1
|
Abosi OJ, Trannel A, Schwartzhoff P, Ackman M, Zilles B, Marra AR, Dains A, Naito T, Salinas JL, Diekema DJ, Hanna B, Murphy JP, Wellington M, Brust K, Kobayashi T. A review of extended coronavirus disease 2019 (COVID-19) isolation duration among inpatients in a tertiary-care hospital-Iowa, 2020-2022. Infect Control Hosp Epidemiol 2024; 45:110-113. [PMID: 37528757 PMCID: PMC10782192 DOI: 10.1017/ice.2023.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/26/2023] [Accepted: 06/18/2023] [Indexed: 08/03/2023]
Abstract
Of the 2,668 patients admitted with coronavirus disease 2019 (COVID-19), 4% underwent prolonged isolation for >20 days. Reasons for extended isolation were inconsistent with Centers for Disease Control and Prevention (CDC) guidelines in 25% of these patients and were questionable in 54% due to an ongoing critically ill condition at day 20 without CDC-defined immunocompromised status.
Collapse
Affiliation(s)
- Oluchi J. Abosi
- University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States
| | - Alexandra Trannel
- University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States
| | | | - Mark Ackman
- University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States
| | - Barbara Zilles
- University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States
| | - Alexandre R. Marra
- University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Angelique Dains
- University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States
| | - Toshio Naito
- General Medicine, Juntendo University Hospital, Tokyo, Japan
| | | | - Daniel J. Diekema
- University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States
| | - Beth Hanna
- University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States
| | - Jaime P. Murphy
- University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States
| | | | - Karen Brust
- University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States
| | - Takaaki Kobayashi
- University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States
- General Medicine, Juntendo University Hospital, Tokyo, Japan
| |
Collapse
|
2
|
Ho T, Shahzad A, Jones A, Raghavan N, Loeb M, Johnston N. Examining the effect of the COVID-19 pandemic on community virus prevalence and healthcare utilisation reveals that peaks in asthma, COPD and respiratory tract infection occur with the re-emergence of rhino/enterovirus. Thorax 2023; 78:1248-1253. [PMID: 37423763 PMCID: PMC10715522 DOI: 10.1136/thorax-2022-219957] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/30/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION Airway disease exacerbations are cyclical related to respiratory virus prevalence. The COVID-19 pandemic has been associated with reduced exacerbations possibly related to public health measures and their impact on non-COVID-19 respiratory viruses. We aimed to investigate the prevalence of non-COVID-19 respiratory viruses during the pandemic compared with prior in Ontario, Canada and healthcare utilisation related to asthma, chronic obstructive pulmonary disease (COPD) and respiratory tract infection. METHODS This is a population-based retrospective analysis of respiratory virus tests, emergency department (ED) visits and hospitalisations between 2015 and 2021 in Ontario. Weekly virus testing data were used to estimate viral prevalence for all non-COVID-19 respiratory viruses. We plotted the %positivity and observed and expected counts of each virus to visualise the impact of the pandemic. We used Poisson and binomial logistic regression models to estimate the change in %positivity, count of positive viral cases and count of healthcare utilisation during the pandemic. RESULTS The prevalence of all non-COVID-19 respiratory viruses decreased dramatically during the pandemic compared with prior. Comparing periods, the incidence rate ratio (IRR) for positive cases corresponded to a >90% reduction for non-COVID-19 respiratory viruses except adenovirus and rhino/enterovirus. Asthma-related ED visits and hospital admissions fell by 57% (IRR 0.43 (95% CI 0.37 to 0.48)) and 61% (IRR 0.39 (95% CI 0.33 to 0.46)). COPD-related ED visits and admissions fell by 63% (IRR 0.37 (95% CI 0.30 to 0.45)) and 45% (IRR 0.55 (95% CI 0.48 to 0.62)). Respiratory tract infection ED visits and admissions fell by 85% (IRR 0.15 (95% CI 0.10 to 0.22)), and 85% (IRR 0.15 (95% CI 0.09 to 0.24)). Rather than the usual peaks in disease condition, during the pandemic, healthcare utilisation peaked in October when rhino/enterovirus peaked. CONCLUSIONS The prevalence of nearly all non-COVID-19 respiratory viruses decreased during the pandemic and was associated with marked reductions in ED visits and hospitalisations. The re-emergence of rhino/enterovirus was associated with increased healthcare utilisation.
