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Menkir TF, Citarella BW, Sigfrid L, Doshi Y, Reyes LF, Calvache JA, Kildal AB, Nygaard AB, Holter JC, Panda PK, Jassat W, Merson L, Donnelly CA, Santillana M, Buckee C, Verguet S, Hejazi NS. Modeling the relative influence of socio-demographic variables on post-acute COVID-19 quality of life. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.21.24303099. [PMID: 39040190 PMCID: PMC11261939 DOI: 10.1101/2024.02.21.24303099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Importance Post-acute sequelae of SARS-CoV-2, referred to as "long COVID", are a globally pervasive threat. While their many clinical determinants are commonly considered, their plausible social correlates are often overlooked. Objective To compare social and clinical predictors of differences in quality of life (QoL) with long COVID. Additionally, to measure how much adjusted associations between social factors and long COVID-associated quality of life are unexplained by important clinical intermediates. Design Setting and Participants Data from the ISARIC long COVID multi-country prospective cohort study. Subjects from Norway, the United Kingdom (UK), and Russia, aged 16 and above, with confirmed acute SARS-CoV-2 infection reporting >= 1 long COVID-associated symptoms 1+ month following infection. Exposure The social exposures considered were educational attainment (Norway), employment status (UK and Russia), and female vs male sex (all countries). Main outcome and measures Quality of life-adjusted days, or QALDs, with long COVID. Results This cohort study included a total of 3891 participants. In all three countries, educational attainment, employment status, and female sex were important predictors of long COVID QALDs. Furthermore, a majority of the estimated relationships between each of these social correlates and long COVID QALDs could not be attributed to key long COVID-predicting comorbidities. In Norway, 90% (95% CI: 77%, 100%) of the adjusted association between the top two quintiles of educational attainment and long COVID QALDs was not explained by clinical intermediates. The same was true for 86% (73%, 100%) and 93% (80%,100%) of the adjusted associations between full-time employment and long COVID QALDs in the United Kingdom (UK) and Russia. Additionally, 77% (46%,100%) and 73% (52%, 94%) of the adjusted associations between female sex and long COVID QALDs in Norway and the UK were unexplained by the clinical mediators. Conclusions and Relevance This study highlights the role of socio-economic status indicators and female sex, in line with or beyond commonly cited clinical conditions, as predictors of long COVID-associated QoL, and further reveal that other (non-clinical) mechanisms likely drive their observed relationships. Our findings point to the importance of COVID interventions which go further than an exclusive focus on comorbidity management in order to help redress inequalities in experiences with this chronic disease.
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Affiliation(s)
- Tigist F Menkir
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, USA
- ISARIC, Pandemic Sciences Institute, University of Oxford, UK
| | | | - Louise Sigfrid
- ISARIC, Pandemic Sciences Institute, University of Oxford, UK
- Policy and Practice Research Group, Pandemic Sciences Institute, University of Oxford, Oxford UK
| | - Yash Doshi
- Terna Speciality Hospital & Research Centre, Mumbai, India
| | - Luis Felipe Reyes
- ISARIC, Pandemic Sciences Institute, University of Oxford, UK
- Universidad de La Sabana, Chia, Colombia
- Clinica Universidad de La Sabana, Chia, Colombia
| | - Jose A Calvache
- Departamento de Anestesiología, Universidad del Cauca, Colombia
- Department of Anesthesiology, Erasmus University Medical Center, Netherlands
| | - Anders Benjamin Kildal
- Department of Anesthesiology and Intensive Care, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UIT The Arctic University of Norway, Tromsø, Norway
| | - Anders B Nygaard
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
| | - Jan Cato Holter
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Waasila Jassat
- National Institute for Communicable Diseases, South Africa
- Right to Care, South Africa
| | - Laura Merson
- ISARIC, Pandemic Sciences Institute, University of Oxford, UK
| | - Christl A Donnelly
- Department of Statistics, University of Oxford, Oxford, UK
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics and Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Mauricio Santillana
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, USA
- Machine Intelligence Group for the Betterment of Health and the Environment, Network Science Institute, Northeastern University, Boston, MA, USA
| | - Caroline Buckee
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, USA
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, USA
| | - Nima S Hejazi
- Department of Biostatistics, Harvard TH Chan School of Public Health, Harvard University, USA
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Zaidan M, Puebla Neira D, Polychronopoulou E, Yong-Fang K, Sharma G. Healthcare utilization 9 months pre- and post- COVID-19 hospitalization among patients discharged alive. PLoS One 2024; 19:e0303509. [PMID: 38900737 PMCID: PMC11189225 DOI: 10.1371/journal.pone.0303509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 04/25/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Emerging evidence suggests that there is an increase in healthcare utilization (HCU) in patients due to Coronavirus Disease 2019 (COVID-19). We investigated the change in HCU pre and post hospitalization among patients discharged home from COVID-19 hospitalization for up to 9 months of follow up. STUDY DESIGN AND METHODS This retrospective study from a United States cohort used Optum® de-identified Clinformatics Data Mart; it included adults discharged home post hospitalization with primary diagnosis of COVID-19 between April 2020 and March 2021. We evaluated HCU of patients 9 months pre and post -discharge from index hospitalization. We defined HCU as emergency department (ED), inpatient, outpatient (office), rehabilitation/skilled nursing facility (SNF), telemedicine visits, and length of stay, expressed as number of visits per 10,000 person-days. RESULTS We identified 63,161 patients discharged home after COVID-19 hospitalization. The cohort of patients was mostly white (58.8%) and women (53.7%), with mean age 72.4 (SD± 12) years. These patients were significantly more likely to have increased HCU in the 9 months post hospitalization compared to the 9 months prior. Patients had a 47%, 67%, 65%, and 51% increased risk of ED (rate ratio 1.47; 95% CI 1.45-1.49; p < .0001), rehabilitation (rate ratio 1.67; 95% CI 1.61-1.73; p < .0001), office (rate ratio1.65; 95% CI 1.64-1.65; p < .0001), and telemedicine visits (rate ratio 1.5; 95% CI 1.48-1.54; p < .0001), respectively. We also found significantly different rates of HCU for women compared to men (women have higher risk of ED, rehabilitation, and telemedicine visits but a lower risk of inpatient visits, length of stay, and office visits than men) and for patients who received care in the intensive care unit (ICU) vs those who did not (ICU patients had increased risk of ED, inpatient, office, and telemedicine visits and longer length of stay but a lower risk of rehabilitation visits). Outpatient (office) visits were the highest healthcare service utilized post discharge (64.5% increase). Finally, the risk of having an outpatient visit to any of the specialties studied significantly increased post discharge. Interestingly, the risk of requiring a visit to pulmonary medicine was the highest amongst the specialties studied (rate ratio 3.35, 95% CI 3.26-3.45, p < .0001). CONCLUSION HCU was higher after index hospitalization compared to 9 months prior among patients discharged home post-COVID-19 hospitalization. The increases in HCU may be driven by those patients who received care in the ICU.
