Post-acute health care burden after SARS-CoV-2 infection: a retrospective cohort study

The post-acute burden of health care use after SARS-CoV-2 infection is unknown. We sought to quantify the post-acute burden of health care use after SARS-CoV-2 infection among community-dwelling adults in Ontario by comparing those with positive and negative polymerase chain reaction (PCR) test resu...

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Bibliographic Details
Published in:Canadian Medical Association journal (CMAJ) Vol. 194; no. 40; pp. E1368 - E1376
Main Authors: McNaughton, Candace D., Austin, Peter C., Sivaswamy, Atul, Fang, Jiming, Abdel-Qadir, Husam, Daneman, Nick, Udell, Jacob A., Wodchis, Walter P., Mostarac, Ivona, Lee, Douglas S., Atzema, Clare L.
Format: Journal Article
Language:English
Published: Canada Elsevier Inc 17.10.2022
CMA Impact Inc
CMA Impact, Inc
Subjects:
Adult
Caregiver Burden
Cohort analysis
Coronaviruses
COVID-19
COVID-19 - complications
COVID-19 - epidemiology
Female
Health care policy
Humans
Infections
Internal Medicine
Long COVID
Long term health care
Male
Medical care
Middle Aged
Polymerase chain reaction
Post-Acute COVID-19 Syndrome
Public health
Retrospective Studies
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2
Utilization
Canada
ISSN:0820-3946, 1488-2329, 1488-2329
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Summary:The post-acute burden of health care use after SARS-CoV-2 infection is unknown. We sought to quantify the post-acute burden of health care use after SARS-CoV-2 infection among community-dwelling adults in Ontario by comparing those with positive and negative polymerase chain reaction (PCR) test results for SARS-CoV-2 infection. We conducted a retrospective cohort study involving community-dwelling adults in Ontario who had a PCR test between Jan. 1, 2020, and Mar. 31, 2021. Follow-up began 56 days after PCR testing. We matched people 1:1 on a comprehensive propensity score. We compared per-person-year rates for health care encounters at the mean and 99th percentiles, and compared counts using negative binomial models, stratified by sex. Among 531 702 matched people, mean age was 44 (standard deviation [SD] 17) years and 51% were female. Females who tested positive for SARS-CoV-2 had a mean of 1.98 (95% CI 1.63 to 2.29) more health care encounters overall per-person-year than those who had a negative test result, with 0.31 (95% CI 0.05 to 0.56) more home care encounters to 0.81 (95% CI 0.69 to 0.93) more long-term care days. At the 99th percentile per-person-year, females who tested positive had 6.48 more days of hospital admission and 28.37 more home care encounters. Males who tested positive for SARS-CoV-2 had 0.66 (95% CI 0.34 to 0.99) more overall health care encounters per-person-year than those who tested negative, with 0.14 (95% CI 0.06 to 0.21) more outpatient encounters and 0.48 (95% CI 0.36 to 0.60) long-term care days, and 0.43 (95% CI −0.67 to −0.21) fewer home care encounters. At the 99th percentile, they had 8.69 more days in hospital per-person-year, with fewer home care (−27.31) and outpatient (−0.87) encounters. We found significantly higher rates of health care use after a positive SARS-CoV-2 PCR test in an analysis that matched test-positive with test-negative people. Stakeholders can use these findings to prepare for health care demand associated with post-COVID-19 condition (long COVID).
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ISSN:0820-3946
1488-2329
1488-2329
DOI:10.1503/cmaj.220728