Year: 2024
Type: article
Study design: Observational Study
Abstract: Importance: Research demonstrates that SARS-CoV-2 infection is associated with increased risk of all-cause hospitalization. However, no prior studies have assessed the association between SARS-CoV-2 and potentially preventable hospitalizations-that is, hospitalizations for conditions that can usually be effectively managed in ambulatory care settings. Objective: To examine whether SARS-CoV-2 is associated with potentially preventable hospitalization in a nationwide cohort of US veterans. Design, Setting, and Participants: This cohort study used an emulated target randomized trial design with monthly sequential trials to compare risk of a potentially preventable hospitalization among veterans with SARS-CoV-2 and matched comparators without SARS-CoV-2. A total of 189 136 US veterans enrolled in the Veterans Health Administration (VHA) who were diagnosed with SARS-CoV-2 between March 1, 2020, and April 30, 2021, and 943 084 matched comparators were included in the analysis. Data were analyzed from May 10, 2023, to January 26, 2024. Exposure: SARS-CoV-2 infection. Main Outcomes and Measures: The primary outcome was a first potentially preventable hospitalization in VHA facilities, VHA-purchased community care, or Medicare fee-for-service care. Extended Cox models were used to examine adjusted hazard ratios (AHRs) of potentially preventable hospitalization among veterans with SARS-CoV-2 and comparators during follow-up periods of 0 to 30, 0 to 90, 0 to 180, and 0 to 365 days. The start of follow-up was defined as the date of each veteran's first positive SARS-CoV-2 diagnosis, with the same index date applied to their matched comparators. Results: The 1 132 220 participants were predominantly men (89.06%), with a mean (SD) age of 60.3 (16.4) years. Most veterans were of Black (23.44%) or White (69.37%) race. Veterans with SARS-CoV-2 and comparators were well-balanced (standardized mean differences, all <0.100) on observable baseline clinical and sociodemographic characteristics. Overall, 3.10% of veterans (3.81% of those with SARS-CoV-2 and 2.96% of comparators) had a potentially preventable hospitalization during 1-year follow-up. Risk of a potentially preventable hospitalization was greater among veterans with SARS-CoV-2 than comparators in 4 follow-up periods: 0- to 30-day AHR of 3.26 (95% CI, 3.06-3.46); 0- to 90-day AHR of 2.12 (95% CI, 2.03-2.21); 0- to 180-day AHR of 1.69 (95% CI, 1.63-1.75); and 0- to 365-day AHR of 1.44 (95% CI, 1.40-1.48). Conclusions and Relevance: In this cohort study, an increased risk of preventable hospitalization in veterans with SARS-CoV-2, which persisted for at least 1 year after initial infection, highlights the need for research on ways in which SARS-CoV-2 shapes postinfection care needs and engagement with the health system. Solutions are needed to mitigate preventable hospitalization after SARS-CoV-2.
Source: JAMA Network Open
Authors: Diana J. Govier, Meike Niederhausen, Yumie Takata, Alex Hickok, Mazhgan Rowneki, Holly McCready, Valerie A. Smith, Thomas F. Osborne, Edward J. Boyko, George N. Ioannou, Matthew L. Maciejewski, Elizabeth M. Viglianti, Amy S. B. Bohnert, Ann M. O’Hare, Theodore J. Iwashyna, Denise M. Hynes, Theodore Berkowitz, Jacob Doll, Breana Floyd, Susan Nicole Hastings, Eric Hawkins, Makoto Jones, Lee Kamphius, Abby Moss, Michael Ong, Sarah Seelye, Javeed Shah, Troy Shahoumian, Aasma Shaukat, Megan Shepherd-Banigan, Christopher Slatore, Battista Smith, Pradeep Suri, Alan Teo, Kelly Vranas, Kara Winchell, Edwin Wong, Kristin Wyatt
Institutions: Portland State University, Oregon Health & Science University, Portland VA Medical Center, VA Portland Health Care System, Oregon State University, Duke University, Durham VA Health Care System, VA Palo Alto Health Care System, Stanford Medicine, Stanford University, VA Puget Sound Health Care System, Seattle Epidemiologic Information and Research Center, University of Washington, University of Michigan, VA Ann Arbor Healthcare System, Michigan Medicine, VA Center for Clinical Management Research, Johns Hopkins University, Health Services Research & Development
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,000
Award: G5486692884
OpenAlex ID: W4394687948