Characterizing the clinical and economic burden of COVID-19 among individuals with immunocompromising conditions in Ontario, Canada – a matched, population-based observational study
Notice bibliographique
Résumé
Aims Despite high vaccination rates, COVID-19 continues to be associated with substantial burden among immunocompromised patients (IC). This study aimed to describe and compare outcomes during and following COVID-19 hospitalizations among immunocompromised IC and non-immunocompromised patients (non-IC).Methods Patients hospitalized with COVID-19 (01/2020-03/2023) were identified in Ontario health administrative claims databases. All eligible IC (≥1 of solid organ or stem cell transplant; hematological malignancy; rheumatoid arthritis; multiple sclerosis; or primary immunodeficiency) were matched (1:4) to eligible non-IC. Clinical burden, healthcare resource use, and costs were assessed during hospitalization and post-discharge. Multivariate regression models were used to estimate relative risks (RRi), rates (RRa), and corresponding 95% confidence intervals (CIs), adjusting for neighborhood deprivation, long-term care residency, baseline comorbidities, and COVID-19 vaccination status.Results 9,283 IC hospitalized with COVID-19 (mean age 68.7 years; 52.1% female) were matched to 37,127 non-IC. During index hospitalization, IC had greater risks of intensive care unit admission (RRi = 1.06[1.01-1.12]), receipt of ventilation (RRi = 1.27[1.19-1.36]), and all-cause mortality (RRi = 1.34[1.27-1.41]) compared to non-IC. Within 30-days post-discharge, IC had greater rates of all-cause readmission to hospital (RRa = 1.33[1.26-1.40]), admission to emergency departments (RRa = 1.13[1.08-1.18]), home oxygen use (RRi = 1.35[1.15-1.58]), and COVID-19-related rehabilitation (RRa = 1.52[1.22-1.89]), resulting in 21%(16%-25%) and 51%(45%-58%) greater costs in hospital and post-discharge, respectively. All-cause mortality remained approximately 5% higher for IC compared to non-IC at 30- and 60- days post-discharge (p < 0.001). Resource use rates remained elevated among IC with 57%(50%-64%) greater costs within 180 days post-discharge.Limitations Unmeasured confounding remain; the use of treatments for COVID-19 were not adjusted due to a lack of in-hospital prescription data. Attribution of post-discharge resource use and costs to COVID-19 hospitalizations was subject to greater uncertainty further from the index hospitalization.Conclusion IC experienced more severe COVID-19 outcomes in hospital and post-discharge compared to non-IC. COVID-mitigating policies and prophylactic treatments are needed to continue to protect immunocompromised populations.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».