COVID-19_hosp_survl_v8.1.pdf
  7. Graham MS, Sudre CH, May A, Antonelli M, Murray B, Varsavsky T, et al. Changes in symptomatology, reinfection, and transmissibility associated with the SARS-CoV-2 variant B.1.1.7: an ecological study. Lancet Public Health. 2021;6(5):e335-45.  https://doi.org/10.1016/S2468-2667(21)00055-4  PMID: 33857453 
  8. Volz E, Mishra S, Chand M, Barrett JC, Johnson R, Geidelberg L, et al. Assessing transmissibility of SARS-CoV-2 lineage B.1.1.7 in England. Nature. 2021;593(7858):266-9.  https://doi.org/10.1038/s41586-021-03470-x  PMID: 33767447 
  9. Mlcochova P, Kemp SA, Dhar MS, Papa G, Meng B, Ferreira IATM, et al. SARS-CoV-2 B.1.617.2 Delta variant replication and immune evasion. Nature. 2021;599(7883):114-9.  https://doi.org/10.1038/s41586-021-03944-y  PMID: 34488225 
  10. IMove Influenza - Monitoring vaccine effectiveness in Europe. Paris: Epiconcept. [Accessed: 31 Mar 2022]. Available from: https://www.imoveflu.org/
  11. European Centre for Disease Prevention and Control (ECDC). Case definition for COVID-19. Stockholm: ECDC. [Accessed: 25 May 2023]. Available from: https://www.ecdc.europa.eu/en/covid-19/surveillance/case-definition
  12. World Health Organization (WHO). International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10 Version:2019). Geneva: WHO; 2019. Available from: https://icd.who.int/browse10/2019/en
  13. R Studio Team. RStudio: Integrated Development Environment for R. Boston, MA: PBC; 2020. Available from: http://www.rstudio.com
  14. GitHub. Public-Health-Scotland/cocin-scotland: Analysis of Scottish data from ISARIC CoCIN dataset. [Accessed: 17 Aug 2022]. Available from: https://github.com/Public-Health-Scotland/cocin-scotland
  15. Liang W-H, Guan W-J, Li C-C, Li Y-M, Liang H-R, Zhao Y, et al. Clinical characteristics and outcomes of hospitalised patients with COVID-19 treated in Hubei (epicentre) and outside Hubei (non-epicentre): a nationwide analysis of China. Eur Respir J. 2020;55(6):2000562.  https://doi.org/10.1183/13993003.00562-2020  PMID: 32269086 
  16. Castro MC, Gurzenda S, Macário EM, França GVA. Characteristics, outcomes and risk factors for mortality of 522 167 patients hospitalised with COVID-19 in Brazil: a retrospective cohort study. BMJ Open. 2021;11(5):e049089.  https://doi.org/10.1136/bmjopen-2021-049089  PMID: 33947740 
  17. Jiménez E, Fontán-Vela M, Valencia J, Fernandez-Jimenez I, Álvaro-Alonso EA, Izquierdo-García E, et al. Characteristics, complications and outcomes among 1549 patients hospitalised with COVID-19 in a secondary hospital in Madrid, Spain: a retrospective case series study. BMJ Open. 2020;10(11):e042398.  https://doi.org/10.1136/bmjopen-2020-042398  PMID: 33172949 
  18. Castilla J, Guevara M, Miqueleiz A, Baigorria F, Ibero-Esparza C, Navascués A, et al. Risk factors of infection, hospitalization and death from SARS-CoV-2: a population-based cohort study. J Clin Med. 2021;10(12):2608.  https://doi.org/10.3390/jcm10122608  PMID: 34199198 
  19. Kim L, Garg S, O’Halloran A, Whitaker M, Pham H, Anderson EJ, et al. Risk factors for intensive care unit admission and in-hospital mortality among hospitalized adults identified through the US Coronavirus Disease 2019 (COVID-19)-Associated Hospitalization Surveillance Network (COVID-NET). Clin Infect Dis. 2021;72(9):e206-14.  https://doi.org/10.1093/cid/ciaa1012  PMID: 32674114 
