{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T10:00:02Z","timestamp":1790935202821,"version":"4.1.0"},"reference-count":45,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T00:00:00Z","timestamp":1757376000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>A comprehensive understanding of the factors influencing the epidemiological dynamics of COVID-19 across the pandemic waves\u2014particularly in terms of disease severity and mortality\u2014is critical for optimizing healthcare services and prioritizing high-risk populations. Here we aim to analyze the factors associated with short-term and prolonged hospitalization for COVID-19 during the first three pandemic waves. We conducted a retrospective observational study using data from individuals reported in the e-SUS-VS system who were hospitalized for COVID-19 in a state in a southeast state of Brazil. Hospitalization duration was classified as short or prolonged based on a 7-day cutoff, corresponding to the median length of hospital stay during the second pandemic wave. Bivariate analyses were performed using the chi-square test for heterogeneity. Logistic regression models were used to estimate odds ratios (ORs) and their respective 95% confidence intervals (CIs), with statistical significance set at 5%. When analyzing hospitalization duration across the three waves, we found that 51.1% (95%CI: 49.3\u201353) of hospitalizations in the first wave were prolonged. In contrast, short-duration hospitalizations predominated in the second (54.7%; 95% CI: 52.4\u201357.0) and third (51.7%; 95% CI: 50.2\u201353.2) waves. Factors associated with prolonged hospitalization varied by wave. During the first wave, older adults (\u226560 years) (OR=1.67; 95%CI: 1.35\u20132.06), individuals with \u226510 symptoms (OR=2.03; 95%CI: 1.04\u20133.94), obese individuals (OR=2.0; 95%CI: 1.53\u20132.74), and those with \u22652 comorbidities (OR=2.22; 95%CI: 1.71\u20132.89) were more likely to experience prolonged hospitalization. In the second wave, he likelihood of extended hospital stays was higher among individuals aged \u226560 years (OR=2.04; 95%CI: 1.58\u20132.62) and those with \u22652 comorbidities (OR=1.77; 95%CI: 1.29\u20132.41). In the third wave, prolonged hospitalization was more frequent among older adults (OR=1.89; 95%CI: 1.65\u20132.17,), individuals with 5\u20139 symptoms (OR=1.52; 95%CI: 1.20\u20131.92), obese individuals (OR=2.2; 95%CI: 1.78\u20132.73), and those with comorbidities (OR=1.45; 95%CI: 1.22\u20131.72 and OR=2.0; 95%CI: 1.69\u20132.45). In conclusion, we identified variations in hospitalization patterns across the pandemic waves, although the differences were relatively subtle. These variations likely reflect gradual shifts in the risk factors associated with prolonged hospital stays. Our findings highlight t the importance of implementing targeted public health interventions, particularly those designed to reduce disease severity and improve clinical outcomes among vulnerable populations at greater risk of extended hospitalization.<\/jats:p>","DOI":"10.1371\/journal.pone.0332128","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T17:29:47Z","timestamp":1757438987000},"page":"e0332128","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Factors associated with prolonged hospitalizations for COVID-19 during the first three waves of the pandemic: Evidence from a Southeastern State of Brazil"],"prefix":"10.1371","volume":"20","author":[{"given":"Juliana Rodrigues Tovar","family":"Garbin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franci\u00e9le Marabotti Costa","family":"Leite","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Paula Brioschi dos","family":"Santos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larissa Soares","family":"Dell\u2019Antonio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristiano Soares da Silva","family":"Dell\u2019Antonio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2424-6510","authenticated-orcid":true,"given":"Lu\u00eds Carlos","family":"Lopes-J\u00fanior","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,9,9]]},"reference":[{"issue":"8","key":"pone.0332128.ref001","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1001\/jama.2020.1097","article-title":"The Novel Coronavirus Originating in Wuhan, China: Challenges for Global Health Governance","volume":"323","author":"AL Phelan","year":"2020","journal-title":"JAMA"},{"key":"pone.0332128.ref002","unstructured":"World Health Organization. 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