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Affiliation(s)
- Mohammed Zaidan
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch (UTMB), Galveston, TX, United States of America
| | - Daniel Puebla Neira
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Arizona College of Medicine, Phoenix, AZ, United States of America
| | - Efstathia Polychronopoulou
- Office of Biostatistics, University of Texas Medical Branch (UTMB), Galveston, TX, United States of America
| | - Kuo Yong-Fang
- Office of Biostatistics, University of Texas Medical Branch (UTMB), Galveston, TX, United States of America
- Sealy Center on Aging, University of Texas Medical Branch (UTMB), Galveston, TX, United States of America
| | - Gulshan Sharma
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch (UTMB), Galveston, TX, United States of America
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Watson MA, Sandi M, Bixby J, Perry G, Offner PJ, Burnham EL, Jolley SE. An Exploratory Analysis of Sociodemographic Factors Associated With Physical Functional Impairment in ICU Survivors. Crit Care Explor 2024; 6:e1100. [PMID: 38836576 PMCID: PMC11155592 DOI: 10.1097/cce.0000000000001100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024] Open
Abstract
IMPORTANCE Physical functional impairment is one of three components of postintensive care syndrome (PICS) that affects up to 60% of ICU survivors. OBJECTIVES To explore the prevalence of objective physical functional impairment among a diverse cohort of ICU survivors, both at discharge and longitudinally, and to highlight sociodemographic factors that might be associated with the presence of objective physical functional impairment. DESIGN, SETTING, AND PARTICIPANTS This was a secondary analysis of 37 patients admitted to the ICU in New Orleans, Louisiana, and Denver, Colorado between 2016 and 2019 who survived with longitudinal follow-up data. MAIN OUTCOMES AND MEASURES Our primary outcome of physical functional impairment was defined by handgrip strength and the short physical performance battery. We explored associations between functional impairment and sociodemographic factors that included race/ethnicity, sex, primary language, education status, and medical comorbidities. RESULTS More than 75% of ICU survivors were affected by physical functional impairment at discharge and longitudinally at 3- to 6-month follow-up. We did not see a significant difference in the proportion of patients with physical functional impairment by race/ethnicity, primary language, or education status. Impairment was relatively higher in the follow-up period among women, compared with men, and those with comorbidities. Among 18 patients with scores at both time points, White patients demonstrated greater change in handgrip strength than non-White patients. Four non-White patients demonstrated diminished handgrip strength between discharge and follow-up. CONCLUSIONS AND RELEVANCE In this exploratory analysis, we saw that the prevalence of objective physical functional impairment among ICU survivors was high and persisted after hospital discharge. Our findings suggest a possible relationship between race/ethnicity and physical functional impairment. These exploratory findings may inform future investigations to evaluate the impact of sociodemographic factors on functional recovery.
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Affiliation(s)
- Megan A Watson
- Division of Pulmonary and Critical Care, University of Colorado, Aurora, CO
| | - Marie Sandi
- Section of Pulmonary/Critical Care, Louisiana State University, New Orleans, LA
| | - Johanna Bixby
- Division of Pulmonary and Critical Care, University of Colorado, Aurora, CO
| | - Grace Perry
- Division of Pulmonary and Critical Care, University of Colorado, Aurora, CO
| | - Patrick J Offner
- Division of Pulmonary and Critical Care, University of Colorado, Aurora, CO
| | - Ellen L Burnham
- Division of Pulmonary and Critical Care, University of Colorado, Aurora, CO
| | - Sarah E Jolley
- Division of Pulmonary and Critical Care, University of Colorado, Aurora, CO
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Vakkalanka JP, Gadag K, Lavin L, Ternes S, Healy HS, Merchant KAS, Scott W, Wiggins W, Ward MM, Mohr NM. Telehealth Use and Health Equity for Mental Health and Substance Use Disorder During the COVID-19 Pandemic: A Systematic Review. Telemed J E Health 2024; 30:1205-1220. [PMID: 38227387 DOI: 10.1089/tmj.2023.0588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024] Open
Abstract
Background: As a result of the COVID-19 public health emergency (PHE), telehealth utilization accelerated to facilitate health care management and minimize risk. However, those with mental health conditions and substance use disorders (SUD)-who represent a vulnerable population, and members of underrepresented minorities (e.g., rural, racial/ethnic minorities, the elderly)-may not benefit from telehealth equally. Objective: To evaluate health equality in clinical effectiveness and utilization measures associated with telehealth for clinical management of mental health disorders and SUD to identify emerging patterns for underrepresented groups stratified by race/ethnicity, gender, age, rural status, insurance, sexual minorities, and social vulnerability. Methods: We performed a systematic review in PubMed, Embase, Cochrane Central Register of Controlled Trials, and CINAHL through November 2022. Studies included those with telehealth, COVID-19, health equity, and mental health or SUD treatment/care concepts. Our outcomes included general clinical measures, mental health or SUD clinical measures, and operational measures. Results: Of the 2,740 studies screened, 25 met eligibility criteria. The majority of studies (n = 20) evaluated telehealth for mental health conditions, while the remaining five studies evaluated telehealth for opioid use disorder/dependence. The most common study outcomes were utilization measures (n = 19) or demographic predictors of telehealth utilization (n = 3). Groups that consistently demonstrated less telehealth utilization during the PHE included rural residents, older populations, and Black/African American minorities. Conclusions: We observed evidence of inequities in telehealth utilization among several underrepresented groups. Future efforts should focus on measuring the contribution of utilization disparities on outcomes and strategies to mitigate disparities in implementation.