  20. Page JH, Londhe AA, Brooks C, Zhang J, Sprafka JM, Bennett C, et al. Trends in characteristics and outcomes among US adults hospitalised with COVID-19 throughout 2020: an observational cohort study. BMJ Open. 2022;12(2):e055137.  https://doi.org/10.1136/bmjopen-2021-055137  PMID: 35228287 
  21. Eurostat. 22% of people in the EU have high blood pressure. Luxembourg: Eurostat; 29 Sep 2021. Available from: https://ec.europa.eu/eurostat/web/products-eurostat-news/-/edn-20210929-1
  22. European Heart Network (EHN). European Cardiovascular Disease Statistics 2017. Brussels: EHN; 2017. Available from: https://www.bhf.org.uk/informationsupport/publications/statistics/european-cardiovascular-disease-statistics-2017
  23. Organisation for Economic Co-operation and Development (OECD) iLibrary. Health at a Glance: Europe 2020. Obesity among adults. Paris: OECD. [Accessed: 21 Jul 2022]. Available from: https://www.oecd-ilibrary.org/sites/8cdeadfa-en/index.html?itemId=/content/component/8cdeadfa-en
  24. Organisation for Economic Co-operation and Development (OECD) iLibrary. Health at a Glance: Europe 2020. Diabetes prevalence. Paris: OECD. [Accessed: 21 Jul 2022]. Available from: https://www.oecd-ilibrary.org/sites/83231356-en/index.html?itemId=/content/component/83231356-en
  25. Nicoll A, Ciancio B, Tsolova S, Blank P, Yilmaz C. The scientific basis for offering seasonal influenza immunisation to risk groups in Europe. Euro Surveill. 2008;13(43):19018.  https://doi.org/10.2807/ese.13.43.19018-en  PMID: 18947519 
  26. Pijls BG, Jolani S, Atherley A, Derckx RT, Dijkstra JIR, Franssen GHL, et al. Demographic risk factors for COVID-19 infection, severity, ICU admission and death: a meta-analysis of 59 studies. BMJ Open. 2021;11(1):e044640.  https://doi.org/10.1136/bmjopen-2020-044640  PMID: 33431495 
  27. Ko JY, Danielson ML, Town M, Derado G, Greenlund KJ, Kirley PD, et al. Risk factors for coronavirus disease 2019 (COVID-19)-associated hospitalization: COVID-19-associated hospitalization surveillance network and behavioral risk factor surveillance system. Clin Infect Dis. 2021;72(11):e695-703.  https://doi.org/10.1093/cid/ciaa1419  PMID: 32945846 
  28. Leblanc G, Boumendil A, Guidet B. Ten things to know about critically ill elderly patients. Intensive Care Med. 2017;43(2):217-9.  https://doi.org/10.1007/s00134-016-4477-2  PMID: 27492269 
  29. Haas LEM, de Lange DW, van Dijk D, van Delden JJM. Should we deny ICU admission to the elderly? Ethical considerations in times of COVID-19. Crit Care. 2020;24(1):321.  https://doi.org/10.1186/s13054-020-03050-x  PMID: 32517776 
  30. Organisation for Economic Co-operation and Development (OECD) iLibrary. Health at a Glance: Europe 2020. Average length of stay in hospital. Paris: OECD. [Accessed: 25 Jul 2022]. Available from: https://www.oecd-ilibrary.org/sites/c762d8be-en/index.html?itemId=/content/component/c762d8be-en
  31. Chiam T, Subedi K, Chen D, Best E, Bianco FB, Dobler G, et al. Hospital length of stay among COVID-19-positive patients. J Clin Transl Res. 2021;7(3):377-85. PMID: 34239994 
  32. Eurostat. Data browser: Population change - demographic balance and crude rates at national level. Luxembourg: Eurostat. [Accessed: 25 Jul 2022]. Available from: https://ec.europa.eu/eurostat/databrowser/bookmark/80240eaf-d662-4184-a4d7-f3e2679a9c8f?lang=en
