Substantial health and economic burden of COVID-19 during the year after acute illness among US adults at high risk of severe COVID-19
verfasst von:
Amie Scott, Wajeeha Ansari, Farid Khan, Richard Chambers, Michael Benigno, Manuela Di Fusco, Leah McGrath, Deepa Malhotra, Florin Draica, Jennifer Nguyen, Joanna Atkinson, Jessica E. Atwell
Post-COVID conditions encompass a range of long-term symptoms after SARS-CoV-2 infection. The potential clinical and economic burden in the United States is unclear. We evaluated diagnoses, medications, healthcare use, and medical costs before and after acute COVID-19 illness in US patients at high risk of severe COVID-19.
Methods
Eligible adults were diagnosed with COVID-19 from April 1 to May 31, 2020, had ≥ 1 condition placing them at risk of severe COVID-19, and were enrolled in Optum’s de-identified Clinformatics® Data Mart Database for ≥ 12 months before and ≥ 13 months after COVID-19 diagnosis. Percentages of diagnoses, medications, resource use, and costs were calculated during baseline (12 months preceding diagnosis) and the post-acute phase (12 months after the 30-day acute phase of COVID-19). Data were stratified by age and COVID-19 severity.
Results
The cohort included 19,558 patients (aged 18–64 y, n = 9381; aged ≥ 65 y, n = 10,177). Compared with baseline, patients during the post-acute phase had increased percentages of blood disorders (16.3%), nervous system disorders (11.1%), and mental and behavioral disorders (7.7%), along with increases in related prescriptions. Overall, there were substantial increases in inpatient and outpatient healthcare utilization, along with a 23.0% increase in medical costs. Changes were greatest among older patients and those admitted to the intensive care unit for acute COVID-19 but were also observed in younger patients and those who did not require COVID-19 hospitalization.
Conclusions
There is a significant clinical and economic burden of post-COVID conditions among US individuals at high risk for severe COVID-19.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Abkürzungen
CDC
US Centers for Disease Control and Prevention
CDM
Optum’s de-identified Clinformatics® Data Mart Database
CPT
Current Procedural Terminology
ED
Emergency department
HCPCS
Healthcare Common Procedure Coding System
ICD-10
International Classification of Diseases, 10th Revision
ICD-10-CM
International Classification of Diseases, 10th Revision, Clinical Modification
ICD-10-PCS
International Classification of Diseases, 10th Revision, Procedure Coding System
ICU
Intensive care unit
LOS
Length of stay
LTCF
Long-term care facility
NC
Not calculable
NDC
National Drug Code
PASC
Post-acute sequelae of COVID-19
Q1
Quartile 1
Q3
Quartile 3
SAS
Statistical analysis software
SNF
Skilled nursing facility
USC
Uniform System of Classification
USD
United States dollars
Background
Post-COVID conditions are characterized by symptoms of COVID-19 that extend beyond the initial recovery from acute illness [1‐3]. Presentation is highly variable across patients and may include residual symptoms that persist after acute illness, persistent organ dysfunction, or new symptoms or syndromes that develop after initial recovery from COVID-19 [1‐3]. Post-COVID conditions often affect multiple organ systems, persist for several months, and have a substantial impact on daily functioning and productivity [4]. The clinical diagnosis, termed post-acute sequelae of COVID-19 (PASC), was officially defined and assigned an International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), code (U09.9) in October 2021 [5, 6], but a widely accepted case definition and associated symptom timeframe is still under development.
Multiple studies have identified post-COVID conditions as a frequent result of COVID-19 illness [1, 7‐10], but prevalence estimates vary. The Centers for Disease Control and Prevention (CDC) recently reported that 38.2% of patients diagnosed with COVID-19 experienced ≥ 1 post-COVID condition from 30 to 365 days following diagnosis [10]. The World Health Organization reports a range from 10% to 20% of patients diagnosed with COVID-19 [2], and other studies have reported rates of up to 57% 6 months after diagnosis [8, 11‐14]. Heterogeneous cohorts likely contribute to varying results given that certain characteristics, such as female sex and older age, are associated with developing long-term sequelae [15, 16].
Anzeige
Although the risk of post-COVID conditions has been associated with more severe cases of acute illness, it can occur across all levels of COVID-19 severity [1, 15, 17]. In a systematic review of > 2000 studies conducted worldwide among patients with varying disease severity, more than half of patients who recovered from acute illness experienced long-term sequelae for ≥ 6 months after diagnosis [8]. In 2 studies from Germany and the Faroe Islands of mainly nonhospitalized patients with asymptomatic or mild to moderate acute illness, approximately 28% to 53% of patients experienced persistent symptoms of COVID-19 months later [11, 13].
The potential for post-COVID conditions to develop in patients with mild or moderate illness is particularly relevant as new variants emerge, such as the highly transmissible Omicron variant, which is associated with milder illness compared with earlier strains [18‐21]. In the context of these variants, immunity from natural infection or vaccination may provide better protection against severe disease than against overall infection [21]. Moreover, evidence suggests that risk of developing long-term symptoms may vary by circulating strain [22, 23]. The effects of these changes on population-level incidence of post-COVID conditions remain to be determined, but it is likely that the true burden of COVID-19 in terms of reduced quality of life, loss of productivity, strains on healthcare systems, and economic impact reaches far beyond acute infection.
Emerging data on long-term COVID-19 impact indicate a substantial healthcare burden. In 2 studies using the US Department of Veterans Affairs database, patients with COVID-19 compared with a control cohort had increased healthcare resource and medication use, as well as abnormalities across multiple organ systems, during the year after diagnosis [24, 25]. Other studies in patients with COVID-19 have identified increases in COVID-19─related healthcare provider visits, emergency department (ED) visits, and readmissions for up to 7 months after diagnosis [26‐28]. However, comparison studies are often limited by the small numbers of patients and high variability between patient characteristics.
The aim of this retrospective analysis was to describe morbidity, healthcare resource use, and costs associated with the post-acute phase of COVID-19 among patients with underlying medical conditions or characteristics associated with higher risk of severe COVID-19 (hereafter referred to as “high risk”) in the United States [29]. This population was selected based on immediate relevance of the data to emerging COVID-19 treatments, which are authorized first for high-risk patients. To maintain focus on descriptive results and the guiding of hypothesis generation for future research, no formal comparisons were planned.
Anzeige
Methods
Study design and data source
This was a descriptive, retrospective, cohort study in patients diagnosed with COVID-19 between April 1 and May 31, 2020, in which each patient served as their own control for evaluation of diagnoses, medications, healthcare utilization, and costs before versus after acute COVID-19. Patients were identified using administrative health claims from Optum’s de-identified Clinformatics® Data Mart Database (CDM), which contains de-identified patient-level information derived from administrative healthcare claims from commercial and Medicare Advantage health plan members in all 50 states. Claims encompass medical and pharmacy healthcare services and include information regarding healthcare costs and resource utilization.
The index period was April 1 to May 31, 2020, and the index date was defined as the date of the first COVID-19 diagnosis. Individual patient data were described during the 12 months before the index date (baseline phase) and during the 12 months after the end of the 30-day acute phase [3] of COVID-19 illness (Fig. 1). For patients whose hospital stays spanned across study phases, total numbers of events and associated costs were calculated per hospitalization day and were attributed to each phase based on the number of days falling within that phase.
Fig. 1
Study design. The date of first COVID-19 diagnosis was defined as the index date, and the index period was April 1 through May 31, 2020. For each patient, the baseline phase included the 12 months before the index date, and the post-acute phase included the 12 months after the end of the acute phase of COVID-19 illness. aThe acute phase, defined as the 30-day period after the index date, was excluded from analysis
×
Participants
Patients were eligible for inclusion if they had ≥ 1 ICD-10 diagnosis code for confirmed COVID-19 (U07.1) during the index period. Patients were required to have continuous enrollment (gaps of ≤ 45 days were permitted) in Optum CDM over the 12 months before and 13 months after COVID-19 diagnosis, to be aged ≥ 18 years on the index date, and to have ≥ 1 high risk condition per CDC definition as of October 14, 2021 [29]. Sentinel code lists [30] were used to define these conditions when available, and all codes were reviewed by sponsor personnel with medical expertise (FD, JCA, NB, MLNFV). Criteria for immunocompromised individuals were developed from a recent literature review [31]. Inclusion criteria specified having a diagnosis code (ICD-10-CM), procedure code (ICD-10-Procedure Coding System [ICD-10-PCS], Current Procedural Terminology [CPT®], Healthcare Common Procedures Coding System [HCPCS]), or National Drug Code (NDC) for ≥ 1 of the listed conditions within the 12 months before the index date or being aged ≥ 65 years at the index date. Patients were excluded if they were hospitalized for ≥ 5 consecutive days during the baseline phase; spent any time at a long-term care facility, skilled nursing facility, inpatient rehabilitation, or hospice during baseline or at index date; had an ICD-10 code for confirmed COVID-19 before the index period; or died during the acute phase of COVID-19.
Descriptive analysis
Outcomes of interest included ICD-10 diagnosis codes (other than confirmed COVID-19); medication use; outpatient visits and laboratory tests; ED visits; inpatient hospitalizations, including length of stay (LOS), intensive care unit (ICU) visits/LOS, ventilator use, and 30-day readmissions; and both standard and nonzero healthcare-associated costs. Standard costs were calculated based on all patients with a related visit or service, and nonzero costs were calculated based on all patients with a cost > 0 associated with that visit or service. The top 500 individual diagnosis codes were aggregated to their chapter and broader diagnostic categories and used for further analysis. Medications were analyzed via AnalySource® (Fayetteville, NY, USA) according to the Uniform System of Classification class. Diagnoses and medications were calculated as dichotomous occurrences during the 12 months before the index date (baseline phase) and the 12 months after the 30-day acute phase (post-acute phase); those with a prevalence of < 2% within the overall population during the baseline phase were excluded. Biologics were also excluded because the category primarily consisted of incompletely captured vaccine data. No adjustments were made for patients who died during the 12-month post-acute phase; all deaths that occurred during the post-acute phase were accounted for and reported. Continuous measures were totaled for each period. For each outcome, absolute and relative change from baseline to the post-acute phase was calculated using frequency counts.