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Affiliation(s)
- J Priyanka Vakkalanka
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Khyathi Gadag
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Lauren Lavin
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Sara Ternes
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Heather S Healy
- Hardin Library for the Health Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Kimberly A S Merchant
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Wakina Scott
- Office for the Advancement of Telehealth, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland, USA
| | - Whitney Wiggins
- Office for the Advancement of Telehealth, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland, USA
| | - Marcia M Ward
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
- Department of Anesthesia and Critical Care, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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Baymon DE, Vakkalanka JP, Krishnadasan A, Mohr NM, Talan DA, Hagen MB, Wallace K, Harland KK, Aisiku IP, Hou PC. Race, Ethnicity, and Delayed Time to COVID-19 Testing Among US Health Care Workers. JAMA Netw Open 2024; 7:e245697. [PMID: 38598239 PMCID: PMC11007575 DOI: 10.1001/jamanetworkopen.2024.5697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/12/2024] [Indexed: 04/11/2024] Open
Abstract
Importance Access to COVID-19 testing is critical to reducing transmission and supporting early treatment decisions; when made accessible, the timeliness of testing may also be an important metric in mitigating community spread of the infection. While disparities in transmission and outcomes of COVID-19 have been well documented, the extent of timeliness of testing and the association with demographic factors is unclear. Objectives To evaluate demographic factors associated with delayed COVID-19 testing among health care personnel (HCP) during the COVID-19 pandemic. Design, Setting, and Participants This cross-sectional study used data from the Preventing Emerging Infections Through Vaccine Effectiveness Testing study, a multicenter, test-negative, case-control vaccine effectiveness study that enrolled HCP who had COVID-19 symptoms and testing between December 2020 and April 2022. Data analysis was conducted from March 2022 to Junne 2023. Exposure Displaying COVID-19-like symptoms and polymerase chain reaction testing occurring from the first day symptoms occurred up to 14 days after symptoms occurred. Main Outcomes and Measures Variables of interest included patient demographics (sex, age, and clinical comorbidities) and COVID-19 characteristics (vaccination status and COVID-19 wave). The primary outcome was time from symptom onset to COVID-19 testing, which was defined as early testing (≤2 days) or delayed testing (≥3 days). Associations of demographic characteristics with delayed testing were measured while adjusting for clinical comorbidities, COVID-19 characteristics, and test site using multivariable modeling to estimate relative risks and 95% CIs. Results A total of 5551 HCP (4859 female [82.9%]; 1954 aged 25-34 years [35.2%]; 4233 non-Hispanic White [76.3%], 370 non-Hispanic Black [6.7%], and 324 non-Hispanic Asian [5.8%]) were included in the final analysis. Overall, 2060 participants (37.1%) reported delayed testing and 3491 (62.9%) reported early testing. Compared with non-Hispanic White HCP, delayed testing was higher among non-Hispanic Black HCP (adjusted risk ratio, 1.18; 95%CI, 1.10-1.27) and for non-Hispanic HCP of other races (adjusted risk ratio, 1.17; 95% CI, 1.03-1.33). Sex and age were not associated with delayed testing. Compared with clinical HCP with graduate degrees, all other professional and educational groups had significantly delayed testing. Conclusions and Relevance In this cross-sectional study of HCP, compared with non-Hispanic White HCP and clinical HCP with graduate degrees, non-Hispanic Black HCP, non-Hispanic HCP of other races, and HCP all other professional and education backgrounds were more likely to have delayed COVID-19 testing. These findings suggest that time to testing may serve as a valuable metric in evaluating sociodemographic disparities in the response to COVID-19 and future health mitigation strategies.
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Affiliation(s)
- DaMarcus E. Baymon
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - J. Priyanka Vakkalanka
- Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
| | - Anusha Krishnadasan
- Olive View-University of California, Los Angeles Education and Research Institute, Los Angeles
| | - Nicholas M. Mohr
- Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
- Department of Anesthesia Critical Care, Carver College of Medicine, University of Iowa, Iowa City
| | - David A. Talan
- Olive View-University of California, Los Angeles Education and Research Institute, Los Angeles
- David Geffen School of Medicine, University of California, Los Angeles
| | - Melissa Briggs Hagen
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control & Prevention, Atlanta, Georgia
| | - Kelli Wallace
- University of Iowa Holden Comprehensive Cancer Center, University of Iowa, Iowa City
| | - Karisa K. Harland
- Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City
| | - Imoigele P. Aisiku
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Peter C. Hou
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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Verma A, Manojkumar A, Dhasmana A, Tripathi MK, Jaggi M, Chauhan SC, Chauhan DS, Yallapu MM. Recurring SARS-CoV-2 variants: an update on post-pandemic, co-infections and immune response. Nanotheranostics 2024; 8:247-269. [PMID: 38444741 PMCID: PMC10911975 DOI: 10.7150/ntno.91910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/30/2024] [Indexed: 03/07/2024] Open
Abstract
The post-pandemic era following the global spread of the SARS-CoV-2 virus has brought about persistent concerns regarding recurring coinfections. While significant strides in genome mapping, diagnostics, and vaccine development have controlled the pandemic and reduced fatalities, ongoing virus mutations necessitate a deeper exploration of the interplay between SARS-CoV-2 mutations and the host's immune response. Various vaccines, including RNA-based ones like Pfizer and Moderna, viral vector vaccines like Johnson & Johnson and AstraZeneca, and protein subunit vaccines like Novavax, have played critical roles in mitigating the impact of COVID-19. Understanding their strengths and limitations is crucial for tailoring future vaccines to specific variants and individual needs. The intricate relationship between SARS-CoV-2 mutations and the immune response remains a focus of intense research, providing insights into personalized treatment strategies and long-term effects like long-COVID. This article offers an overview of the post-pandemic landscape, highlighting emerging variants, summarizing vaccine platforms, and delving into immunological responses and the phenomenon of long-COVID. By presenting clinical findings, it aims to contribute to the ongoing understanding of COVID-19's progression in the aftermath of the pandemic.
