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

Autor: 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
Jazyk: angličtina
Rok vydání: 2024
Předmět:
Zdroj: The Lancet Regional Health. Americas, Vol 39, Iss , Pp 100910- (2024)
Druh dokumentu: article
ISSN: 2667-193X
DOI: 10.1016/j.lana.2024.100910
Popis: Summary: 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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