Risk of Potentially Preventable Hospitalizations After SARS-CoV-2 Infection
Importance: Research demonstrates that SARS-CoV-2 infection is associated with increased risk of all-cause hospitalization. However, no prior studies have assessed the association between SARS-CoV-2 and potentially preventable hospitalizations-that is, hospitalizations for conditions that can usually be effectively managed in ambulatory care settings.
Objective: To examine whether SARS-CoV-2 is associated with potentially preventable hospitalization in a nationwide cohort of US veterans.
Design, Setting, and Participants: This cohort study used an emulated target randomized trial design with monthly sequential trials to compare risk of a potentially preventable hospitalization among veterans with SARS-CoV-2 and matched comparators without SARS-CoV-2. A total of 189 136 US veterans enrolled in the Veterans Health Administration (VHA) who were diagnosed with SARS-CoV-2 between March 1, 2020, and April 30, 2021, and 943 084 matched comparators were included in the analysis. Data were analyzed from May 10, 2023, to January 26, 2024.
Exposure: SARS-CoV-2 infection.
Main Outcomes and Measures: The primary outcome was a first potentially preventable hospitalization in VHA facilities, VHA-purchased community care, or Medicare fee-for-service care. Extended Cox models were used to examine adjusted hazard ratios (AHRs) of potentially preventable hospitalization among veterans with SARS-CoV-2 and comparators during follow-up periods of 0 to 30, 0 to 90, 0 to 180, and 0 to 365 days. The start of follow-up was defined as the date of each veteran's first positive SARS-CoV-2 diagnosis, with the same index date applied to their matched comparators.
Results: The 1 132 220 participants were predominantly men (89.06%), with a mean (SD) age of 60.3 (16.4) years. Most veterans were of Black (23.44%) or White (69.37%) race. Veterans with SARS-CoV-2 and comparators were well-balanced (standardized mean differences, all <0.100) on observable baseline clinical and sociodemographic characteristics. Overall, 3.10% of veterans (3.81% of those with SARS-CoV-2 and 2.96% of comparators) had a potentially preventable hospitalization during 1-year follow-up. Risk of a potentially preventable hospitalization was greater among veterans with SARS-CoV-2 than comparators in 4 follow-up periods: 0- to 30-day AHR of 3.26 (95% CI, 3.06-3.46); 0- to 90-day AHR of 2.12 (95% CI, 2.03-2.21); 0- to 180-day AHR of 1.69 (95% CI, 1.63-1.75); and 0- to 365-day AHR of 1.44 (95% CI, 1.40-1.48).
Conclusions and Relevance: In this cohort study, an increased risk of preventable hospitalization in veterans with SARS-CoV-2, which persisted for at least 1 year after initial infection, highlights the need for research on ways in which SARS-CoV-2 shapes postinfection care needs and engagement with the health system. Solutions are needed to mitigate preventable hospitalization after SARS-CoV-2.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:7 |
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| Enthalten in: |
JAMA network open - 7(2024), 4 vom: 01. Apr., Seite e245786 |
| Sprache: |
Englisch |
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| Links: |
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| Themen: |
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| Anmerkungen: |
Date Completed 11.04.2024 Date Revised 13.04.2024 published: Electronic Citation Status MEDLINE |
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| doi: |
10.1001/jamanetworkopen.2024.5786 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM370875745 |
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| 100 | 1 | |a Govier, Diana J |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Risk of Potentially Preventable Hospitalizations After SARS-CoV-2 Infection |
| 264 | 1 | |c 2024 | |
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| 500 | |a Date Completed 11.04.2024 | ||
| 500 | |a Date Revised 13.04.2024 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Importance: Research demonstrates that SARS-CoV-2 infection is associated with increased risk of all-cause hospitalization. However, no prior studies have assessed the association between SARS-CoV-2 and potentially preventable hospitalizations-that is, hospitalizations for conditions that can usually be effectively managed in ambulatory care settings | ||
| 520 | |a Objective: To examine whether SARS-CoV-2 is associated with potentially preventable hospitalization in a nationwide cohort of US veterans | ||