Because older age is a risk factor for both increased COVID-19 severity and post-COVID conditions [21], data were separated into categories of patients aged 18 to 64 years or aged ≥ 65 years at the index date. To better understand the relationship between post-COVID conditions and acute COVID-19 severity, data were also stratified according to patient disposition during acute COVID-19 illness: not hospitalized, hospitalized without ICU admission, or admitted to the ICU. All variables were presented descriptively using mean ± SD or median (quartile 1 [Q1]; quartile 3 [Q3]) for continuous variables and frequencies and percentages for categorical variables. No statistical inference tests were conducted. Analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC, USA).
Results
Patient population
The full cohort included 19,558 patients with a median (Q1; Q3) age of 66 (51; 74) years (Table 1). A slight majority of patients were female (55.4%), White (52.3%), enrolled in Medicare (54.7%), and aged ≥ 65 years (52.0%). When categorized by acute COVID-19 severity, 15,457 patients (79.0%) did not require hospitalization, 2916 patients (14.9%) were hospitalized without ICU admission, and 1185 patients (6.1%) were admitted to the ICU. Male patients, Black patients, and those aged ≥ 65 years were observed in higher proportions among the cohorts that were hospitalized (with or without ICU admission) for COVID-19.
Table 1
Baseline demographic characteristics
Characteristic
All Patients (N = 19,558)
Age Group, years
Disposition During Acute COVID-19 Illness
18–64 (n = 9381)
≥ 65 (n = 10,177)
No Hospitalization (n = 15,457)
Hospitalization Without ICU Admission (n = 2916)
ICU Admission (n = 1185)
Sex, n (%)
Female
10,844 (55.4)
5186 (55.3)
5658 (55.6)
8755 (56.6)
1522 (52.2)
567 (47.8)
Male
8714 (44.6)
4195 (44.7)
4519 (44.4)
6702 (43.4)
1394 (47.8)
618 (52.2)
Age, y
Mean ± SD
61.9 ± 16.4
47.9 ± 11.7
74.9 ± 6.6
59.8 ± 16.5
70.5 ± 13.5
69.0 ± 12.0
Median (Q1; Q3)
66 (51; 74)
50 (40; 58)
74 (69; 79)
62 (48; 72)
73 (64; 80)
71 (62; 77)
Age group, y, n (%)
18–29
858 (4.4)
858 (9.2)
0 (0)
817 (5.3)
33 (1.1)
8 (0.7)
30–49
3596 (18.4)
3596 (38.3)
0 (0)
3327 (21.5)
204 (7.0)
65 (5.5)
50–64
4927 (25.2)
4927 (52.5)
0 (0.0)
4126 (26.7)
522 (17.9)
279 (23.5)
65–74
5640 (28.8)
0 (0)
5640 (55.4)
4293 (27.8)
912 (31.3)
435 (36.7)
≥ 75
4537 (23.2)
0 (0)
4537 (44.6)
2894 (18.7)
1245 (42.7)
398 (33.6)
Race or ethnicity, n (%)
White
10,232 (52.3)
4679 (49.9)
5553 (54.6)
8410 (54.4)
1366 (46.8)
456 (38.5)
Black
3398 (17.4)
1564 (16.7)
1834 (18.0)
2391 (15.5)
716 (24.6)
291 (24.6)
Hispanic
3884 (19.9)
2096 (22.3)
1788 (17.6)
3050 (19.7)
539 (18.5)
295 (24.9)
Asian
768 (3.9)
357 (3.8)
411 (4.0)
590 (3.8)
121 (4.2)
57 (4.8)
Unknown
1276 (6.5)
685 (7.3)
591 (5.8)
1016 (6.6)
174 (6.0)
86 (7.3)
Geographic division, n (%)
New England
1729 (8.8)
648 (6.9)
1081 (10.6)
1356 (8.8)
270 (9.3)
103 (8.7)
Mid-Atlantic
5299 (27.1)
2127 (22.7)
3172 (31.2)
4386 (28.4)
738 (25.3)
175 (14.8)
East North Central
2409 (12.3)
1320 (14.1)
1089 (10.7)
1804 (11.7)
430 (14.8)
175 (14.8)
West North Central
988 (5.1)
677 (7.2)
311 (3.1)
790 (5.1)
133 (4.6)
65 (5.5)
South Atlantic
3983 (20.4)
1963 (20.9)
2020 (19.9)
3046 (19.7)
621 (21.3)
316 (26.7)
East South Central
527 (2.7)
301 (3.2)
226 (2.2)
399 (2.6)
92 (3.2)
36 (3.0)
West South Central
1790 (9.2)
1099 (11.7)
691 (6.8)
1375 (8.9)
269 (9.2)
146 (12.3)
Mountain
1576 (8.1)
677 (7.2)
899 (8.8)
1253 (8.1)
225 (7.7)
98 (8.3)
Pacific
1218 (6.2)
556 (5.9)
662 (6.5)
1019 (6.6)
131 (4.5)
68 (5.7)
Insurance, n (%)
Commercial
8857 (45.3)
8115 (86.5)
742 (7.3)
7991 (51.7)
584 (20.0)
282 (23.8)
Medicare
10,696 (54.7)
1265 (13.5)
9431 (92.7)
7462 (48.3)
2332 (80.0)
902 (76.1)
Commercial/Medicare
3 (0.02)
0 (0.0)
3 (0.03)
2 (0.01)
0 (0.0)
1 (0.1)
Unknown
2 (0.01)
1 (0.01)
1 (0.01)
2 (0.01)
0 (0.0)
0 (0.0)
ICU intensive care unit, Q1 quartile 1, Q3 quartile 3
The majority of patients (81.5%) had ≥ 2 high-risk conditions, and 7.7% of patients had ≥ 8 such conditions (Table 2). The most common high-risk conditions in the overall population were immunocompromised state (71.2%), hypertension (60.5%), and age ≥ 65 years (52.0%). Most conditions were more common among older patients and among those who were hospitalized (with or without ICU admission) for acute COVID-19.
Table 2
Baseline medical characteristics, including presence of high-risk conditionsa
Characteristic, n (%)
All Patients (N = 19,558)
Age Group, years
Disposition During Acute COVID-19 Illness
18–64 (n = 9381)
≥ 65 (n = 10,177)
No Hospitalization (n = 15,457)
Hospitalization Without ICU Admission (n = 2916)
ICU Admission (n = 1185)
High-risk condition
Aged ≥ 65 years
10,177 (52.0)
0 (0.0)
10,177 (100)
7187 (46.5)
2157 (74.0)
833 (70.3)
Cancer history
2933 (15.0)
722 (7.7)
2211 (21.7)
2214 (14.3)
533 (18.3)
186 (15.7)
Chronic kidney disease
2783 (14.2)
612 (6.5)
2171 (21.3)
1646 (10.7)
832 (28.5)
305 (25.7)
Chronic liver diseaseb
218 (1.1)
88 (0.9)
130 (1.3)
139 (0.9)
56 (1.9)
23 (1.9)
Chronic lung diseasec
2566 (13.1)
915 (9.8)
1651 (16.2)
1755 (11.4)
613 (21.0)
198 (16.7)
Dementia or other neurologic condition
1121 (5.7)
237 (2.5)
884 (8.7)
716 (4.6)
320 (11.0)
85 (7.2)
Diabetes
6081 (31.1)
2060 (22.0)
4021 (39.5)
4168 (27.0)
1319 (45.2)
594 (50.1)
Down syndrome
4 (0.02)
4 (0.04)
0 (0.0)
2 (0.01)
1 (0.03)
1 (0.1)
Heart conditiond
6347 (32.5)
1593 (17.0)
4754 (46.7)
4375 (28.3)
1472 (50.5)
500 (42.2)
HIV
158 (0.8)
107 (1.1)
51 (0.5)
120 (0.8)
28 (1.0)
10 (0.8)
Hypertension
11,823 (60.5)
3966 (42.3)
7857 (77.2)
8558 (55.4)
2323 (79.7)
942 (79.5)
Immunocompromised statee
13,931 (71.2)
6464 (68.9)
7467 (73.4)
10,848 (70.2)
2222 (76.2)
861 (72.7)
Mental health conditionf
3214 (16.4)
1615 (17.2)
1599 (15.7)
2453 (15.9)
570 (19.6)
191 (16.1)
Overweight or obesity
7361 (37.6)
3742 (39.9)
3619 (35.6)
5615 (36.3)
1209 (41.5)
537 (45.3)
Pregnancy or recent pregnancyg
375 (1.9)
375 (4.0)
0 (0.0)
331 (2.1)
41 (1.4)
3 (0.3)
Sickle cell disease or thalassemia
72 (0.4)
45 (0.5)
27 (0.3)
57 (0.4)
12 (0.4)
3 (0.3)
Smoking, current or previous
3463 (17.7)
1274 (13.6)
2189 (21.5)
2393 (15.5)
806 (27.6)
264 (22.3)
Solid organ or blood stem cell transplanth
34 (0.2)
22 (0.2)
12 (0.1)
21 (0.1)
12 (0.4)
1 (0.1)
Stroke or cerebrovascular disease
1730 (8.9)
326 (3.5)
1404 (13.8)
1152 (7.5)
440 (15.1)
138 (11.7)
Substance use disorderi
589 (3.0)
317 (3.4)
272 (2.7)
413 (2.7)
145 (5.0)
31 (2.6)
Tuberculosis
124 (0.6)
68 (0.7)
56 (0.6)
97 (0.6)
22 (0.8)
5 (0.4)
Number of high-risk conditions, mutually exclusive
1
3623 (18.5)
3147 (33.6)
476 (4.7)
3322 (21.5)
205 (7.0)
96 (8.1)
2
3229 (16.5)
2376 (25.3)
853 (8.4)
2878 (18.6)
235 (8.1)
116 (9.8)
3
2999 (15.3)
1590 (17.0)
1409 (13.8)
2496 (16.2)