  33. Hernandez C, Jansa M, Vidal M, Nuñez M, Bertran MJ, Garcia-Aymerich J, et al. The burden of chronic disorders on hospital admissions prompts the need for new modalities of care: a cross-sectional analysis in a tertiary hospital. QJM. 2009;102(3):193-202.  https://doi.org/10.1093/qjmed/hcn172  PMID: 19147657 
  34. Salisbury C, Johnson L, Purdy S, Valderas JM, Montgomery AA. Epidemiology and impact of multimorbidity in primary care: a retrospective cohort study. Br J Gen Pract. 2011;61(582):e12-21.  https://doi.org/10.3399/bjgp11X548929  PMID: 21401985 
  35. Bird CE, Rieker PP. Gender matters: an integrated model for understanding men’s and women’s health. Soc Sci Med. 1999;48(6):745-55.  https://doi.org/10.1016/S0277-9536(98)00402-X  PMID: 10190637 
  36. Bwire GM. Coronavirus: why men are more vulnerable to covid-19 than women? SN Compr Clin Med. 2020;2(7):874-6.  https://doi.org/10.1007/s42399-020-00341-w  PMID: 32838138 
  37. Aleksanyan Y, Weinman JP. Women, men and COVID-19. Soc Sci Med. 2022;294:114698.  https://doi.org/10.1016/j.socscimed.2022.114698  PMID: 34999529 
  38. Marsh K, Griffiths E, Young JJ, Gibb C-A, McMenamin J. Contributions of the EURO 2020 football championship events to a third wave of SARS-CoV-2 in Scotland, 11 June to 7 July 2021. Euro Surveill. 2021;26(31):2100707.  https://doi.org/10.2807/1560-7917.ES.2021.26.31.2100707  PMID: 34355691 
  39. Finnish Institute for Health and Welfare (THL). COVID-19 cases on the rise again in Finland — infections reported particularly among Euro 2020 football fans returning from Russia. Helsinki: THL; 2021. Available from: https://thl.fi/en/web/thlfi-en/-/covid-19-cases-on-the-rise-again-in-finland-infections-reported-particularly-among-euro-2020-football-fans-returning-from-russia
  40. Andrews N, Tessier E, Stowe J, Gower C, Kirsebom F, Simmons R, et al. Duration of protection against mild and severe disease by covid-19 vaccines. N Engl J Med. 2022;386(4):340-50.  https://doi.org/10.1056/NEJMoa2115481  PMID: 35021002 
  41. Self WH, Tenforde MW, Rhoads JP, Gaglani M, Ginde AA, Douin DJ, et al. Comparative effectiveness of Moderna, Pfizer-BioNTech, and Janssen (Johnson & Johnson) vaccines in preventing COVID-19 hospitalizations among adults without immunocompromising conditions - United States, March-August 2021. MMWR Morb Mortal Wkly Rep. 2021;70(38):1337-43.  https://doi.org/10.15585/mmwr.mm7038e1  PMID: 34555004 
  42. Whitaker HJ, Tsang RSM, Byford R, Andrews NJ, Sherlock J, Sebastian Pillai P, et al. Pfizer-BioNTech and Oxford AstraZeneca COVID-19 vaccine effectiveness and immune response amongst individuals in clinical risk groups. J Infect. 2022;84(5):675-83.  https://doi.org/10.1016/j.jinf.2021.12.044  PMID: 34990709 
  43. Iftekhar EN, Priesemann V, Balling R, Bauer S, Beutels P, Calero Valdez A, et al. A look into the future of the COVID-19 pandemic in Europe: an expert consultation. Lancet Reg Health Eur. 2021;8:100185.  https://doi.org/10.1016/j.lanepe.2021.100185  PMID: 34345876 
  44. European Centre for Disease Prevention and Control (ECDC). Managing heterogeneity when pooling data from different surveillance systems. Stockholm: ECDC; 2019. Available from: https://www.ecdc.europa.eu/en/publications-data/managing-heterogeneity-when-pooling-data-different-surveillance-systems

Data & Media loading...

Submit comment
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error