| 520 | |a Design, Setting, and Participants: This cohort study used an emulated target randomized trial design with monthly sequential trials to compare risk of a potentially preventable hospitalization among veterans with SARS-CoV-2 and matched comparators without SARS-CoV-2. A total of 189 136 US veterans enrolled in the Veterans Health Administration (VHA) who were diagnosed with SARS-CoV-2 between March 1, 2020, and April 30, 2021, and 943 084 matched comparators were included in the analysis. Data were analyzed from May 10, 2023, to January 26, 2024 | ||
| 520 | |a Exposure: SARS-CoV-2 infection | ||
| 520 | |a Main Outcomes and Measures: The primary outcome was a first potentially preventable hospitalization in VHA facilities, VHA-purchased community care, or Medicare fee-for-service care. Extended Cox models were used to examine adjusted hazard ratios (AHRs) of potentially preventable hospitalization among veterans with SARS-CoV-2 and comparators during follow-up periods of 0 to 30, 0 to 90, 0 to 180, and 0 to 365 days. The start of follow-up was defined as the date of each veteran's first positive SARS-CoV-2 diagnosis, with the same index date applied to their matched comparators | ||
| 520 | |a Results: The 1 132 220 participants were predominantly men (89.06%), with a mean (SD) age of 60.3 (16.4) years. Most veterans were of Black (23.44%) or White (69.37%) race. Veterans with SARS-CoV-2 and comparators were well-balanced (standardized mean differences, all <0.100) on observable baseline clinical and sociodemographic characteristics. Overall, 3.10% of veterans (3.81% of those with SARS-CoV-2 and 2.96% of comparators) had a potentially preventable hospitalization during 1-year follow-up. Risk of a potentially preventable hospitalization was greater among veterans with SARS-CoV-2 than comparators in 4 follow-up periods: 0- to 30-day AHR of 3.26 (95% CI, 3.06-3.46); 0- to 90-day AHR of 2.12 (95% CI, 2.03-2.21); 0- to 180-day AHR of 1.69 (95% CI, 1.63-1.75); and 0- to 365-day AHR of 1.44 (95% CI, 1.40-1.48) | ||
| 520 | |a Conclusions and Relevance: In this cohort study, an increased risk of preventable hospitalization in veterans with SARS-CoV-2, which persisted for at least 1 year after initial infection, highlights the need for research on ways in which SARS-CoV-2 shapes postinfection care needs and engagement with the health system. Solutions are needed to mitigate preventable hospitalization after SARS-CoV-2 | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Niederhausen, Meike |e verfasserin |4 aut | |
| 700 | 1 | |a Takata, Yumie |e verfasserin |4 aut | |
| 700 | 1 | |a Hickok, Alex |e verfasserin |4 aut | |
| 700 | 1 | |a Rowneki, Mazhgan |e verfasserin |4 aut | |
| 700 | 1 | |a McCready, Holly |e verfasserin |4 aut | |
| 700 | 1 | |a Smith, Valerie A |e verfasserin |4 aut | |
| 700 | 1 | |a Osborne, Thomas F |e verfasserin |4 aut | |
| 700 | 1 | |a Boyko, Edward J |e verfasserin |4 aut | |
| 700 | 1 | |a Ioannou, George N |e verfasserin |4 aut | |
| 700 | 1 | |a Maciejewski, Matthew L |e verfasserin |4 aut | |
| 700 | 1 | |a Viglianti, Elizabeth M |e verfasserin |4 aut | |
| 700 | 1 | |a Bohnert, Amy S B |e verfasserin |4 aut | |
| 700 | 1 | |a O'Hare, Ann M |e verfasserin |4 aut | |
| 700 | 1 | |a Iwashyna, Theodore J |e verfasserin |4 aut | |
| 700 | 1 | |a Hynes, Denise M |e verfasserin |4 aut | |
| 700 | 0 | |a US Department of Veterans Affairs Health Services Research and Development COVID-19 Observational Research Collaboratory |e verfasserin |4 aut | |
| 700 | 1 | |a Berkowitz, Theodore |e investigator |4 oth | |
| 700 | 1 | |a Doll, Jacob |e investigator |4 oth | |
| 700 | 1 | |a Floyd, Breana |e investigator |4 oth | |
| 700 | 1 | |a Hastings, Susan Nicole |e investigator |4 oth | |
| 700 | 1 | |a Hawkins, Eric |e investigator |4 oth | |
| 700 | 1 | |a Jones, Makoto |e investigator |4 oth | |
| 700 | 1 | |a Kamphius, Lee |e investigator |4 oth | |
| 700 | 1 | |a Moss, Abby |e investigator |4 oth | |
| 700 | 1 | |a Ong, Michael |e investigator |4 oth | |
| 700 | 1 | |a Seelye, Sarah |e investigator |4 oth | |
| 700 | 1 | |a Shah, Javeed |e investigator |4 oth | |
| 700 | 1 | |a Shahoumian, Troy |e investigator |4 oth | |
| 700 | 1 | |a Shaukat, Aasma |e investigator |4 oth | |
| 700 | 1 | |a Shepherd-Banigan, Megan |e investigator |4 oth | |
| 700 | 1 | |a Slatore, Christopher |e investigator |4 oth | |
| 700 | 1 | |a Smith, Battista |e investigator |4 oth | |
| 700 | 1 | |a Suri, Pradeep |e investigator |4 oth | |
| 700 | 1 | |a Teo, Alan |e investigator |4 oth | |
| 700 | 1 | |a Vranas, Kelly |e investigator |4 oth | |
| 700 | 1 | |a Winchell, Kara |e investigator |4 oth | |
| 700 | 1 | |a Wong, Edwin |e investigator |4 oth | |
| 700 | 1 | |a Wyatt, Kristin |e investigator |4 oth | |
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