Collapse
Affiliation(s)
- Terence Ho
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Abdullah Shahzad
- The University of Melbourne Melbourne Medical School, Melbourne, Victoria, Australia
| | - Aaron Jones
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Natya Raghavan
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mark Loeb
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Neil Johnston
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
3
|
Skowronski DM, Kaweski SE, Irvine MA, Chuang ESY, Kim S, Sabaiduc S, Reyes RC, Henry B, Sekirov I, Smolina K. Risk of hospital admission and death from first-ever SARS-CoV-2 infection by age group during the Delta and Omicron periods in British Columbia, Canada. CMAJ 2023; 195:E1427-E1439. [PMID: 37903524 PMCID: PMC10615343 DOI: 10.1503/cmaj.230721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Population-based cross-sectional serosurveys within the Lower Mainland, British Columbia, Canada, showed about 10%, 40% and 60% of residents were infected with SARS-CoV-2 by the sixth (September 2021), seventh (March 2022) and eighth (July 2022) serosurveys. We conducted the ninth (December 2022) and tenth (July 2023) serosurveys and sought to assess risk of severe outcomes from a first-ever SARS-CoV-2 infection during intersurvey periods. METHODS Using increments in cumulative infection-induced seroprevalence, population census, discharge abstract and vital statistics data sets, we estimated infection hospitalization and fatality ratios (IHRs and IFRs) by age and sex for the sixth to seventh (Delta/Omicron-BA.1), seventh to eighth (Omicron-BA.2/BA.5) and eighth to ninth (Omicron-BA.5/BQ.1) intersurvey periods. As derived, IHR and IFR estimates represent the risk of severe outcome from a first-ever SARS-CoV-2 infection acquired during the specified intersurvey period. RESULTS The cumulative infection-induced seroprevalence was 74% by December 2022 and 79% by July 2023, exceeding 80% among adults younger than 50 years but remaining less than 60% among those aged 80 years and older. Period-specific IHR and IFR estimates were consistently less than 0.3% and 0.1% overall. By age group, IHR and IFR estimates were less than 1.0% and up to 0.1%, respectively, except among adults aged 70-79 years during the sixth to seventh intersurvey period (IHR 3.3% and IFR 1.0%) and among those aged 80 years and older during all periods (IHR 4.7%, 2.2% and 3.5%; IFR 3.3%, 0.6% and 1.3% during the sixth to seventh, seventh to eighth and eighth to ninth periods, respectively). The risk of severe outcome followed a J-shaped age pattern. During the eighth to ninth period, we estimated about 1 hospital admission for COVID-19 per 300 newly infected children younger than 5 years versus about 1 per 30 newly infected adults aged 80 years and older, with no deaths from COVID-19 among children but about 1 death per 80 newly infected adults aged 80 years and older during that period. INTERPRETATION By July 2023, we estimated about 80% of residents in the Lower Mainland, BC, had been infected with SARS-CoV-2 overall, with low risk of hospital admission or death; about 40% of the oldest adults, however, remained uninfected and at highest risk of a severe outcome. First infections among older adults may still contribute substantial burden from COVID-19, reinforcing the need to continue to prioritize this age group for vaccination and to consider them in health care system planning.