340 (11.7)
163 (13.8)
4
2626 (13.4)
936 (10.0)
1690 (16.6)
2087 (13.5)
383 (13.1)
156 (13.2)
5
2377 (12.2)
573 (6.1)
1804 (17.7)
1729 (11.2)
442 (15.2)
206 (17.4)
6
1880 (9.6)
356 (3.8)
1524 (15.0)
1293 (8.4)
413 (14.2)
174 (14.7)
7
1327 (6.8)
207 (2.2)
1120 (11.0)
835 (5.4)
370 (12.7)
122 (10.3)
≥ 8
1497 (7.7)
196 (2.1)
1301 (12.8)
817 (5.3)
528 (18.1)
152 (12.8)
Care setting of COVID-19 diagnosis
Inpatient
3385 (17.3)
847 (9.0)
2538 (24.9)
0 (0.0)
2431 (83.4)
954 (80.5)
Outpatient
16,173 (82.7)
8534 (91.0)
7639 (75.1)
15,457 (100)
485 (16.6)
231 (19.5)
Disposition during acute COVID-19 illness
No hospitalization
15,457 (79.0)
8270 (88.2)
7187 (70.6)
Hospitalization without ICU admission
2916 (14.9)
759 (8.1)
2157 (21.2)
ICU admission
1185 (6.1)
352 (3.8)
833 (8.2)
COVID-19 inpatient stay that overlaps acute and post-acute phases; > 30 days
143 (0.7)
35 (0.4)
108 (1.1)
0 (0.0)
36 (1.2)
107 (9.0)
ICU intensive care unit
aConditions placing individuals at high risk of developing severe illness from COVID-19 were determined by the Centers for Disease Control and Prevention [29]
cIncludes moderate to severe asthma, bronchiectasis, bronchopulmonary dysplasia, chronic obstructive pulmonary disease, emphysema, chronic bronchitis, interstitial lung disease, pulmonary fibrosis, cystic fibrosis, pulmonary embolism, and pulmonary hypertension
dIncludes heart failure, coronary artery disease, and cardiomyopathies
eIncluded both primary immunocompromised state (genetic condition) and secondary or acquired immunocompromised state (prolonged use of medication that weakens the immune system, such as corticosteroids or antimetabolites). Qualifying diagnoses included HIV/AIDS, solid malignancy, bone marrow transplant, organ transplant, rheumatologic/inflammatory conditions, primary immunodeficiency, chronic kidney disease or end-stage renal disease, and hematologic malignancy
fIncluded mood disorder or schizophrenia spectrum disorder
gRecent pregnancy defined as a pregnancy occurring within 42 days before the index date; excludes women aged ≥ 45 years
hIncluding bone marrow transplant
iIncluded alcohol, opioid, or cocaine abuse
Most patients (82.7%) were diagnosed with COVID-19 in the outpatient setting (Table 2). Of those who were hospitalized at any time during the acute phase, 143 patients (0.7%) had hospital stays spanning > 30 days after the index date and therefore overlapping the acute and post-acute phases. Few patients (0.5% of the overall cohort) died during the post-acute phase. A full list of reasons for exclusion from the analysis is shown in Table S1.
Anzeige
Diagnoses
Between the baseline and post-acute phases, the frequency of individual ICD-10-CM diagnosis codes increased within several chapters (Fig. 2). The greatest percentage increase was observed in the ICD-10 chapter of “diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism” (+ 16.3%), followed by “diseases of the nervous system” (+ 11.1%), “external causes of morbidity and mortality” (+ 7.9%), and “mental and behavioral disorders” (+ 7.7%).
Fig. 2
Percentage change from baseline to post-acute phase in ICD-10 diagnoses in the overall population (N = 19,558). Diagnosis codes (shown in parentheses) include those with a prevalence of ≥ 2% in the baseline population and with an increase from baseline to post-acute phases. Code ranges, raw values at baseline and post-acute phases, and diagnoses decreasing from baseline to post-acute phases are shown in Table 3. ICD-10, International Classification of Diseases, Tenth Revision
×
Frequencies of other disorders increased more modestly or decreased (Table 3); the greatest percentage decrease was observed in the chapter of “diseases of the respiratory system” (–18.3%). Within this chapter, the decrease was driven specifically by a drop in frequency of the subchapters acute upper and lower respiratory infections (–56.6% and –69.3%, respectively), which outweighed increases in frequency of other respiratory conditions, such as “other respiratory diseases principally affecting the interstitium” (+ 59.8%; Table S2 and Fig. S1).
Table 3
Diagnoses during the baseline and post-acute phases in the overall population (N = 19,558)a
ICD-10 Diagnosis Description
ICD-10 Diagnosis Code
Baseline Phase, n (%)
Post-Acute Phase, n (%)
Change From Baseline to Post-Acute Phase, Δ n (% Change)
Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
D50–D89
5010 (25.6)
5825 (29.8)
815 (16.3)
Diseases of the nervous system
G00–G99
7345 (37.6)
8159 (41.7)
814 (11.1)
External causes of morbidity and mortality
V00–Y99
1503 (7.7)
1621 (8.3)
118 (7.9)
Mental and behavioral disorders
F00–F99
6875 (35.2)
7404 (37.9)
529 (7.7)
Diseases of the digestive system
K00–K95
8361 (42.8)
8736 (44.7)
375 (4.5)
Diseases of the genitourinary system
N00–N99
9532 (48.7)
9954 (50.9)
422 (4.4)
Diseases of the eye and adnexa
H00–H59
7332 (37.5)
7630 (39.0)
298 (4.1)
Diseases of the skin and subcutaneous tissue
L00–L99
7205 (36.8)
7396 (37.8)
191 (2.7)
Injury, poisoning, and certain other consequences of external causes
S00–T98
5445 (27.8)
5564 (28.4)
119 (2.2)
Factors influencing health status and contact with health services
Z00–Z99
18,359 (93.9)
18,629 (95.3)
270 (1.5)
Neoplasms
C00–D49
6066 (31.0)
6152 (31.5)
86 (1.4)
Diseases of the circulatory system
I00–I99
13,381 (68.4)
13,551 (69.3)
170 (1.3)
Diseases of the musculoskeletal system and connective tissue
M00–M99
12,618 (64.5)
12,766 (65.3)
148 (1.2)
Congenital malformations, deformations, and chromosomal abnormalities
Q00–Q99
730 (3.7)
735 (3.8)
5 (0.7)
Endocrine, nutritional, and metabolic diseases
E00–E90
15,251 (78.0)
15,305 (78.3)
54 (0.4)
Symptoms, signs, and abnormal clinical and laboratory findings not elsewhere classified
R00–R99
16,977 (86.8)
16,225 (83.0)
–752 (–4.4)
Diseases of the ear and mastoid process
H60–H95
3041 (15.5)
2902 (14.8)
–139 (–4.6)
Certain infectious and parasitic diseases
A00–B99
6543 (33.5)
5701 (29.1)
–842 (–12.9)
Diseases of the respiratory system
J00–J99
11,296 (57.8)
9227 (47.2)
–2069 (–18.3)
ICD-10 International Classification of Diseases, Tenth Revision
aThe baseline phase was the 12 months before the index date, and the post-acute phase spanned from 1 to 13 months after the index date
Medication use
Prescription frequencies across several medication classes increased between baseline and the post-acute phase (Fig. 3). The greatest percentage increases were observed for vitamins (+ 47.5%), miscellaneous preparations (+ 38.0%), blood factors (+ 31.6%), and hemostatic modifiers (+ 29.9%). Among medication classes with increases of ≥ 10% in the overall population, increases in prescription frequency were observed across all ages and severities (Tables 4 and 5).