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Affiliation(s)
- Ashmit Verma
- Divyasampark iHub Roorkee for Devices Materials and Technology Foundation, Indian Institute of Technology Roorkee, Uttarakhand, 247667, India
- Samrat Ashok Technological Institute, Vidisha, Madhya Pradesh, 464001, India
| | - Anjali Manojkumar
- Department of Immunology and Microbiology, School of Medicine, University of Texas Rio Grande Valley, McAllen, Texas 78504, USA
- Department of Biology, College of Science, University of Texas Rio Grande Valley, McAllen, Texas 78504, USA
| | - Anupam Dhasmana
- Department of Immunology and Microbiology, School of Medicine, University of Texas Rio Grande Valley, McAllen, Texas 78504, USA
- South Texas Center of Excellence in Cancer Research, School of Medicine, University of Texas Rio Grande Valley, McAllen, Texas 78504, USA
| | - Manish K. Tripathi
- Department of Immunology and Microbiology, School of Medicine, University of Texas Rio Grande Valley, McAllen, Texas 78504, USA
- South Texas Center of Excellence in Cancer Research, School of Medicine, University of Texas Rio Grande Valley, McAllen, Texas 78504, USA
| | - Meena Jaggi
- Department of Immunology and Microbiology, School of Medicine, University of Texas Rio Grande Valley, McAllen, Texas 78504, USA
- South Texas Center of Excellence in Cancer Research, School of Medicine, University of Texas Rio Grande Valley, McAllen, Texas 78504, USA
| | - Subhash C. Chauhan
- Department of Immunology and Microbiology, School of Medicine, University of Texas Rio Grande Valley, McAllen, Texas 78504, USA
- South Texas Center of Excellence in Cancer Research, School of Medicine, University of Texas Rio Grande Valley, McAllen, Texas 78504, USA
| | - Deepak S. Chauhan
- Faculté de Pharmacie, Université de Montréal, Montréal H3C 3J7, QC, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS, Canada
- Department of Pediatrics, IWK Research Center, Halifax, NS, Canada
| | - Murali M. Yallapu
- Department of Immunology and Microbiology, School of Medicine, University of Texas Rio Grande Valley, McAllen, Texas 78504, USA
- South Texas Center of Excellence in Cancer Research, School of Medicine, University of Texas Rio Grande Valley, McAllen, Texas 78504, USA
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Yeow RY, O'Leary MP, Reddy AR, Kamdar NS, Hayek SS, de Lemos JA, Sutton NR. Survival Characteristics of Older Patients Hospitalized With COVID-19: Insights From the American Heart Association COVID-19 Cardiovascular Disease Registry. J Am Med Dir Assoc 2024; 25:348-350. [PMID: 38211937 PMCID: PMC11072581 DOI: 10.1016/j.jamda.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 01/13/2024]
Affiliation(s)
- Raymond Y Yeow
- Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Michael P O'Leary
- Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Akshay R Reddy
- Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Neil S Kamdar
- Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Salim S Hayek
- Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - James A de Lemos
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nadia R Sutton
- Division of Cardiovascular Medicine, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA.
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Robinson-Lane SG, Leggett AN, Johnson FU, Leonard N, Carmichael AG, Oxford G, Miah T, Wright JJ, Blok AC, Iwashyna TJ, Gonzalez R. Caregiving in the COVID-19 pandemic: Family adaptations following an intensive care unit hospitalisation. J Clin Nurs 2024; 33:203-214. [PMID: 36262026 PMCID: PMC9874809 DOI: 10.1111/jocn.16560] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/21/2022] [Accepted: 09/29/2022] [Indexed: 01/29/2023]
Abstract
AIM AND OBJECTIVE To identify how family caregivers adapt to the caregiving role following a relative's COVID-19-related intensive care unit (ICU) hospitalisation. BACKGROUND Family caregiving is often associated with poor health amongst caregivers which may limit their capacity to effectively support patients. Though severe COVID-19 infection has necessitated increasing numbers of persons who require caregiver support, little is known about these caregivers, the persons they are caring for, or the strategies used to effectively adjust to the caregiving role. DESIGN A qualitative descriptive study design was adopted, and findings are reported using COREQ. METHODS A secondary analysis of transcripts from semi-structured interviews conducted with recently discharged ICU patients who had COVID-19 (n = 16) and their family caregivers (n = 16) was completed using thematic analysis. MAXQDA 2020 and Miro were used to organise data and complete coding. Analysis involved a structured process of open and closed coding to identify and confirm themes that elucidated adaptation to family caregiving. RESULTS Six themes highlight how family caregivers adapt to the caregiving role following an ICU COVID-19-related hospitalisation including (1) engaging the support of family and friends, (2) increased responsibilities to accommodate caregiving, (3) managing emotions, (4) managing infection control, (5) addressing patient independence and (6) engaging support services. These themes were found to be congruent with the Roy adaptation model. CONCLUSIONS Family caregiving is a stressful transition following a patient's acute hospitalisation. Effective adaptation requires flexibility and sufficient support, beginning with the care team who can adequately prepare the family for the anticipated challenges of recovery. RELEVANCE TO CLINICAL PRACTICE Clinical teams may improve post-hospitalisation care outcomes of patients by preparing families to effectively adjust to the caregiver role-particularly in identifying sufficient support resources. PATIENT OR PUBLIC CONTRIBUTION Participation of patients/caregivers in this study was limited to the data provided through participant interviews.