Collapse
Affiliation(s)
- Danuta M Skowronski
- Immunization Programs and Vaccine Preventable Diseases Service (Skowronski, Kaweski, Chuang, Kim), BC Centre for Disease Control; School of Population and Public Health (Skowronski, Henry, Smolina), University of British Columbia; Data and Analytic Services (Irvine, Smolina), BC Centre for Disease Control, Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; Public Health Laboratory (Sabaiduc, Sekirov), BC Centre for Disease Control; Department of Pathology and Laboratory Medicine (Reyes, Sekirov), University of British Columbia, Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Ministry of Health (Henry), Office of the Provincial Health Officer, Victoria, BC
| | - Samantha E Kaweski
- Immunization Programs and Vaccine Preventable Diseases Service (Skowronski, Kaweski, Chuang, Kim), BC Centre for Disease Control; School of Population and Public Health (Skowronski, Henry, Smolina), University of British Columbia; Data and Analytic Services (Irvine, Smolina), BC Centre for Disease Control, Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; Public Health Laboratory (Sabaiduc, Sekirov), BC Centre for Disease Control; Department of Pathology and Laboratory Medicine (Reyes, Sekirov), University of British Columbia, Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Ministry of Health (Henry), Office of the Provincial Health Officer, Victoria, BC
| | - Michael A Irvine
- Immunization Programs and Vaccine Preventable Diseases Service (Skowronski, Kaweski, Chuang, Kim), BC Centre for Disease Control; School of Population and Public Health (Skowronski, Henry, Smolina), University of British Columbia; Data and Analytic Services (Irvine, Smolina), BC Centre for Disease Control, Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; Public Health Laboratory (Sabaiduc, Sekirov), BC Centre for Disease Control; Department of Pathology and Laboratory Medicine (Reyes, Sekirov), University of British Columbia, Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Ministry of Health (Henry), Office of the Provincial Health Officer, Victoria, BC
| | - Erica S Y Chuang
- Immunization Programs and Vaccine Preventable Diseases Service (Skowronski, Kaweski, Chuang, Kim), BC Centre for Disease Control; School of Population and Public Health (Skowronski, Henry, Smolina), University of British Columbia; Data and Analytic Services (Irvine, Smolina), BC Centre for Disease Control, Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; Public Health Laboratory (Sabaiduc, Sekirov), BC Centre for Disease Control; Department of Pathology and Laboratory Medicine (Reyes, Sekirov), University of British Columbia, Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Ministry of Health (Henry), Office of the Provincial Health Officer, Victoria, BC
| | - Shinhye Kim
- Immunization Programs and Vaccine Preventable Diseases Service (Skowronski, Kaweski, Chuang, Kim), BC Centre for Disease Control; School of Population and Public Health (Skowronski, Henry, Smolina), University of British Columbia; Data and Analytic Services (Irvine, Smolina), BC Centre for Disease Control, Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; Public Health Laboratory (Sabaiduc, Sekirov), BC Centre for Disease Control; Department of Pathology and Laboratory Medicine (Reyes, Sekirov), University of British Columbia, Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Ministry of Health (Henry), Office of the Provincial Health Officer, Victoria, BC
| | - Suzana Sabaiduc
- Immunization Programs and Vaccine Preventable Diseases Service (Skowronski, Kaweski, Chuang, Kim), BC Centre for Disease Control; School of Population and Public Health (Skowronski, Henry, Smolina), University of British Columbia; Data and Analytic Services (Irvine, Smolina), BC Centre for Disease Control, Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; Public Health Laboratory (Sabaiduc, Sekirov), BC Centre for Disease Control; Department of Pathology and Laboratory Medicine (Reyes, Sekirov), University of British Columbia, Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Ministry of Health (Henry), Office of the Provincial Health Officer, Victoria, BC
| | - Romina C Reyes
- Immunization Programs and Vaccine Preventable Diseases Service (Skowronski, Kaweski, Chuang, Kim), BC Centre for Disease Control; School of Population and Public Health (Skowronski, Henry, Smolina), University of British Columbia; Data and Analytic Services (Irvine, Smolina), BC Centre for Disease Control, Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; Public Health Laboratory (Sabaiduc, Sekirov), BC Centre for Disease Control; Department of Pathology and Laboratory Medicine (Reyes, Sekirov), University of British Columbia, Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Ministry of Health (Henry), Office of the Provincial Health Officer, Victoria, BC