Fig. 3
Percentage change from baseline to post-acute phase in prescription frequency in the overall population (N = 19,558). Medication classes shown are according to USC designations; included classes are those prescribed to ≥ 2% of the baseline population and with a percentage change from baseline to post-acute phase of ≥ 10%. Percentage changes from baseline to post-acute phase according to age group and disease severity are shown in Table 4, and raw values during baseline and post-acute phases for all medication classes regardless of percentage change are shown for the overall population in Table S3. USC, Uniform System of Classification
Table 4
Medications with frequency Increases ≥ 10% from the baseline to the post-acute phasea by age group
USC Medication Class Description
All Patients (N = 19,558)
Patients Aged 18–64 Years (n = 9381)
Patients Aged ≥ 65 Years (n = 10,177)
Baseline Phase, n (%)
Post-Acute Phase, n (%)
Change From Baseline to Post-Acute Phase, Δ (% Change)
Baseline Phase, n (%)
Post-Acute Phase, n (%)
Change From Baseline to Post-Acute Phase, Δ (% Change)
Baseline Phase, n (%)
Post-Acute Phase, n (%)
Change From Baseline to Post-Acute Phase, Δ (% Change)
Vitamins
771 (3.9)
1137 (5.8)
366 (47.5)
576 (6.1)
663 (7.1)
87 (15.1)
195 (1.9)
474 (4.7)
279 (143.1)
Miscellaneous preparations
831 (4.2)
1147 (5.9)
316 (38.0)
407 (4.3)
546 (5.8)
139 (34.2)
424 (4.2)
601 (5.9)
177 (41.7)
Blood factors
675 (3.5)
888 (4.5)
213 (31.6)
313 (3.3)
368 (3.9)
55 (17.6)
362 (3.6)
520 (5.1)
158 (43.6)
Hemostatic modifiers
2093 (10.7)
2719 (13.9)
626 (29.9)
563 (6.0)
759 (8.1)
196 (34.8)
1530 (15.0)
1960 (19.3)
430 (28.1)
Nutrients and supplements
980 (5.0)
1246 (6.4)
266 (27.1)
340 (3.6)
405 (4.3)
65 (19.1)
640 (6.3)
841 (8.3)
201 (31.4)
Cardiac agents
1203 (6.2)
1485 (7.6)
282 (23.4)
459 (4.9)
529 (5.6)
70 (15.3)
744 (7.3)
956 (9.4)
212 (28.5)
Antineoplastic targeted therapy
536 (2.7)
644 (3.3)
108 (20.1)
183 (2.0)
227 (2.4)
44 (24.0)
353 (3.5)
417 (4.1)
64 (18.1)
Thyroid therapy
2222 (11.4)
2553 (13.1)
331 (14.9)
797 (8.5)
916 (9.8)
119 (14.9)
1425 (14.0)
1637 (16.1)
212 (14.9)
Neurologic/neuromuscular disorders
3790 (19.4)
4271 (21.8)
481 (12.7)
1682 (17.9)
1851 (19.7)
169 (10.0)
2108 (20.7)
2420 (23.8)
312 (14.8)
Gastrointestinal
5002 (25.6)
5595 (28.6)
593 (11.9)
2067 (22.0)
2234 (23.8)
167 (8.1)
2935 (28.8)
3361 (33.0)
426 (14.5)
Psychotherapeutic drugs
5876 (30.0)
6530 (33.4)
654 (11.1)
3150 (33.6)
3366 (35.9)
216 (6.9)
2726 (26.8)
3164 (31.1)
438 (16.1)
Diagnostic aids
3288 (16.8)
3652 (18.7)
364 (11.1)
1428 (15.2)
1582 (16.9)
154 (10.8)
1860 (18.3)
2070 (20.3)
210 (11.3)
USC Uniform System of Classification
aThe baseline period was the 12 months before the index date, and the post-acute phase spanned from 1 to 13 months after the index date
Table 5
Medications with frequency increases ≥ 10% from baseline to post-acute phasea by disposition during acute COVID-19
USC Medication Class Description
No Hospitalization (n = 15,457)
Hospitalization Without ICU Admission (n = 2916)
ICU Admission (n = 1185)
Baseline Phase, n (%)
Post-Acute Phase, n (%)
Change From Baseline to Post-Acute Phase, Δ (% Change)
Baseline Phase, n (%)
Post-Acute Phase, n (%)
Change From Baseline to Post-Acute Phase, Δ (% Change)
Baseline Phase, n (%)
Post-Acute Phase, n (%)
Change From Baseline to Post-Acute Phase, Δ (% Change)
Vitamins
619 (4.0)
891 (5.8)
272 (43.9)
100 (3.4)
166 (5.7)
66 (66.0)
52 (4.4)
80 (6.8)
28 (53.8)
Miscellaneous preparations
603 (3.9)
792 (5.1)
189 (31.3)
161 (5.5)
250 (8.6)
89 (55.3)
67 (5.7)
105 (8.9)
38 (56.7)
Blood factors
499 (3.2)
627 (4.1)
128 (25.7)
134 (4.6)
185 (6.3)
51 (38.1)
42 (3.5)
76 (6.4)
34 (81.0)
Hemostatic modifiers
1366 (8.8)
1618 (10.5)
252 (18.4)
533 (18.3)
765 (26.2)
232 (43.5)
194 (16.4)
336 (28.4)
142 (73.2)
Nutrients and supplements
625 (4.0)
771 (5.0)
146 (23.4)
258 (8.8)
325 (11.1)
67 (26.0)
97 (8.2)
150 (12.7)
53 (54.6)
Cardiac agents
808 (5.2)
968 (6.3)
160 (19.8)
279 (9.6)
352 (12.1)
73 (26.2)
116 (9.8)
165 (13.9)
49 (42.2)
Antineoplastic targeted therapy
384 (2.5)
454 (2.9)
70 (18.2)
109 (3.7)
135 (4.6)
26 (23.9)
43 (3.6)
55 (4.6)
12 (27.9)
Thyroid therapy
1722 (11.1)
1958 (12.7)
236 (13.7)
361 (12.4)
427 (14.6)
66 (18.3)
139 (11.7)
168 (14.2)
29 (20.9)
Neurologic/neuromuscular disorders
2736 (17.7)
3065 (19.8)
329 (12.0)
749 (25.7)
836 (28.7)
87 (11.6)
305 (25.7)
370 (31.2)
65 (21.3)
Gastrointestinal
3769 (24.4)
4097 (26.5)
328 (8.7)
879 (30.1)
1015 (34.8)
136 (15.5)
354 (29.9)
483 (40.8)
129 (36.4)
Psychotherapeutic drugs
4697 (30.4)
5077 (32.8)
380 (8.1)
871 (29.9)
1043 (35.8)
172 (19.7)
308 (26.0)
410 (34.6)
102 (33.1)
Diagnostic aids
2394 (15.5)
2614 (16.9)
220 (9.2)
611 (21.0)
710 (24.3)
99 (16.2)
283 (23.9)
328 (27.7)
45 (15.9)
ICU intensive care unit, USC Uniform System of Classification
aThe baseline period was the 12 months before the index date, and the post-acute phase spanned from 1 to 13 months after the index date
×
Other prescription frequencies increased marginally or decreased (Table S3). The greatest overall decreases were within the classes of cough/cold/flu preparations (− 73.7%), antimalarials (–54.5%), and antivirals (–40.4%).
Anzeige
Medical care and hospitalizations
Increases in total and per-patient inpatient and outpatient visits and procedures were observed during the post-acute phase compared with baseline (Tables 6 and 7). The greatest percentage increases were observed for LOS (including total days [+ 165.6%] and mean days per patient [+ 132.9%]), inpatient lab tests (+ 105.1%), and all-cause readmissions within 30 days (+ 249.9%). For these 3 variables, increases from baseline to the post-acute phase were greatest among patients who were admitted to the ICU during acute COVID-19, but were substantial even among those who did not require hospitalization for acute COVID-19. The number of patients with ICU visits was relatively consistent from baseline to the post-acute phase in the overall population but increased by 43.2% among those who were admitted to the ICU during acute COVID-19 illness. Among all age and severity categories, the numbers of patients visiting the ED decreased. Regarding hospital discharge status, percentages of all discharges to another hospital department or facility (such as hospice care or a skilled nursing facility) were low during the baseline phase owing to exclusion criteria but substantially increased among both age groups (up to a 13,000% increase in intra-institution transfers among patients aged ≥ 65 years; Table S4).
Table 6
Healthcare resource use during baseline and post-acute phasesa in the overall population and by age
Visit or Procedure
All Patients (N = 19,558)
Patients Aged 18–64 Years (n = 9381)
Patients Aged ≥ 65 Years (n = 10,177)
Baseline Phase
Post-Acute Phase
Change From Baseline to Post-Acute Phase, Δ (% Change)
Baseline Phase
Post-Acute Phase
Change From Baseline to Post-Acute Phase, Δ (% Change)
Baseline Phase
Post-Acute Phase
Change From Baseline to Post-Acute Phase, Δ (% Change)
Outpatient lab tests
Tests, n
36,229
47,716
11,487 (31.7)
16,008
21,590
5582 (34.9)
20,221
26,126
5905 (29.2)
Patients, n
12,453
13,565
1112 (8.9)
5809
6279
470 (8.1)
6644
7286
642 (9.7)
Mean ± SD
1.9 ± 2.6
2.4 ± 3.3
0.6
1.7 ± 2.5
2.3 ± 3.2
0.6
2.0 ± 2.7
2.6 ± 3.3
0.6
Median (Q1; Q3)
1 (0; 3)
1 (0; 3)
0
1 (0; 2)
1 (0; 3)
0
1 (0; 3)
2 (0; 4)
1
Outpatient visits (specialist or nonspecialist)
Visits, n
488,305
613,201
124,896 (25.6)
190,988
235,557
44,569 (23.3)
297,317
377,644
80,327 (27.0)
Patients, n
19,413
19,223
–190 (–1.0)
9357
9173
–184 (–2.0)
10,056
10,050
–6 (–0.1)
Mean ± SD
25.0 ± 29.0
31.4 ± 36.3
6.4
20.4 ± 25.5
25.1 ± 30.5
4.8
29.2 ± 31.3
37.1 ± 40.1
7.9
Median (Q1; Q3)
17 (9; 31)
20 (10; 39)
3
13 (7; 24)
16 (8; 31)
3
20 (11; 36)
26 (13; 47)
6
Emergency department visits
Visits, n
11,168
9205
–1963 (–17.6)
5514
4418
–1096 (–19.9)
5654
4787
–867 (–15.3)
Patients, n
5943
4756