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Affiliation(s)
- Sheria G. Robinson-Lane
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Amanda N. Leggett
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Florence U. Johnson
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Natalie Leonard
- BioSocial Methods Collaborative, Research Center for Group Dynamics, University of Michigan Institute for Social Research, Ann Arbor, Michigan, USA
| | - Alicia G. Carmichael
- BioSocial Methods Collaborative, Research Center for Group Dynamics, University of Michigan Institute for Social Research, Ann Arbor, Michigan, USA
| | - Grace Oxford
- BioSocial Methods Collaborative, Research Center for Group Dynamics, University of Michigan Institute for Social Research, Ann Arbor, Michigan, USA
| | - Tanbirul Miah
- BioSocial Methods Collaborative, Research Center for Group Dynamics, University of Michigan Institute for Social Research, Ann Arbor, Michigan, USA
| | - Johnny J. Wright
- BioSocial Methods Collaborative, Research Center for Group Dynamics, University of Michigan Institute for Social Research, Ann Arbor, Michigan, USA
| | - Amanda C. Blok
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Theodore J. Iwashyna
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Richard Gonzalez
- BioSocial Methods Collaborative, Research Center for Group Dynamics, University of Michigan Institute for Social Research, Ann Arbor, Michigan, USA
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Leggett AN, Robinson-Lane SG, Oxford G, Leonard N, Carmichael AG, Baker E, Paratore J, Blok AC, Prescott HC, Iwashyna TJ, Gonzalez R. Barriers to and Facilitators of Family Caregiving of Patients With COVID-19 Early in the Pandemic. Am J Crit Care 2023; 32:431-439. [PMID: 37907378 DOI: 10.4037/ajcc2023364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND In 2020, many family members were thrust into the role of caregiving for a relative with COVID-19 with little preparation, training, or understanding of the disease and its symptoms. OBJECTIVES To explore the barriers to and facilitators of caregiving experienced by family caregivers of patients with COVID-19 who had been in intensive care in the pandemic's earliest months. METHODS In-depth qualitative interviews were conducted by web conference with 16 adults recovering at home after intubation for COVID-19 in an intensive care unit at a major academic medical center and their primary caregivers from March to August 2020 (N = 32). Thematic qualitative analysis was done using Watkins' rigorous and accelerated data reduction technique with MAXQDA software. RESULTS Seven themes emerged regarding factors that facilitated or posed barriers to care: other health conditions that increased complexity of care, interactions and experiences in the health care system, COVID-19's proliferation into other areas of life, the psychological well-being of the patient-caregiver dyad, experience of support from the dyad's network, the role of caregiving in the dyad, and contextual circumstances of the dyad. The themes often included both barriers and facilitators, depending on the experience of the dyad (eg, feeling encouraged vs fatigued by their support network). CONCLUSIONS Understanding how patients with COVID-19 and their caregivers experience illness management across the recovery journey can help clarify the COVID-19 care-giving process and identify intervention targets to improve overall health and well-being of the care dyad.
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Affiliation(s)
- Amanda N Leggett
- Amanda N. Leggett is an assistant professor in the Institute of Gerontology at Wayne State University, Detroit, Michigan, and an adjunct assistant professor, Department of Psychiatry, School of Medicine, University of Michigan Ann Arbor
| | - Sheria G Robinson-Lane
- Sheria G. Robinson-Lane is an assistant professor, Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan Ann Arbor
| | - Grace Oxford
- Grace Oxford is a research assistant, Biosocial Methods Collaborative, University of Michigan Ann Arbor
| | - Natalie Leonard
- Natalie Leonard is a research technician, Research Center for Group Dynamics, Institute for Social Research, University of Michigan Ann Arbor
| | - Alicia G Carmichael
- Alicia G. Carmichael is a research process manager, Research Center for Group Dynamics, Institute for Social Research, University of Michigan Ann Arbor
| | - Elaina Baker
- Elaina Baker is a research assistant, Department of Psychiatry, School of Medicine, University of Michigan Ann Arbor
| | - Janeann Paratore
- Janeann Paratore is a research assistant, Biosocial Methods Collaborative, University of Michigan Ann Arbor
| | - Amanda C Blok
- Amanda C. Blok is a research assistant professor, Department of Systems, Populations and Leadership, School of Nursing, University of Michigan and a research health scientist, VA Center for Clinical Management Research, Ann Arbor VA Healthcare System, Ann Arbor, Michigan
| | - Hallie C Prescott
- Hallie C. Prescott is an associate professor, Pulmonary and Critical Care, Department of Internal Medicine, School of Medicine, University of Michigan and a research investigator, VA Center for Clinical Management Research, Ann Arbor VA Healthcare System
| | - Theodore J Iwashyna
- Theodore J. Iwashyna is the Bloomberg Distinguished Professor of Social Science and Justice in Medicine and professor of medicine, Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Richard Gonzalez
- Richard Gonzalez is the Amos N. Tversky Professor, Psychology and Statistics and director, Research Center for Group Dynamics, University of Michigan
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Ahlberg CD, Wallam S, Tirba LA, Itumba SN, Gorman L, Galiatsatos P. Linking Sepsis with chronic arterial hypertension, diabetes mellitus, and socioeconomic factors in the United States: A scoping review. J Crit Care 2023; 77:154324. [PMID: 37159971 DOI: 10.1016/j.jcrc.2023.154324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/28/2023] [Accepted: 04/29/2023] [Indexed: 05/11/2023]
Abstract
RATIONALE Sepsis is a syndrome of life-threatening organ dysfunction caused by a dysregulated host immune response to infection. Social risk factors including location and poverty are associated with sepsis-related disparities. Understanding the social and biological phenotypes linked with the incidence of sepsis is warranted to identify the most at-risk populations. We aim to examine how factors in disadvantage influence health disparities related to sepsis. METHODS A scoping review was performed for English-language articles published in the United States from 1990 to 2022 on PubMed, Web of Science, and Scopus. Of the 2064 articles found, 139 met eligibility criteria and were included for review. RESULTS There is consistency across the literature of disproportionately higher rates of sepsis incidence, mortality, readmissions, and associated complications, in neighborhoods with socioeconomic disadvantage and significant poverty. Chronic arterial hypertension and diabetes mellitus also occur more frequently in the same geographic distribution as sepsis, suggesting a potential shared pathophysiology. CONCLUSIONS The distribution of chronic arterial hypertension, diabetes mellitus, social risk factors associated with socioeconomic disadvantage, and sepsis incidence, are clustered in specific geographical areas and linked by endothelial dysfunction. Such population factors can be utilized to create equitable interventions aimed at mitigating sepsis incidence and sepsis-related disparities.
