In a recent study posted to the medRxiv* preprint server, researchers assessed the long coronavirus disease (COVID) health care burden in Ontario, Canada. The post-acute period of COVID 2019 (COVID-19) has led to a substantial increase in the usage of healthcare facilities. However, the magnitude of the increase is unknown.
Study: Post-acute health care burden after SARS-CoV-2 infection: A retrospective cohort study among 530,892 adults. Image Credit: Mary Long / Shutterstock
About the study
In the present retrospective study, researchers assessed the increase in healthcare usage by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients during the post-acute period of COVID-19.
Long COVID patients who underwent polymerase chain reaction (PCR) tests between January 1, 2020, and March 31, 2021, and who were community residents in the Ontario province of Canada were retrospectively assessed using population-based data. Individuals were categorized based on the detection of SARS-CoV-2 in the PCR tests as PCR-positive or PCR-negative. Individuals with indeterminate or pending PCR results were excluded from the study.
PCR-positive individuals were matched in a 1:1 ratio with PCR-negative controls based on their sex, hospitalization within two weeks of the index test date, date of PCR tests, public healthcare units, and the propensity scores based on several clinical and socio-demographic factors.
For the analysis, the date of the first PCR-positive report was considered the index date for exposed individuals. For individuals with several PCR-negative reports, the last test date was considered the index date. Follow-up assessments were performed eight weeks post the index date up to September 30, 2021, or the patient's death, whichever occurred first.
The study's primary outcome was the rate of healthcare use, a composite measure of healthcare utilization per individual per year. Healthcare utilization was the sum of the number of outpatient encounters (virtual, telephonic or in-person), emergency department visits, duration of hospitalization, home care visits, and the duration of long-term care.
The mean healthcare utilization rate was derived from the count of outpatient encounters, homecare encounters, visits to the emergency departments, duration of hospitalization, and the long-term care duration per patient per year. The utilization of healthcare facilities by PCR-positive patients was compared to that by the controls based on the relative risks (RR), calculated at the 95th percentile and the 99th percentile using a 95% confidence interval (CI) and binomial regression modeling. In addition, the outcomes were sex-stratified.
Based on the eligibility criteria, 530,232 out of 530,892 individuals were considered for the final analysis. The mean age of the participants was 44 years, and 51% of the participants were women. About 0.6% of the individuals were vaccinated with ≥1 dose of SARS-CoV-2 vaccines.
In the study, the mean healthcare utilization rate was higher by 11% among the PCR-positive long COVID patients (RR 1.1) compared to the PCR-negative controls, with a greater number of outpatient encounters, longer duration of hospitalization, and more extended periods of long-term care.
At the 95th percentile and the 99th percentile, PCR-positive COVID-19 patients had 2.1 (95% CI 1.5 to 2.6) more and 71.9 (95% CI 57.6 to 83.2) more healthcare encounters, respectively, per individual per year.
On stratifying by sex, at the 95th percentile, PCR-positive females had 3.8 (95% CI 2.8 to 4.8) more healthcare encounters per individual per year while no differences were observed for the PCR-positive males. At the 99th percentile, PCR-positive females had 76.7 (95% CI 56.3 to 89.6) more healthcare encounters per individual per year, in comparison to 37.6 (95% CI 16.7 to 64.3) more healthcare encounters per individual per year among males.
Each day of January 2022 with ≥100,000 infections was estimated to translate into an increase of 72,000 more post-acute health care encounters each year for the 1% of patients with the most severe COVID-19 complications. Severe COVID-19 patients in the top 50% of health care usage would translate to 245,000 more healthcare encounters each year. Healthcare use will increase in response to the ongoing SARS-CoV-2 pandemic, and in healthcare systems, a decrease in workforce and backlogs would exacerbate the problem. If not addressed, the increase in healthcare demand could exacerbate the currently prevalent health inequities.
According to the study results, the healthcare burden associated with long COVID patients has significantly increased and underscored the need for proper planning by healthcare facilities to accommodate the growing increase in healthcare demands of these patients.
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
- Post-acute health care burden after SARS-CoV-2 infection: A retrospective cohort study of long COVID among 530,892 adults. Candace D. McNaughton MD PhD MPH, Peter C. Austin PhD, Atul Sivaswamy MSc, Jiming Fang PhD, Husam Abdel-Qadir MD PhD, Nick Daneman, MD MSc, Jacob A. Udell MD MPH, Walter Wodchis PhD, Ivona Mostarac, RN MPH, Clare L. Atzema MD MSc. medRxiv preprint 2022, DOI: https://doi.org/10.1101/2022.05.06.22274782, https://www.medrxiv.org/content/10.1101/2022.05.06.22274782v1