–1187 (–20.0)
2830
2149
–681 (–24.1)
3113
2607
–506 (–16.3)
Mean ± SD
0.6 ± 1.6
0.5 ± 1.9
–0.1
0.6 ± 1.9
0.5 ± 2.3
–0.1
0.6 ± 1.2
0.5 ± 1.3
–0.1
Median (Q1; Q3)
0 (0; 1)
0 (0; 0)
0
0 (0; 1)
0 (0; 0)
0
0 (0; 1)
0 (0; 1)
0
Prescription classes
Prescriptions, n
110,001
111,618
1617 (1.5)
49,424
48,329
–1095 (–2.2)
60,577
63,289
2712 (4.5)
Patients, n
17,609
17,520
–89 (–0.5)
8795
8550
–245 (–2.8)
8814
8970
156 (1.8)
Mean ± SD
5.6 ± 4.0
5.7 ± 4.1
0.1
5.3 ± 3.8
5.2 ± 4.0
–0.1
6.0 ± 4.1
6.2 ± 4.2
0.3
Median (Q1; Q3)
5 (3; 8)
5 (3; 8)
0
5 (2; 7)
4 (2; 7)
–1
6 (3; 9)
6 (3; 9)
0
Inpatient visits
Visits, n
3642
5301
1659 (45.6)
1314
1528
214 (16.3)
2328
3773
1445 (62.1)
Patients, n
2523
2877
354 (14.0)
884
878
–6 (–0.7)
1639
1999
360 (22.0)
Mean ± SD
0.2 ± 0.6
0.3 ± 0.9
0.1
0.1 ± 0.6
0.2 ± 0.8
0.0
0.2 ± 0.6
0.4 ± 1.0
0.1
Median (Q1; Q3)
0 (0; 0)
0 (0; 0)
0
0 (0; 0)
0 (0; 0)
0
0 (0; 0)
0 (0; 0)
0
Inpatient lab tests
Tests, n
851
1745
894 (105.1)
299
397
98 (32.8)
552
1348
796 (144.2)
Patients, n
379
521
142 (37.5)
108
149
41 (38.0)
271
372
101 (37.3)
Mean ± SD
0.0 ± 0.5
0.1 ± 1.0
0.1
0.0 ± 0.6
0.0 ± 0.6
0.0
0.1 ± 0.5
0.1 ± 1.3
0.1
Median (Q1; Q3)
0 (0; 0)
0 (0; 0)
0
0 (0; 0)
0 (0; 0)
0
0 (0; 0)
0 (0; 0)
0
Length of hospital stay
Days, n
18,941
50,310
31,369 (165.6)
7313
12,290
4977 (68.1)
11,628
38,020
26,392 (227.0)
Patients, n
2523
2877
354 (14.0)
884
878
–6 (–0.7)
1639
1999
360 (22.0)
Mean ± SD
7.5 ± 10.1
17.5 ± 25.2
10.0 (132.9)
8.3 ± 12.7
14.0 ± 25.9
5.7 (69.2)
7.1 ± 8.3
19.0 ± 24.8
11.9 (168.1)
Median (Q1; Q3)
4 (3; 8)
8 (4; 21)
4
4 (3; 8)
5 (3; 13)
1
5 (3; 8)
9 (4; 24)
4
Length of ICU stay
Days, n
937
1068
131 (14.0)
298
396
98 (32.9)
639
672
33 (5.2)
Patients, n
742
743
1 (0.1)
214
217
3 (1.4)
528
526
–2 (–0.4)
Mean ± SD
0.4 ± 0.7
0.4 ± 0.9
0.0 (0.0)
0.3 ± 0.8
0.5 ± 1.3
0.1 (33.8)
0.4 ± 0.7
0.3 ± 0.7
–0.1 (–13.8)
Median (Q1; Q3)
0 (0; 1)
0 (0; 1)
0
0 (0; 0)
0 (0; 0)
0
0 (0; 1)
0 (0; 1)
0
Patients with invasive mechanical ventilation use, n (%)
165 (0.8)
210 (1.1)
45 (27.3)
58 (0.6)
75 (0.8)
17 (29.3)
107 (1.1)
135 (1.3)
28 (26.2)
Patients with noninvasive mechanical ventilation use, n (%)
147 (0.8)
173 (0.9)
26 (17.7)
51 (0.5)
60 (0.6)
9 (17.7)
96 (0.9)
113 (1.1)
17 (17.7)
Patients with supplemental oxygen use, n (%)
199 (1.0)
358 (1.8)
159 (79.9)
53 (0.6)
90 (1.0)
37 (69.8)
146 (1.4)
268 (2.6)
122 (83.6)
Patients with readmission within 30 days, n (%)
327 (1.7)
1144 (5.9)
817 (249.9)
131 (1.4)
220 (2.3)
89 (67.9)
196 (1.9)
924 (9.1)
728 (371.4)
For visits, tests, prescriptions, and procedures, means or percentages were calculated using the total number of patients within the cohort as the denominator. For length of hospital stay and ICU stay, means were calculated as the total number of days divided by the number of patients with any inpatient hospital stay
ICU intensive care unit, Q1 quartile 1, Q3 quartile 3
aThe baseline period was the 12 months before the index date, and the post-acute phase spanned from 1 to 13 months after the index date
Table 7
Healthcare resource use during baseline and post-acute phasesa stratified by disposition during acute COVID-19
Visit or Procedure
No Hospitalization (n = 15,457)
Hospitalization Without ICU Admission (n = 2916)
ICU Admission (n = 1185)
Baseline Phase
Post-Acute Phase
Change From Baseline to Post-Acute Phase, Δ (% Change)
Baseline Phase
Post-Acute Phase
Change From Baseline to Post-Acute Phase, Δ (% Change)
Baseline Phase
Post-Acute Phase
Change From Baseline to Post-Acute Phase, Δ (% Change)
Outpatient lab tests
Tests, n
28,074
37,092
9018 (32.1)
5694
7323
1629 (28.6)
2461
3301
840 (34.1)
Patients, n
9941
10,762
821 (8.3)
1778
1975
197 (11.1)
734
828
94 (12.8)
Mean ± SD
1.8 ± 2.5
2.4 ± 3.2
0.6
2.0 ± 3.0
2.5 ± 3.6
0.6
2.1 ± 3.3
2.8 ± 3.6
0.7
Median (Q1; Q3)
1 (0; 3)
1 (0; 3)
0
1 (0; 3)
1 (0; 3.5)
0
1 (0; 3)
2 (0; 4)
1
Outpatient visits (specialist or nonspecialist)
Visits, n
357,264
424,453
67,189 (18.8)
95,986
132,282
36,296 (37.8)
35,055
56,466
21,411 (61.1)
Patients, n
15,362
15,183
–179 (–1.2)
2882
2878
–4 (–0.1)
1169
1162
–7 (–0.6)
Mean ± SD
23.1 ± 25.3
27.5 ± 30.5
4.3
32.9 ± 39.0
45.4 ± 49.8
12.4
29.6 ± 40.2
47.7 ± 50.6
18.1
Median (Q1; Q3)
16 (8; 29)
18 (9; 35)
2
21 (11; 41)
30 (14; 57)
9
17 (9; 34)
33 (17; 61)
16
Emergency department visits
Visits, n
7753
6196
–1557 (–20.1)
2615
2191
–424 (–16.2)
800
818
18 (2.3)
Patients, n
4368
3427
–941 (–21.5)
1168
968
–200 (–17.1)
407
361
–46 (–11.3)
Mean ± SD
0.5 ± 1.4
0.4 ± 1.5
–0.1
0.9 ± 2.3
0.8 ± 2.0
–0.1
0.7 ± 1.5
0.7 ± 4.2
< 0.1
Median (Q1; Q3)
0 (0; 1)
0 (0; 0)
0
0 (0; 1)
0 (0; 1)
0
0 (0; 1)
0 (0; 1)
0
Prescription classes
Prescriptions, n
83,348
82,917
–431 (–0.5)
18,783
20,082
1299 (6.9)
7870
8619
749 (9.5)
Patients, n
13,958
13,821
–137 (–1.0)
2564
2608
44 (1.7)
1087
1091
4 (0.4)
Mean ± SD
5.4 ± 3.8
5.4 ± 3.9
–0.0
6.4 ± 4.4
6.9 ± 4.5
0.4
6.6 ± 4.3
7.3 ± 4.5
0.6
Median (Q1; Q3)
5 (3; 8)
5 (2; 8)
0
6 (3; 9)
7 (4; 10)
1
6 (4; 9)
7 (4; 10)
1
Inpatient visits
Visits, n
1998
2372
374 (18.7)
1334
1940
606 (45.4)
310
989
679 (219.0)
Patients, n
1528
1526
–2 (–0.1)
808
886
78 (9.7)
187
465
278 (148.7)
Mean ± SD
0.1 ± 0.5
0.2 ± 0.6
0.0
0.5 ± 1.0
0.7 ± 1.5
0.2
0.3 ± 0.8
0.8 ± 1.5
0.6
Median (Q1; Q3)
0 (0; 0)
0 (0; 0)
0
0 (0; 1)
0 (0; 1)
0
0 (0; 0)
0 (0; 1)
0
Inpatient lab tests
Tests, n
466
684
218 (46.8)
332
504
172 (51.8)
53
557
504 (950.9)
Patients, n
221
240
19 (8.6)
124
170
46 (37.1)
34
111
77 (226.5)
Mean ± SD
0.0 ± 0.3
0.0 ± 0.6
0.0
0.1 ± 1.0
0.2 ± 1.2
0.1
0.0 ± 0.3
0.5 ± 3.1
0.4
Median (Q1; Q3)
0 (0; 0)
0 (0; 0)
0
0 (0; 0)
0 (0; 0)
0
0 (0; 0)
0 (0; 0)
0
Length of hospital stay
Days, n
10,536
17,390
6854 (65.1)
6639
19,480
12,841 (193.4)
1766
13,440
11,674 (661.0)
Patients, n
1528
1526
–2 (–0.1)
808
886
78 (9.7)
187
465
278 (148.7)
Mean ± SD
6.9 ± 8.7
11.4 ± 16.0
4.5 (65.3)
8.2 ± 12.2
22.0 ± 28.2
13.8 (167.6)
9.4 ± 10.4
28.9 ± 36.0
19.5 (206.1)
Median (Q1; Q3)
4 (3; 7)
5 (3; 12)
1
5 (3; 9)
11 (5; 26)
6
5 (3; 11)
17 (6; 38)
12
Length of ICU stay
Days, n
470
505
35 (7.4)
365
354
–11 (–3.0)
102
209
107 (104.9)
Patients, n
377
384
7 (1.9)
284
243
–41 (–14.4)
81
116
35 (43.2)
Mean ± SD
0.3 ± 0.7
0.3 ± 0.7
0.02 (7.6)
0.5 ± 0.8
0.4 ± 0.9
–0.1 (–11.6)
0.5 ± 0.8
0.4 ± 1.4
–0.1 (–17.6)
Median (Q1; Q3)
0 (0; 0)
0 (0; 1)
0
0 (0; 1)
0 (0; 1)
0
0 (0; 1)
0 (0; 0)
0
Patients with invasive mechanical ventilation use, n (%)
62 (0.4)
78 (0.5)
16 (25.8)
87 (3.0)
64 (2.2)
–23 (–26.4)
16 (1.4)
68 (5.7)
52 (325.0)
Patients with noninvasive mechanical ventilation use, n (%)
61 (0.4)
61 (0.4)
0 (0.0)
72 (2.5)
50 (1.7)
–22 (–30.6)
14 (1.2)
62 (5.2)
48 (342.9)
Patients with supplemental oxygen use, n (%)
91 (0.6)
107 (0.7)
16 (17.6)
84 (2.9)
148 (5.1)
64 (76.2)
24 (2.0)
103 (8.7)
79 (329.2)
Patients with readmission within 30 days, n (%)
165 (1.1)
348 (2.3)
183 (110.9)
130 (4.5)
477 (16.4)
347 (266.9)
32 (2.7)
319 (26.9)
287 (896.9)
For visits, tests, and prescriptions, means were calculated as the total value divided by the total number of patients within the cohort. For length of hospital stay and ICU stay, means were calculated as the total number of days divided by the number of patients in the cohort with any inpatient hospital stay
ICU intensive care unit, Q1 quartile 1, Q3 quartile 3
aThe baseline period was the 12 months before the index date, and the post-acute phase spanned from 1 to 13 months after the index date
Healthcare costs
In the overall population, total medical costs (including prescription, inpatient, and outpatient costs) increased by 23.0% from the baseline to the post-acute phase (Table 8). Increased percentages were observed across all categories of age and acute COVID-19 severity but were greater among patients aged ≥ 65 years (+ 27.2%) versus younger patients (+ 16.7%) and were greater among patients admitted to the ICU during the acute phase of COVID-19 (+ 70.6%) versus those who were not hospitalized (+ 14.3%) or who were hospitalized without ICU admission (+ 27.9%; Tables 8 and 9).