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Affiliation(s)
- Caitlyn D Ahlberg
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Sara Wallam
- The Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Lemya A Tirba
- The Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Stephanie N Itumba
- The Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Linda Gorman
- Harrison Medical Library, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA
| | - Panagis Galiatsatos
- Division of Pulmonary and Critical Care Medicine, the Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
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11
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Abstract
An estimated 10-15% of those infected with SARS-CoV-2 may have post-COVID-19 condition. Common lingering signs and symptoms include shortness of breath, fatigue, high heart rate, and memory and cognitive dysfunction even several months after infection, often impacting survivors' quality of life. The prevalence and duration of individual symptoms remain difficult to ascertain due to the lack of standardized research methods across various studies and limited patient follow-up in clinical studies. Nonetheless, data indicate post-COVID-19 condition may occur independent of acuity of initial infection, hospitalization status, age, or pre-existing comorbidities. Risk factors may include female sex and underlying respiratory or psychiatric disease. Supportive therapies to mitigate symptoms remain the mainstay of treatment. Reassuringly, most patients experience a reduction in symptoms by 1 year. The use of a universal case definition and shared research methods will allow for further clarity regarding the pervasiveness of this entity and its long-term health consequences.
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Affiliation(s)
- Ani Nalbandian
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA; ,
| | - Amar D Desai
- Rutgers New Jersey Medical School, Newark, New Jersey, USA;
| | - Elaine Y Wan
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA; ,
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Bergmans RS, Chambers-Peeple K, Aboul-Hassan D, Dell'Imperio S, Martin A, Wegryn-Jones R, Xiao LZ, Yu C, Williams DA, Clauw DJ, DeJonckheere M. Opportunities to Improve Long COVID Care: Implications from Semi-structured Interviews with Black Patients. THE PATIENT 2022; 15:715-728. [PMID: 35907120 PMCID: PMC9362503 DOI: 10.1007/s40271-022-00594-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Long coronavirus disease (COVID) is an emerging condition that could considerably burden healthcare systems. Prior qualitative studies characterize the experience of having long COVID, which is valuable for informing care strategies. However, evidence comes from predominantly White samples. This is a concern because underrepresentation of Black patients in research and intervention development contribute to racial inequities. OBJECTIVE To facilitate racial equity in long COVID care, the purpose of this qualitative study was to inform the development of care strategies that are responsive to the experiences and perspectives of Black patients with long COVID in the United States of America. METHODS Using convenience sampling, we conducted race-concordant, semi-structured, and open-ended interviews with Black adults (80% female, mean age = 39) who had long COVID. We transcribed and anonymized the recorded interviews. We analyzed the transcripts using inductive, thematic analysis. Theme development focused on who can help or hinder strategies for reducing health inequities, what should be done to change care policies or treatment strategies, and when are the critical timepoints for intervention. RESULTS We developed four main themes. Participants reported challenges before and after COVID testing. Many participants contacted primary care physicians as a first step for long COVID treatment. However, not all respondents had positive experiences and at times felt dismissed. Without a qualifying diagnosis, participants could not obtain disability benefits, which negatively influenced their employment and increased financial hardship. CONCLUSIONS There are possible targets for improving long COVID care, from COVID testing through to long-term treatment plans. There is a need to increase long COVID awareness among physicians. Diagnosis and a standardized treatment plan could help patients avoid unnecessary healthcare utilization and obtain comprehensive support.
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Affiliation(s)
- Rachel S Bergmans
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Medical School, Ann Arbor, MI, USA.
| | - Keiyana Chambers-Peeple
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Deena Aboul-Hassan
- College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI, USA
| | - Samantha Dell'Imperio
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Medical School, Ann Arbor, MI, USA
- College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI, USA
| | - Allie Martin
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Riley Wegryn-Jones
- College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI, USA
| | - Lillian Z Xiao
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Christine Yu
- College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI, USA
| | - David A Williams
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Daniel J Clauw
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Melissa DeJonckheere
- Department of Family Medicine, University of Michigan, Medical School, Ann Arbor, MI, USA
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Hentschel CB, Abramoff BA, Dillingham TR, Pezzin LE. Race, ethnicity, and utilization of outpatient rehabilitation for treatment of post COVID-19 condition. PM R 2022; 14:1315-1324. [PMID: 35789541 PMCID: PMC9350262 DOI: 10.1002/pmrj.12869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/26/2022] [Accepted: 06/20/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Outpatient rehabilitation is recommended in the treatment of post coronavirus disease 2019 (COVID-19) condition. Although racial and ethnic disparities in the incidence and severity of COVID-19 have been well documented, little is known about the use of outpatient rehabilitation among patients with post COVID-19 condition. OBJECTIVE To examine factors associated with outpatient rehabilitation use following COVID-19 and to ascertain whether differential incidence of sequelae explain variation in post COVID-19 rehabilitation utilization by race and ethnicity. DESIGN Case-control study. SETTING Community. PARTICIPANTS U.S. adults with COVID-19 during 2020 in the TriNetX database. INTERVENTION N/A. MAIN OUTCOME MEASURES Receipt of outpatient rehabilitation services within 6 months of COVID-19 diagnosis and incidence of post COVID-19 condition symptoms (weakness, fatigue, pain, cognitive impairment, mobility difficulties, and dyspnea). RESULTS From 406,630 laboratory-confirmed COVID-19 cases, we identified 8724 individuals who received outpatient rehabilitation and matched 28,719 controls. Of rehabilitation users, 43.3% were 40 years old or younger, 54.8% were female, 58.2% were White, 17.9% were African American/Black, 2.1% were Asian, 13.0% were Hispanic, 39.2% had no comorbidities, and 40.3% had been hospitalized for COVID-19. Dyspnea (20.4%), fatigue (12.4%), and weakness (8.2%) were the most frequently identified symptoms. Although there were no racial differences in the incidence of the six post COVID-19 condition symptoms considered, African American/Black individuals were significantly less likely than their White counterparts to receive outpatient rehabilitation (odds ratio [OR] = 0.89; 95% confidence interval [CI]: 0.84-0.96; p = .003). Hispanic individuals had higher outpatient rehabilitation utilization (OR = 1.22; 95% CI: 1.11-1.33; p < .001) and a significantly higher incidence of post COVID-19 fatigue. CONCLUSIONS In this large nationally representative study, African American/Black race was associated with lower utilization of outpatient rehabilitation services despite a similar incidence of post COVID-19 condition symptoms. Further research is needed to better understand access barriers to rehabilitation services for post COVID-19 condition recovery care and address racial inequalities in receipt of care.