| | - Bonnie Henry
- Immunization Programs and Vaccine Preventable Diseases Service (Skowronski, Kaweski, Chuang, Kim), BC Centre for Disease Control; School of Population and Public Health (Skowronski, Henry, Smolina), University of British Columbia; Data and Analytic Services (Irvine, Smolina), BC Centre for Disease Control, Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; Public Health Laboratory (Sabaiduc, Sekirov), BC Centre for Disease Control; Department of Pathology and Laboratory Medicine (Reyes, Sekirov), University of British Columbia, Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Ministry of Health (Henry), Office of the Provincial Health Officer, Victoria, BC
| | - Inna Sekirov
- Immunization Programs and Vaccine Preventable Diseases Service (Skowronski, Kaweski, Chuang, Kim), BC Centre for Disease Control; School of Population and Public Health (Skowronski, Henry, Smolina), University of British Columbia; Data and Analytic Services (Irvine, Smolina), BC Centre for Disease Control, Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; Public Health Laboratory (Sabaiduc, Sekirov), BC Centre for Disease Control; Department of Pathology and Laboratory Medicine (Reyes, Sekirov), University of British Columbia, Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Ministry of Health (Henry), Office of the Provincial Health Officer, Victoria, BC
| | - Kate Smolina
- Immunization Programs and Vaccine Preventable Diseases Service (Skowronski, Kaweski, Chuang, Kim), BC Centre for Disease Control; School of Population and Public Health (Skowronski, Henry, Smolina), University of British Columbia; Data and Analytic Services (Irvine, Smolina), BC Centre for Disease Control, Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; Public Health Laboratory (Sabaiduc, Sekirov), BC Centre for Disease Control; Department of Pathology and Laboratory Medicine (Reyes, Sekirov), University of British Columbia, Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Ministry of Health (Henry), Office of the Provincial Health Officer, Victoria, BC
| |
Collapse
|
4
|
Shappell CN, Klompas M, Chan C, Chen T, Rhee C. Impact of changing case definitions for coronavirus disease 2019 (COVID-19) hospitalization on pandemic metrics. Infect Control Hosp Epidemiol 2023; 44:1458-1466. [PMID: 36912323 DOI: 10.1017/ice.2022.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
OBJECTIVE To examine the impact of commonly used case definitions for coronavirus disease 2019 (COVID-19) hospitalizations on case counts and outcomes. DESIGN, PATIENTS, AND SETTING Retrospective analysis of all adults hospitalized between March 1, 2020, and March 1, 2022, at 5 Massachusetts acute-care hospitals. INTERVENTIONS We applied 6 commonly used definitions of COVID-19 hospitalization: positive severe acute respiratory coronavirus virus 2 (SARS-CoV-2) polymerase chain reaction (PCR) assay within 14 days of admission, PCR plus dexamethasone administration, PCR plus remdesivir, PCR plus hypoxemia, institutional COVID-19 flag, or COVID-19 International Classification of Disease, Tenth Revision (ICD-10) codes. Outcomes included case counts and in-hospital mortality. Overall, 100 PCR-positive cases were reviewed to determine each definition's accuracy for distinguishing primary or contributing versus incidental COVID-19 hospitalizations. RESULTS Of 306,387 hospital encounters, 15,436 (5.0%) met the PCR-based definition. COVID-19 hospitalization counts varied substantially between definitions: 4,628 (1.5% of all encounters) for PCR plus dexamethasone, 5,757 (1.9%) for PCR plus remdesivir, 11,801 (3.9%) for PCR plus hypoxemia, 15,673 (5.1%) for institutional flags, and 15,868 (5.2%) for ICD-10 codes. Definitions requiring dexamethasone, hypoxemia, or remdesivir selected sicker patients compared to PCR alone (mortality rates 12.2%, 10.7%, and 8.8% vs 8.3%, respectively). Definitions requiring PCR plus remdesivir or dexamethasone did not detect a reduction in in-hospital mortality associated with the SARS-CoV-2 Omicron variant. ICD-10 codes had the highest sensitivity (98.4%) but low specificity (39.5%) for distinguishing primary or contributing versus incidental COVID-19 hospitalizations. PCR plus dexamethasone had the highest specificity (92.1%) but low sensitivity (35.5%). CONCLUSIONS Commonly used definitions for COVID-19 hospitalizations generate variable case counts and outcomes and differentiate poorly between primary or contributing versus incidental COVID-19 hospitalizations. Surveillance definitions that better capture and delineate COVID-19-associated hospitalizations are needed.