Table 8
Medical costs during baseline and post-acute phasesa in the overall population and by ageb
Cost Description
All Patients (N = 19,558)
Patients Aged 18–64 Years (n = 9381)
Patients Aged ≥ 65 Years (n = 10,177)
Baseline Phase
Post-Acute Phase
Change From Baseline to Post-Acute Phase, Δ (% Change)
Baseline Phase
Post-Acute Phase
Change From Baseline to Post-Acute Phase, Δ (% Change)
Baseline Phase
Post-Acute Phase
Change From Baseline to Post-Acute Phase, Δ (% Change)
Inpatient visits
Total cost
100,310,406
148,478,802
48,168,396 (48.0)
33,383,596
46,783,646
13,400,051 (40.1)
66,926,810
101,695,155
34,768,345 (52.0)
Standard costs, patient n
2523
2877
884
878
1639
1999
Mean ± SD
39,758 ± 53,027
51,609 ± 67,633
11,851 (29.8)
37,764 ± 45,741
53,284 ± 75,612
15,520 (41.1)
40,834 ± 56,553
50,873 ± 63,821
10,039 (24.6)
Median (Q1; Q3)
23,539 (14,930; 42,393)
29,812 (14,174; 63,142)
6273 (26.6)
21,110 (13,853; 39,804)
28,505 (13,705; 62,482)
7395 (35.0)
24,902 (15,564; 44,262)
30,535 (14,450; 63,458)
5634 (22.6)
Nonzero costs, patient n
2519
2857
338 (13.4)
882
874
–8 (–0.9)
1637
1983
346 (21.1)
Mean ± SD
39,822 ± 53,046
51,970 ± 67,731
12,149 (30.5)
37,850 ± 45,757
53,528 ± 75,699
15,678 (41.4)
40,884 ± 56,570
51,283 ± 63,914
10,400 (25.4)
Median (Q1; Q3)
23,619 (14,979; 42,401)
30,001 (14,418; 63,458)
6381 (27.0)
21,165 (13,872; 39,837)
28,663 (13,872; 62,649)
7498 (35.4)
24,951 (15,604; 44,262)
30,996 (14,591; 63,718)
6045 (24.2)
Readmission
Total cost
15,508,222
56,595,103
41,086,881 (264.9)
5,968,848
15,288,400
9,319,552 (156.1)
9,539,374
41,306,702
31,767,328 (333.0)
Standard costs, patient n
327
1145
131
220
196
925
Mean ± SD
47,426 ± 55,733
49,428 ± 72,129
2002 (4.2)
45,564 ± 43,757
69,493 ± 99,048
23,929 (52.5)
48,670 ± 62,550
44,656 ± 63,226
–4014 (–8.3)
Median (Q1; Q3)
28,400 (16,155; 57,798)
22,978 (8525; 60,113)
–5422 (–19.1)
29,053 (16,565; 64,883)
37,735 (13,202; 84,318)
8681 (29.9)
28,348 (16,134; 56,708)
21,351 (7368; 56,103)
–6998 (–24.7)
Nonzero costs, patient n
327
1124
797 (243.7)
131
218
87 (66.4)
196
906
710 (362.2)
Mean ± SD
47,426 ± 55,733
50,352 ± 72,480
2926 (6.2)
45,564 ± 43,757
70,130 ± 99,277
24,567 (53.9)
48,670 ± 62,550
45,592 ± 63,551
–3078 (–6.3)
Median (Q1; Q3)
28,400 (16,155; 57,798)
23,734 (10,067; 62,107)
–4665 (–16.4)
29,053 (16,565; 64,883)
37,895 (13,937; 85,396)
8842 (30.4)
28,348 (16,134; 56,708)
22,147 (8769; 57,039)
–6201 (–21.9)
Outpatient visits
Total cost
252,738,072
293,241,964
40,503,891 (16.0)
101,032,115
111,061,227
10,029,113 (9.9)
151,705,958
182,180,736
30,474,779 (20.1)
Standard costs, patient n
19,413
19,223
9357
9173
10,056
10,050
Mean ± SD
13,019 ± 50,071
15,255 ± 50,870
2236 (17.2)
10,797 ± 44,453
12,107 ± 42,523
1310 (12.1)
15,086 ± 54,704
18,127 ± 57,291
3041 (20.2)
Median (Q1; Q3)
4516 (1746; 11,434)
5284 (1981; 13,581)
768 (17.0)
3363 (1302; 8746)
3781 (1398; 9813)
418 (12.4)
5899 (2369; 13,841)
7071 (2792; 16,649)
1172 (19.9)
Nonzero costs, patient n
19,412
19,222
–190 (–1.0)
9357
9173
–184 (–2.0)
10,055
10,049
–6 (–0.1)
Mean ± SD
13,020 ± 50,072
15,256 ± 50,871
2236 (17.2)
10,797 ± 44,453
12,107 ± 42,523
1310 (12.1)
15,088 ± 54,707
18,129 ± 57,293
3042 (20.2)
Median (Q1; Q3)
4516 (1746; 11,435)
5284 (1981; 13,581)
768 (17.0)
3363 (1302; 8746)
3781 (1398; 9813)
418 (12.4)
5901 (2369; 13,844)
7071 (2792; 16,649)
1170 (19.8)
Emergency department visits
Total cost
20,718,445
16,776,569
–3,941,876 (–19.0)
10,216,455
8,135,400
–2,081,054 (–20.4)
10,501,990
8,641,168
–1,860,822 (–17.7)
Standard costs, patient n
5943
4756
2830
2149
3113
2607
Mean ± SD
3486 ± 5082
3527 ± 6118
41 (1.2)
3610 ± 6055
3786 ± 7975
176 (4.9)
3374 ± 3993
3315 ± 3972
–59 (–1.8)
Median (Q1; Q3)
2322 (1358; 3981)
2344 (1328; 3971)
22 (0.9)
2265 (1268; 3930)
2385 (1293; 4001)
121 (5.3)
2344 (1484; 4006)
2319 (1360; 3918)
–25 (–1.1)
Nonzero costs, patient n
5935
4752
–1183 (–19.9)
2828
2149
–679 (–24.0)
3107
2603
–504 (–16.2)
Mean ± SD
3491 ± 5083
3530 ± 6120
40 (1.1)
3613 ± 6057
3786 ± 7975
173 (4.8)
3380 ± 3994
3320 ± 3973
–60 (–1.8)
Median (Q1; Q3)
2322 (1362; 3983)
2346 (1332; 3973)
24 (1.0)
2267 (1270; 3932)
2385 (1293; 4001)
118 (5.2)
2352 (1486; 4009)
2322 (1368; 3919)
–30 (–1.3)
Prescription claims
Total cost
73,381,260
82,891,287
9,510,027 (13.0)
34,332,199
39,019,983
4,687,784 (13.7)
39,049,062
43,871,304
4,822,243 (12.4)
Standard costs, patient n
17,845
17,824
8832
8604
9013
9220
Mean ± SD
4112 ± 15,111
4651 ± 16,138
538 (13.1)
3887 ± 14,812
4535 ± 16,441
648 (16.7)
4333 ± 15,396
4758 ± 15,851
426 (9.8)
Median (Q1; Q3)
652 (183; 2888)
722 (198; 3598)
70 (10.8)
399 (108; 2052)
458 (116; 2631)
59 (14.7)
942 (316; 3624)
1004 (327; 4345)
62 (6.5)
Nonzero costs, patient n
17,845
17,824
–21 (–0.1)
8832
8604
–228 (–2.6)
9013
9220
207 (2.3)
Mean ± SD
4112 ± 15,111
4651 ± 16,138
538 (13.1)
3887 ± 14,812
4535 ± 16,441
648 (16.7)
4333 ± 15,396
4758 ± 15,851
426 (9.8)
Median (Q1; Q3)
652 (183; 2888)
722 (198; 3598)
70 (10.8)
399 (108; 2052)
458 (116; 2631)
59 (14.7)
942 (316; 3624)
1004 (327; 4345)
62 (6.5)
All medical costs (outpatient, inpatient, and prescription claims)
Total cost
426,429,738
524,612,052
98,182,314 (23.0)
168,747,909
196,864,856
28,116,948 (16.7)
257,681,830
327,747,196
70,065,366 (27.2)
Standard costs, patient n
19,492
19,375
9381
9264
10,111
10,111
Mean ± SD
21,877 ± 61,388
27,077 ± 68,249
5200 (23.8)
17,988 ± 54,361
21,251 ± 59,851
3262 (18.1)
25,485 ± 67,055
32,415 ± 74,730
6930 (27.2)
Median (Q1; Q3)
7025 (2579; 19,791)
8045 (2842; 23,394)
1020 (14.5)
5093 (1898; 15,184)
5597 (1934; 17,259)
504 (9.9)
9137 (3605; 24,705)
10,803 (4238; 29,450)
1666 (18.2)
Nonzero costs, patient n
19,492
19,373
–119 (–0.6)
9381
9264
–117 (–1.3)
10,111
10,109
–2 (–0.02)
Mean ± SD
21,877 ± 61,388
27,077 ± 68,249
5200 (23.8)
17,988 ± 54,361
21,251 ± 59,851
3262 (18.1)
25,485 ± 67,055
32,415 ± 74,730
6930 (27.2)
Median (Q1; Q3)
7025 (2579; 19,791)
8045 (2842; 23,394)
1020 (14.5)
5093 (1898; 15,184)
5597 (1934; 17,259)
504 (9.9)
9137 (3605; 24,705)
10,803 (4238; 29,450)
1666 (18.2)
Standard cost patient n’s (used to calculate standard mean and median) reflect the number of patients who had any healthcare encounter for the specified outcome (eg, all patients with ≥ 1 outpatient visit during the specified time frame). Nonzero cost patient n’s (used to calculate nonzero mean and median) reflect the number of patients who had any costs associated with the specified outcome (eg, all patients with costs > 0 attributable to outpatient visits)
aThe baseline phase was the 12 months before the index date, and the post-acute phase spanned from 1 to 13 months after the index date
bAll costs are in US dollars rounded to the nearest dollar
Table 9
Medical costs during baseline and post-acute phasesa stratified by disposition during acute COVID-19b
Cost Description
No Hospitalization (n = 15,457)
Hospitalization Without ICU Admission (n = 2916)
ICU Admission (n = 1185)
Baseline Phase
Post-Acute Phase
Change From Baseline to Post-Acute Phase, Δ (% Change)
Baseline Phase
Post-Acute Phase
Change From Baseline to Post-Acute Phase, Δ (% Change)
Baseline Phase
Post-Acute Phase