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Affiliation(s)
| | - Benjamin A. Abramoff
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania – Perelman School of Medicine
| | - Timothy R. Dillingham
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania – Perelman School of Medicine
| | - Liliana E. Pezzin
- Institute for Health and Equity and Collaborative for Healthcare Delivery Science, Medical College of Wisconsin
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14
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Koumpias AM, Schwartzman D, Fleming O. Long-haul COVID: healthcare utilization and medical expenditures 6 months post-diagnosis. BMC Health Serv Res 2022; 22:1010. [PMID: 35941617 PMCID: PMC9358916 DOI: 10.1186/s12913-022-08387-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 07/28/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite extensive evidence that COVID-19 symptoms may persist for up to a year, their long-term implications for healthcare utilization and costs 6 months post-diagnosis remain relatively unexplored. We examine patient-level association of COVID-19 diagnosis association of COVID-19 diagnosis with average monthly healthcare utilization and medical expenditures for up to 6 months, explore heterogeneity across age groups and determine for how many months post-diagnosis healthcare utilization and costs of COVID-19 patients persist above pre-diagnosis levels. METHODS This population-based retrospective cohort study followed COVID-19 patients' healthcare utilization and costs from January 2019 through March 2021 using claims data provided by the COVID-19 Research Database. The patient population includes 250,514 individuals infected with COVID-19 during March-September 2020 and whose last recorded claim was not hospitalization with severe symptoms. We measure the monthly number and costs of total visits and by telemedicine, preventive, urgent care, emergency, immunization, cardiology, inpatient or surgical services and established patient or new patient visits. RESULTS The mean (SD) total number of monthly visits and costs pre-diagnosis were .4783 (4.0839) and 128.06 (1182.78) dollars compared with 1.2078 (8.4962) visits and 351.67 (2473.63) dollars post-diagnosis. COVID-19 diagnosis associated with .7269 (95% CI, 0.7088 to 0.7449 visits; P < .001) more total healthcare visits and an additional $223.60 (95% CI, 218.34 to 228.85; P < .001) in monthly costs. Excess monthly utilization and costs for individuals 17 years old and under subside after 5 months to .070 visits and $2.77, persist at substantial levels for all other groups and most pronounced among individuals age 45-64 (.207 visits and $73.43) and 65 years or older (.133 visits and $60.49). CONCLUSIONS This study found that COVID-19 diagnosis was associated with increased healthcare utilization and costs over a six-month post-diagnosis period. These findings imply a prolonged burden to the US healthcare system from medical encounters of COVID-19 patients and increased spending.
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Affiliation(s)
- Antonios M Koumpias
- Department of Social Sciences, University of Michigan-Dearborn, Dearborn, USA
| | - David Schwartzman
- Olin College of Business, Washington University in St. Louis, St. Louis, USA
| | - Owen Fleming
- Department of Economics, Wayne State University, 656 W. Kirby St FAB 2140, Detroit, USA.
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15
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Gualano MR, Rossi MF, Borrelli I, Santoro PE, Amantea C, Daniele A, Tumminello A, Moscato U. Returning to work and the impact of post COVID-19 condition: A systematic review. Work 2022; 73:405-413. [DOI: 10.3233/wor-220103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND: The COVID-19 pandemic is still ongoing, with rapidly increasing cases all over the world, and the emerging issue of post COVID-19 (or Long COVID-19) condition is impacting the occupational world. OBJECTIVE: The aim of this systematic review was to evaluate the impact of lasting COVID-19 symptoms or disability on the working population upon their return to employment. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statements we performed a systematic review in December 2021, screening three databases (PubMed, ISI Web of Knowledge, Scopus), for articles investigating return to work in patients that were previously hospitalized due to COVID-19. A hand-searched was then performed through the references of the included systematic review. A quality assessment was performed on the included studies. RESULTS: Out of the 263 articles found through the initial search, 11 studies were included in this systematic review. The selected studies were divided based on follow-up time, in two months follow-up, follow-up between two and six months, and six months follow-up. All the studies highlighted an important impact of post COVID-19 condition in returning to work after being hospitalized, with differences based on follow-up time, home Country and mean/median age of the sample considered. CONCLUSIONS: This review highlighted post COVID-19 condition as a rising problem in occupational medicine, with consequences on workers’ quality of life and productivity. The role of occupational physicians could be essential in applying limitations to work duties or hours and facilitating the return to employment in workers with a post COVID-19 condition.
