Comparison of long-term healthcare use among older adults with disabilities following hospitalization for COVID-19, sepsis, or influenza: a population-based cohort study

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas Pub Date : 2024-10-17 DOI:10.1016/j.lana.2024.100910

John M. Lapp , Thérèse A. Stukel , Hannah Chung , Samantha Lee , Yona Lunsky , Chaim M. Bell , Angela M. Cheung , Allan S. Detsky , Susie Goulding , Margaret Herridge , Aisha Ahmad , Fahad Razak , Amol A. Verma , Hilary K. Brown , Pavlos Bobos , Kieran L. Quinn

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引用次数: 0

Abstract

Background

People with disabilities are at elevated risk of adverse short-term outcomes following hospitalization for acute infectious illness. No prior studies have compared long-term healthcare use among this high-risk population. We compared the healthcare use of adults with disabilities in the one year following hospitalization for COVID-19 vs. sepsis vs. influenza.

Methods

We performed a population-based cohort study using linked clinical and health administrative databases in Ontario, Canada of all adults with pre-existing disability (physical, sensory, or intellectual) hospitalized for COVID-19 (n = 22,551, median age 69 [IQR 57–79], 47.9% female) or sepsis (n = 100,669, median age 77 [IQR 66–85], 54.8% female) between January 25, 2020, and February 28, 2022, and for influenza (n = 11,216, median age 78 [IQR 67–86], 54% female) or sepsis (n = 49,326, median age 72 [IQR 62–82], 45.8% female) between January 1, 2014 and March 25, 2019. The exposure was hospitalization for laboratory-confirmed SARS-CoV-2 or influenza, or sepsis (not secondary to COVID-19 or influenza). Outcomes were ambulatory care visits, diagnostic testing, emergency department visits, hospitalization, palliative care visits and death within 1 year. Rates of these outcomes were compared across exposure groups using propensity-based overlap weighted Poisson and Cox proportional hazards models.

Findings

Among older adults with pre-existing disability, hospitalization for COVID-19 was associated with lower rates of ambulatory care visits (adjusted rate ratio (aRR) 0.88, 95% confidence interval (CI), 0.87–0.90), diagnostic testing (aRR 0.86, 95% CI, 0.84–0.89), emergency department visits (aRR 0.91, 95% CI, 0.84–0.97), hospitalization (aRR 0.74, 95% CI, 0.71–0.77), palliative care visits (aRR 0.71, 95% CI, 0.62–0.81) and low hazards of death (adjusted hazard ratio (aHR) 0.71, 95% 0.68–0.75), compared to hospitalization for sepsis during the COVID-19 pandemic. Rates of healthcare use among those hospitalized for COVID-19 varied compared to those hospitalized for influenza or sepsis prior to the pandemic.

Interpretation

This study of older adults with pre-existing disabilities hospitalized for acute infectious illness found that COVID-19 was not associated with higher rates of healthcare use or mortality over the one year following hospital discharge compared to those hospitalized for sepsis. However, hospitalization for COVID-19 was associated with higher rates of ambulatory care use and mortality when compared to influenza. As COVID-19 enters an endemic phase, the associated long-term health resource use and risks in the contemporary era are reassuringly similar to sepsis and influenza, even among people with pre-existing disabilities.

Funding

This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and the Ministry of Long-Term Care. This study also received funding from the Canadian Institutes of Health Research (CIHR GA4-177772).

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残疾老年人因 COVID-19、败血症或流感住院后长期使用医疗服务情况的比较：一项基于人群的队列研究

背景残疾人因急性传染病住院后短期内出现不良后果的风险较高。以前没有研究比较过这一高风险人群的长期医疗保健使用情况。我们比较了残疾成人在 COVID-19 与败血症与流感住院后一年内的医疗保健使用情况。方法我们利用加拿大安大略省的临床和卫生行政数据库，对所有因 COVID-19 （n = 22,551 人，中位年龄 69 [IQR：57-79]，47.9% 为女性）或败血症（n = 22,551 人，中位年龄 69 [IQR：57-79]，47.9% 为女性）住院的已有残疾（肢体、感官或智力）的成人进行了一项基于人群的队列研究。在 2020 年 1 月 25 日至 2022 年 2 月 28 日期间因 COVID-19 （人数 = 22,551 人，中位年龄 69 [IQR：57-79]，女性占 47.9%）或败血症（人数 = 100,669 人，中位年龄 77 [IQR：66-85]，女性占 54.8%）住院，以及在 2014 年 1 月 1 日至 2019 年 3 月 25 日期间因流感（人数 = 11,216 人，中位年龄 78 [IQR：67-86]，女性占 54%）或败血症（人数 = 49,326 人，中位年龄 72 [IQR：62-82]，女性占 45.8%）住院。暴露是指因实验室确诊的 SARS-CoV-2 或流感或败血症（非继发于 COVID-19 或流感）而住院。结果包括门诊就诊、诊断检测、急诊就诊、住院、姑息治疗就诊和 1 年内死亡。采用基于倾向的重叠加权泊松模型和 Cox 比例危险模型比较了不同暴露组的这些结果的发生率。研究结果在原有残疾的老年人中，因 COVID-19 而住院与较低的非住院护理就诊率（调整后比率比 (aRR) 0.88，95% 置信区间 (CI)，0.87-0.90）、诊断检测（aRR 0.86，95% CI，0.84-0.89）、急诊就诊（aRR 0.91，95% CI，0.84-0.97）、住院（aRR 0.74，95% CI，0.71-0.77）、姑息治疗就诊（aRR 0.71，95% CI，0.62-0.81）和较低的死亡风险（调整后危险比（aHR）0.71，95% 0.68-0.75）。与大流行前因流感或败血症而住院的患者相比，因 COVID-19 而住院的患者使用医疗服务的比率有所不同。这项针对因急性传染病而住院的原有残疾老年人的研究发现，与因败血症而住院的患者相比，COVID-19 与出院后一年内较高的医疗服务使用率或死亡率无关。不过，与流感相比，COVID-19 的住院治疗与较高的非卧床护理使用率和死亡率有关。随着COVID-19进入流行阶段，在当代，相关的长期医疗资源使用和风险与败血症和流感相似，甚至在已有残疾的人群中也是如此，这一点令人欣慰。这项研究还得到了加拿大卫生研究院（CIHR GA4-177772）的资助。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Lancet Regional Health-Americas Multiple-

CiteScore

8.00

自引率

0.00%

发文量

期刊介绍： The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.