Change From Baseline to Post-Acute Phase, Δ (% Change)
Inpatient visits
Total cost
55,006,160
71,173,890
16,167,729 (29.4)
37,551,499
48,817,949
11,266,450 (30.0)
7,752,746
28,486,963
20,734,217 (267.4)
Standard costs, patient n
1528
1526
808
886
187
465
Mean ± SD
35,999 ± 45,790
46,641 ± 57,520
10,642 (29.6)
46,475 ± 66,096
55,099 ± 71,721
8625 (18.6)
41,459 ± 40,551
61,262 ± 86,428
19,804 (47.8)
Median (Q1; Q3)
21,462 (14,504; 38,044)
29,627 (14,953; 54,520)
8164 (38.0)
27,718 (16,260; 52,083)
31,155 (13,937; 70,003)
3437 (12.4)
27,769 (15,380; 52,190)
28,301 (6212; 78,651)
532 (1.9)
Nonzero costs, patient n
1527
1520
–7 (–0.5)
805
877
72 (8.9)
187
460
273 (146.0)
Mean ± SD
36,022 ± 45,795
46,825 ± 57,559
10,803 (30.0)
46,648 ± 66,158
55,665 ± 71,869
9017 (19.3)
41,459 ± 40,551
61,928 ± 86,659
20,470 (49.4)
Median (Q1; Q3)
21,480 (14,508; 38,079)
29,780 (15,003; 54,950)
8300 (38.6)
27,784 (16,312; 52,229)
31,884 (14,314; 70,217)
4100 (14.8)
27,769 (15,380; 52,190)
29,569 (7503; 79,361)
1800 (6.5)
Readmission
Total cost
7,197,035
16,934,054
9,737,019 (135.3)
6,826,276
19,945,967
13,119,691 (192.2)
1,484,911
19,715,081
18,230,170 (1227.7)
Standard costs, patient n
165
348
130
477
32
320
Mean ± SD
43,618 ± 44,151
48,661 ± 63,658
5043 (11.6)
52,510 ± 70,981
41,815 ± 65,602
–10,694 (–20.4)
46,403 ± 34,640
61,610 ± 87,131
15,206 (32.8)
Median (Q1; Q3)
26,212 (14,990; 60,310)
24,379 (15,647; 56,754)
–1834 (–7.0)
29,916 (17,377; 53,143)
19,431 (4351; 51,298)
–10,485 (–35.0)
31,421 (21,650; 67,656)
28,680 (2796; 86,050)
–2740 (–8.7)
Nonzero costs, patient n
165
346
181 (109.7)
130
463
333 (256.2)
32
315
283 (884.4)
Mean ± SD
43,618 ± 44,151
48,942 ± 63,734
5324 (12.2)
52,510 ± 70,981
43,080 ± 66,177
–9430 (–18.0)
46,403 ± 34,640
62,588 ± 87,472
16,184 (34.9)
Median (Q1; Q3)
26,212 (14,990; 60,310)
24,660 (15,783; 57,039)
–1552 (–5.9)
29,916 (17,377; 53,143)
20,524 (5966; 52,693)
–9392 (–31.4)
31,421 (21,650; 67,656)
29,724 (3262; 86,370)
–1697 (–5.4)
Outpatient visits
Total cost
165,229,755
182,955,168
17,725,413 (10.7)
62,832,431
80,468,457
17,636,026 (28.1)
24,675,886
29,818,339
5,142,453 (20.8)
Standard costs, patient n
15,362
15,183
2882
2878
1169
1162
Mean ± SD
10,756 ± 26,701
12,050 ± 32,084
1294 (12.0)
21,802 ± 94,115
27,960 ± 93,624
6158 (28.2)
21,109 ± 100,596
25,661 ± 83,776
4553 (21.6)
Median (Q1; Q3)
4226 (1642; 10,315)
4598 (1763; 11,469)
372 (8.8)
6584 (2552; 17,830)
9307 (3257; 23,704)
2723 (41.4)
5090 (1719; 14,685)
9539 (4143; 21,553)
4449 (87.4)
Nonzero costs, patient n
15,361
15,183
–178 (–1.2)
2882
2877
–5 (–0.2)
1169
1162
–7 (–0.6)
Mean ± SD
10,756 ± 26,702
12,050 ± 32,084
1294 (12.0)
21,802 ± 94,115
27,970 ± 93,639
6168 (28.3)
21,109 ± 100,596
25,661 ± 83,776
4553 (21.6)
Median (Q1; Q3)
4227 (1642; 10,315)
4598 (1763; 11,469)
371 (8.8)
6584 (2552; 17,830)
9313 (3257; 23,704)
2729 (41.4)
5090 (1719; 14,685)
9539 (4143; 21,553)
4449 (87.4)
Emergency department visits
Total cost
14,492,784
11,234,026
–3,258,759 (–22.5)
4,705,450
4,066,393
–639,057 (–13.6)
1,520,211
1,476,150
–44,060 (–2.9)
Standard costs, patient n
4368
3427
1168
968
407
361
Mean ± SD
3318 ± 4780
3278 ± 5038
–40 (–1.2)
4029 ± 6268
4201 ± 5832
172 (4.3)
3735 ± 4241
4089 ± 12,625
354 (9.5)
Median (Q1; Q3)
2245 (1304; 3755)
2250 (1293; 3723)
4 (0.2)
2569 (1567; 4738)
2676 (1609; 4931)
107 (4.1)
2445 (1486; 4518)
2467 (1418; 4128)
21 (0.9)
Nonzero costs, patient n
4361
3423
–938 (–21.5)
1168
968
–200 (–17.1)
406
361
–45 (–11.1)
Mean ± SD
3323 ± 4782
3282 ± 5039
–41 (–1.2)
4029 ± 6268
4201 ± 5832
172 (4.3)
3744 ± 4242
4089 ± 12,625
345 (9.2)
Median (Q1; Q3)
2249 (1304; 3761)
2254 (1293; 3725)
5 (0.2)
2569 (1567; 4738)
2676 (1609; 4931)
107 (4.1)
2454 (1488; 4518)
2467 (1418; 4128)
12 (0.5)
Prescription claims
Total cost
53,453,402
58,721,207
5,267,806 (9.9)
14,012,113
17,079,036
3,066,923 (21.9)
5,915,746
7,091,044
1,175,298 (19.9)
Standard costs, patient n
14,144
14,069
2604
2644
1097
1111
Mean ± SD
3779 ± 15,333
4174 ± 16,026
395 (10.4)
5381 ± 13,865
6460 ± 15,983
1079 (20.0)
5393 ± 14,846
6383 ± 17,463
990 (18.4)
Median (Q1; Q3)
556 (162; 2340)
577 (166; 2799)
21 (3.8)
1362 (346; 5153)
1818 (445; 6091)
456 (33.5)
1096 (297; 4402)
1700 (406; 5822)
604 (55.1)
Nonzero costs, patient n
14,144
14,069
–75 (–0.5)
2604
2644
40 (1.5)
1097
1111
14 (1.3)
Mean ± SD
3779 ± 15,333
4174 ± 16,026
395 (10.4)
5381 ± 13,865
6460 ± 15,983
1079 (20.0)
5393 ± 14,846
6383 ± 17,463
990 (18.4)
Median (Q1; Q3)
556 (162; 2340)
577 (166; 2799)
21 (3.8)
1362 (346; 5153)
1818 (445; 6091)
456 (33.5)
1096 (297; 4402)
1700 (406; 5822)
604 (55.1)
All medical costs (outpatient, inpatient, and prescription claims)
Total cost
273,689,317
312,850,265
39,160,948 (14.3)
114,396,043
146,365,442
31,969,399 (28.0)
38,344,378
65,396,345
27,051,967 (70.6)
Standard costs, patient n
15,416
15,313
2899
2890
1177
1172
Mean ± SD
17,754 ± 40,000
20,430 ± 47,834
2677 (15.1)
39,461 ± 108,454
50,645 ± 113,091
11,185 (28.3)
32,578 ± 106,772
55,799 ± 113,215
23,221 (71.3)
Median (Q1; Q3)
6196 (2343; 16,739)
6717 (2497; 18,298)
521 (8.4)
13,543 (4388; 40,384)
16,906 (5460; 51,456)
3363 (24.8)
8493 (2978; 27,941)
18,578 (6643; 57,224)
10,085 (118.7)
Nonzero costs, patient n
15,416
15,313
–103 (–0.7)
2899
2889
–10 (–0.3)
1177
1171
–6 (–0.5)
Mean ± SD
17,754 ± 40,000
20,430 ± 47,834
2677 (15.1)
39,461 ± 108,454
50,645 ± 113,091
11,185 (28.3)
32,578 ± 106,772
55,799 ± 113,215
23,221 (71.3)
Median (Q1; Q3)
6196 (2343; 16,739)
6717 (2497; 18,298)
521 (8.4)
13,543 (4388; 40,384)
16,906 (5460; 51,456)
3363 (24.8)
8493 (2978; 27,941)
18,578 (6643; 57,224)
10,085 (118.7)
Standard cost patient n’s (used to calculate standard mean and median) reflect the number of patients who had any healthcare encounter for the specified outcome (eg, all patients with ≥ 1 outpatient visit during the specified time frame). Nonzero cost patient n’s (used to calculate nonzero mean and median) reflect the number of patients who had any costs associated with the specified outcome (eg, all patients with costs > 0 attributable to outpatient visits)
COVID-19 coronavirus disease 2019, ICU intensive care unit
aThe baseline phase was the 12 months before the index date, and the post-acute phase spanned from 1 to 13 months after the index date
bAll costs are in US dollars rounded to the nearest dollar
Inpatient and outpatient costs also increased in the overall population and across all age and severity categories (Tables 8 and 9). Percentage increases in inpatient costs were driven primarily by cost increases among patients of any age who were admitted to the ICU during acute COVID-19 (+ 267.4%). Much of the increase in inpatient costs within this patient subpopulation was due to an 896% increase in 30-day all-cause readmissions (Table 7), resulting in a 1227.7% cost escalation during the post-acute phase. Outpatient costs increased more modestly and were greatest among older patients and those who were hospitalized (with or without ICU admission) during acute COVID-19. Overall outpatient cost increases were observed despite decreases associated with ED visits across all age and severity categories.