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Affiliation(s)
- Maria Rosaria Gualano
- Department of Public Health Sciences and Paediatrics, University of Torino, Torino, Italy
| | - Maria Francesca Rossi
- Department of Life Sciences and Public Health, Section of Occupational Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ivan Borrelli
- Department of Health Science and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Emilio Santoro
- Department of Health Science and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlotta Amantea
- Department of Life Sciences and Public Health, Section of Occupational Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandra Daniele
- Department of Life Sciences and Public Health, Section of Occupational Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Tumminello
- Department of Life Sciences and Public Health, Section of Occupational Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Umberto Moscato
- Department of Life Sciences and Public Health, Section of Occupational Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Health Science and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Loo WK, Hasikin K, Suhaimi A, Yee PL, Teo K, Xia K, Qian P, Jiang Y, Zhang Y, Dhanalakshmi S, Azizan MM, Lai KW. Systematic Review on COVID-19 Readmission and Risk Factors: Future of Machine Learning in COVID-19 Readmission Studies. Front Public Health 2022; 10:898254. [PMID: 35677770 PMCID: PMC9168237 DOI: 10.3389/fpubh.2022.898254] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/20/2022] [Indexed: 01/19/2023] Open
Abstract
In this review, current studies on hospital readmission due to infection of COVID-19 were discussed, compared, and further evaluated in order to understand the current trends and progress in mitigation of hospital readmissions due to COVID-19. Boolean expression of (“COVID-19” OR “covid19” OR “covid” OR “coronavirus” OR “Sars-CoV-2”) AND (“readmission” OR “re-admission” OR “rehospitalization” OR “rehospitalization”) were used in five databases, namely Web of Science, Medline, Science Direct, Google Scholar and Scopus. From the search, a total of 253 articles were screened down to 26 articles. In overall, most of the research focus on readmission rates than mortality rate. On the readmission rate, the lowest is 4.2% by Ramos-Martínez et al. from Spain, and the highest is 19.9% by Donnelly et al. from the United States. Most of the research (n = 13) uses an inferential statistical approach in their studies, while only one uses a machine learning approach. The data size ranges from 79 to 126,137. However, there is no specific guide to set the most suitable data size for one research, and all results cannot be compared in terms of accuracy, as all research is regional studies and do not involve data from the multi region. The logistic regression is prevalent in the research on risk factors of readmission post-COVID-19 admission, despite each of the research coming out with different outcomes. From the word cloud, age is the most dominant risk factor of readmission, followed by diabetes, high length of stay, COPD, CKD, liver disease, metastatic disease, and CAD. A few future research directions has been proposed, including the utilization of machine learning in statistical analysis, investigation on dominant risk factors, experimental design on interventions to curb dominant risk factors and increase the scale of data collection from single centered to multi centered.
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Affiliation(s)
- Wei Kit Loo
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Khairunnisa Hasikin
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Anwar Suhaimi
- Department of Rehabilitation Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Por Lip Yee
- Department of Computer System and Technology, Faculty of Computer Science and Information Technology, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Kareen Teo
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Kaijian Xia
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Pengjiang Qian
- School of Artificial Intelligence and Computer Science, Jiangnan University, Wuxi, China
| | - Yizhang Jiang
- School of Artificial Intelligence and Computer Science, Jiangnan University, Wuxi, China
| | - Yuanpeng Zhang
- Department of Medical Informatics of Medical (Nursing) School, Nantong University, Nantong, China
| | - Samiappan Dhanalakshmi
- Department of ECE, Faculty of Engineering and Technology, SRM Institute of Science and Technology, Kattankulathur, India
- Samiappan Dhanalakshmi
| | - Muhammad Mokhzaini Azizan
- Department of Electrical and Electronic Engineering, Faculty of Engineering and Built Environment, Universiti Sains Islam Malaysia, Nilai, Malaysia
- Muhammad Mokhzaini Azizan
| | - Khin Wee Lai
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
- *Correspondence: Khin Wee Lai
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Tipirneni R, Karmakar M, O'Malley M, Prescott HC, Chopra V. Contribution of Individual- and Neighborhood-Level Social, Demographic, and Health Factors to COVID-19 Hospitalization Outcomes. Ann Intern Med 2022; 175:505-512. [PMID: 35188790 PMCID: PMC8982172 DOI: 10.7326/m21-2615] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although disparities in COVID-19 outcomes have been observed, factors contributing to these differences are not well understood. OBJECTIVE To determine whether COVID-19 hospitalization outcomes are related to neighborhood-level social vulnerability, independent of patient-level clinical factors. DESIGN Pooled cross-sectional study of prospectively collected data. SETTING 38 Michigan hospitals. PATIENTS Adults older than 18 years hospitalized for COVID-19 in a participating site between March and December 2020. MEASUREMENTS COVID-19 outcomes included acute organ dysfunction, organ failure, invasive mechanical ventilation, intensive care unit stay, death, and discharge disposition. Social vulnerability was measured by the social vulnerability index (SVI), a composite measure of social disadvantage. RESULTS Compared with patients in low-vulnerability ZIP codes, those living in high-vulnerability ZIP codes were more frequently treated in the intensive care unit (29.0% vs. 24.5%); more frequently received mechanical ventilation (19.3% vs. 14.2%); and experienced higher rates of organ dysfunction (51.9% vs. 48.6%), organ failure (54.7% vs. 51.6%), and in-hospital death (19.4% vs. 16.7%). In mixed-effects regression analyses accounting for age, sex, and comorbid conditions, an increase in a patient's neighborhood SVI by 0.25 (1 quartile) was associated with greater likelihood of mechanical ventilation (increase of 2.1 percentage points), acute organ dysfunction (increase of 2.8 percentage points), and acute organ failure (increase of 2.8 percentage points) but was not associated with intensive care unit stay, mortality, or discharge disposition. LIMITATION Observational data focused on hospitalizations in a single state. CONCLUSION Hospitalized patients with COVID-19 from socially vulnerable neighborhoods presented with greater illness severity and required more intensive treatment, but once hospitalized they did not experience differences in hospital mortality or discharge disposition. Policies that target socially vulnerable neighborhoods and access to COVID-19 care may help ameliorate health disparities. PRIMARY FUNDING SOURCE Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network as part of the BCBSM Value Partnerships Program, the Michigan Public Health Institute, and the Michigan Department of Health & Human Services.
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Affiliation(s)
- Renuka Tipirneni
- Department of Internal Medicine, University of Michigan, and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan (R.T.)
| | - Monita Karmakar
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan (M.K.)
| | - Megan O'Malley
- Department of Internal Medicine, University of Michigan, and the MI-COVID19 Initiative and the Michigan Hospital Medicine Safety Collaborative, Ann Arbor, Michigan (M.O.)
| | - Hallie C Prescott
- Department of Internal Medicine, University of Michigan, Institute for Healthcare Policy and Innovation, University of Michigan, The MI-COVID19 Initiative and the Michigan Hospital Medicine Safety Collaborative, and VA Center for Clinical Management Research, Ann Arbor, Michigan (H.C.P.)
| | - Vineet Chopra
- Department of Internal Medicine, University of Michigan, Institute for Healthcare Policy and Innovation, University of Michigan, and the MI-COVID19 Initiative and the Michigan Hospital Medicine Safety Collaborative, Ann Arbor, Michigan, and Department of Medicine, University of Colorado, Denver, Colorado (V.C.)
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