Collapse
Affiliation(s)
- Claire N Shappell
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael Klompas
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christina Chan
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Tom Chen
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Chanu Rhee
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
5
|
Moura CS, Neville A, Liao F, Wen B, Razak F, Roberts S, Verma AA, Bernatsky S. Validity of hospital diagnostic codes to identify SARS-CoV-2 infections in reference to polymerase chain reaction results: a descriptive study. CMAJ Open 2023; 11:E982-E987. [PMID: 37875313 PMCID: PMC10610021 DOI: 10.9778/cmajo.20230033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND In 2020, International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) codes were created for laboratory-confirmed SARS-CoV-2 infections. We assessed the operating characteristics of ICD-10 discharge diagnostic code U07.1 within the General Medicine Inpatient Initiative (GEMINI). METHODS GEMINI assembles hospitalization data (including administrative ICD-10 discharge diagnostic codes, laboratory results and demographic data) from hospitals in Ontario, Canada. We studied adults (age ≥ 18 yr) admitted during 2020 and tested at least once for SARS-CoV-2 via polymerase chain reaction (PCR) during (or within 48 h before) hospitalization. With PCR results as the reference standard, we calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for ICD-10 code U07.1 hospital discharge diagnostic codes. Analyses were stratified by demographic data, calendar period and timing of the first test (within or after 48 h of hospital admission). RESULTS In 11 852 hospitalizations with at least 1 SARS-CoV-2 PCR test, 444 (3.7%) were positive. The sensitivity of code U07.1 to identify SARS-CoV-2 infection was 97.8%, specificity was 99.5%, PPV was 88.2% and NPV was 99.9%. Operating characteristics were similar in most stratified analyses, but the specificity and PPV were lower if the first SARS-CoV-2 test was done more than 48 hours after admission. INTERPRETATION The sensitivity, specificity, PPV and NPV of code U07.1 were high. This supports using code U07.1 to identify SARS-CoV-2 infection in hospitalization data.