Discussion
In this retrospective analysis encompassing > 2 years of healthcare data from nearly 20,000 high-risk individuals diagnosed with COVID-19, resource use and costs were substantially higher in the year after acute COVID-19 illness compared with the previous year. Consistent with previous observations [15], increases were greatest among older individuals and those who required hospitalization for acute COVID-19; however, notable changes were observed even among younger patients and those who had less severe acute disease.
Anzeige
We found increases in incidence of blood-related, neurologic, and psychiatric disorders, all of which are consistent with previous reports on post-COVID conditions [32‐34]. We observed a 16.3% increase in the ICD-10 diagnostic codes comprising “diseases of the blood and blood-forming organs” along with 31.6% and 29.9% increases in blood factor prescriptions and hemostatic modifier prescriptions, respectively. This is consistent with the potential for COVID-19 to cause persistent changes in the mechanisms underlying coagulation and hemostasis [33]. An 11.1% increase in “diseases of the nervous system” and a 7.7% increase in “mental and behavioral disorders” were also observed alongside increased prescribing of neurologic/neuromuscular disorder treatments and psychotherapeutic drugs (+ 12.7% and + 11.1%, respectively). The magnitude of increases in mental health–related prescriptions were relatively similar among patients who were not hospitalized during acute COVID-19 illness compared with the overall cohort, supporting previous reports that identified long-term impairments in mood, anxiety, and cognitive functioning that were unrelated to COVID-19 severity or hospitalization [32, 34, 35]. Our results are further corroborated by a longitudinal study of UK Biobank participants, in which cognitive declines observed > 3 months after COVID-19 diagnosis were significant even among nonhospitalized cases and were associated with structural changes in the brain [35]. In contrast with recent CDC data [10], we did not observe an overall increase in respiratory conditions because acute respiratory infections decreased. CDC defined respiratory conditions only as acute pulmonary embolism, asthma, or respiratory symptoms.
The percentages of outpatient and inpatient medical service use were substantially higher during the post-acute phase compared with baseline, including a 165.6% increase in total days spent in the hospital and a 249.9% increase in 30-day all-cause readmissions. This increase in healthcare utilization was directly reflected in observed medical costs. Total costs increased by 23.0% in the overall population; increases were greater among patients aged ≥ 65 years compared with the younger population and ranged from 14.3% among patients who were not hospitalized for acute COVID-19 to 70.6% among those admitted to the ICU.
Mean overall per-patient medical cost during the year after the acute COVID-19 phase was approximately $27,000 (whereas the baseline cost was approximately $22,000). Although there are no direct comparisons that can be made with previous studies, cost estimates of post-COVID conditions based on similar diagnoses (eg, myalgic encephalomyelitis/chronic fatigue syndrome) were nearly $9000 per person per year [36]. The higher values observed in our study may reflect a greater impact of COVID-19 than similar conditions but could also be a result of our high-risk patient population. Notably, studies comparing post-COVID conditions with long-term sequelae after seasonal influenza found a greater symptom, diagnosis, and healthcare resource burden with COVID [12, 24].
Substantial decreases were observed in the percentages of acute upper and lower respiratory infections, prescriptions for cough/cold/flu preparations, and ED visits. These data are consistent with early reports in the United States that show a sharp decline in both influenza rates and ED visits after the onset of the pandemic, including ED visits specifically for non-COVID upper respiratory infections [37‐39]. This decline was likely due to a combination of reduced influenza circulation because of COVID-19 mitigation strategies and the reluctance of patients to seek treatment because of the perceived risk of contracting COVID-19 in a healthcare setting [37, 39].
A main strength of this study was that all patients served as their own control, which inherently adjusts for potential confounders, including patient demographics and stable characteristics, such as healthcare-seeking behavior. Our study had some limitations, including that the population was limited to commercially insured individuals who were diagnosed early in the pandemic and who survived the acute phase of COVID-19. There was also potential for incomplete data capture (due to nonbillable diagnoses) and surveillance bias by which those who contracted COVID-19 were under higher medical scrutiny following their diagnosis. It is important to note that the study was conducted during a time of low preexisting immunity (ie, before vaccination and previous infection) and before the emergence of and SARS-CoV-2 variants of concern. Such factors could limit the generalizability of the findings to the current landscape. Additionally, baseline assessments were performed during the pre-pandemic period, whereas post-acute COVID-19 assessments were performed during a public health emergency that altered healthcare practices, access, and considerations; these changes may have affected clinical burden and healthcare costs during the post-acute COVID-19 period. Because this study included only high-risk individuals, a companion report describes results from a separate cohort of patients without high risk of developing severe COVID-19.
Conclusion
The health and economic burden of post-COVID conditions among high-risk US adults is substantial. Although the greatest impacts were observed among patients aged ≥ 65 years and those who were admitted to the ICU for acute COVID-19, increases in most outcomes were apparent even among younger individuals and those who did not require COVID-19 hospitalization. These results improve our understanding of post-COVID conditions and associated costs, as well as support hypothesis generation for future work characterizing the COVID-19 impact on individuals and society.
Acknowledgements
The authors thank Nathalie Baillon-Plot and Maria Lavinea Novis de Figueiredo Valente of Pfizer Inc for their help with study design and manuscript preparation. Programming support and expertise were provided by Tomasz Mikolajczyk, Klaudia Niezabitowska, and Kirsten Astbury, all of Quanticate, and Maya Reimbaeva of Pfizer Inc. Editorial/medical writing support was provided by Anna Stern, PhD, of ICON (Blue Bell, PA, USA) and was funded by Pfizer Inc.
Declarations
Ethics approval and consent to participate
This study was considered exempt from review and the need for informed consent by Sterling Institutional Review Board because of the use of deidentified data.
Consent for publication
Not applicable.
Competing interests
All authors are employees of Pfizer Inc and may hold stock or stock options.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Substantial health and economic burden of COVID-19 during the year after acute illness among US adults at high risk of severe COVID-19
verfasst von
Amie Scott Wajeeha Ansari Farid Khan Richard Chambers Michael Benigno Manuela Di Fusco Leah McGrath Deepa Malhotra Florin Draica Jennifer Nguyen Joanna Atkinson Jessica E. Atwell
Bei chronischer Herzinsuffizienz macht es einem internationalen Expertenteam zufolge wenig Sinn, die Diagnose „Eisenmangel“ am Serumferritin festzumachen. Das Team schlägt vor, sich lieber an die Transferrinsättigung zu halten.
Erwachsene, die Medikamente gegen das Aufmerksamkeitsdefizit-Hyperaktivitätssyndrom einnehmen, laufen offenbar erhöhte Gefahr, an Herzschwäche zu erkranken oder einen Schlaganfall zu erleiden. Es scheint eine Dosis-Wirkungs-Beziehung zu bestehen.
Die große Mehrheit der vermeintlichen Penicillinallergien sind keine. Da das „Etikett“ Betalaktam-Allergie oft schon in der Kindheit erworben wird, kann ein frühzeitiges Delabeling lebenslange Vorteile bringen. Ein Team von Pädiaterinnen und Pädiatern aus Kanada stellt vor, wie sie dabei vorgehen.
Eine verbesserte Stoffwechseleinstellung und höhere Lebensqualität – Diabetestechnologien sollen den Alltag der Patienten erleichtern. Dass CGM, AID & Co. bei Typ-1-Diabetes helfen, ist belegt. Bei Typ-2 gestaltet sich die Sache komplizierter.
Update Allgemeinmedizin
Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.