Collapse
Affiliation(s)
- Cristiano S Moura
- Faculty of Medicine (Moura, Bernatsky), McGill University; Research Institute of the McGill University Health Centre (Neville, Bernatsky), Montréal, Que.; Li Ka Shing Knowledge Institute, St. Michael's Hospital (Liao, Wen, Razak, Roberts, Verma), Unity Health Toronto; Department of Medicine (Razak, Verma) and Institute of Health Policy, Management and Evaluation (Razak, Roberts, Verma), University of Toronto, Toronto, Ont
| | - Autumn Neville
- Faculty of Medicine (Moura, Bernatsky), McGill University; Research Institute of the McGill University Health Centre (Neville, Bernatsky), Montréal, Que.; Li Ka Shing Knowledge Institute, St. Michael's Hospital (Liao, Wen, Razak, Roberts, Verma), Unity Health Toronto; Department of Medicine (Razak, Verma) and Institute of Health Policy, Management and Evaluation (Razak, Roberts, Verma), University of Toronto, Toronto, Ont
| | - Fangming Liao
- Faculty of Medicine (Moura, Bernatsky), McGill University; Research Institute of the McGill University Health Centre (Neville, Bernatsky), Montréal, Que.; Li Ka Shing Knowledge Institute, St. Michael's Hospital (Liao, Wen, Razak, Roberts, Verma), Unity Health Toronto; Department of Medicine (Razak, Verma) and Institute of Health Policy, Management and Evaluation (Razak, Roberts, Verma), University of Toronto, Toronto, Ont
| | - Bijun Wen
- Faculty of Medicine (Moura, Bernatsky), McGill University; Research Institute of the McGill University Health Centre (Neville, Bernatsky), Montréal, Que.; Li Ka Shing Knowledge Institute, St. Michael's Hospital (Liao, Wen, Razak, Roberts, Verma), Unity Health Toronto; Department of Medicine (Razak, Verma) and Institute of Health Policy, Management and Evaluation (Razak, Roberts, Verma), University of Toronto, Toronto, Ont
| | - Fahad Razak
- Faculty of Medicine (Moura, Bernatsky), McGill University; Research Institute of the McGill University Health Centre (Neville, Bernatsky), Montréal, Que.; Li Ka Shing Knowledge Institute, St. Michael's Hospital (Liao, Wen, Razak, Roberts, Verma), Unity Health Toronto; Department of Medicine (Razak, Verma) and Institute of Health Policy, Management and Evaluation (Razak, Roberts, Verma), University of Toronto, Toronto, Ont
| | - Surain Roberts
- Faculty of Medicine (Moura, Bernatsky), McGill University; Research Institute of the McGill University Health Centre (Neville, Bernatsky), Montréal, Que.; Li Ka Shing Knowledge Institute, St. Michael's Hospital (Liao, Wen, Razak, Roberts, Verma), Unity Health Toronto; Department of Medicine (Razak, Verma) and Institute of Health Policy, Management and Evaluation (Razak, Roberts, Verma), University of Toronto, Toronto, Ont
| | - Amol A Verma
- Faculty of Medicine (Moura, Bernatsky), McGill University; Research Institute of the McGill University Health Centre (Neville, Bernatsky), Montréal, Que.; Li Ka Shing Knowledge Institute, St. Michael's Hospital (Liao, Wen, Razak, Roberts, Verma), Unity Health Toronto; Department of Medicine (Razak, Verma) and Institute of Health Policy, Management and Evaluation (Razak, Roberts, Verma), University of Toronto, Toronto, Ont
| | - Sasha Bernatsky
- Faculty of Medicine (Moura, Bernatsky), McGill University; Research Institute of the McGill University Health Centre (Neville, Bernatsky), Montréal, Que.; Li Ka Shing Knowledge Institute, St. Michael's Hospital (Liao, Wen, Razak, Roberts, Verma), Unity Health Toronto; Department of Medicine (Razak, Verma) and Institute of Health Policy, Management and Evaluation (Razak, Roberts, Verma), University of Toronto, Toronto, Ont.
| |
Collapse
|
6
|
van Diepen S, McAlister FA, Chu LM, Youngson E, Kaul P, Kadri SS. Association Between Vaccination Status and Outcomes in Patients Admitted to the ICU With COVID-19. Crit Care Med 2023; 51:1201-1209. [PMID: 37192450 DOI: 10.1097/ccm.0000000000005928] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
OBJECTIVES Although COVID-19 vaccines can reduce the need for intensive care unit admission in COVID-19, their effect on outcomes in critical illness remains unclear. We evaluated outcomes in vaccinated patients admitted to the ICU with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and the association between vaccination and booster status on clinical outcomes. DESIGN Retrospective cohort. SETTING AND PATIENTS All patients were admitted to an ICU between January 2021 (after vaccination was available) and July 2022 with a diagnosis of COVID-19 based on a SARS-CoV-2 polymerase chain reaction test in Alberta, Canada. INTERVENTIONS None. MEASUREMENT The propensity-matched primary outcome of all-cause in-hospital mortality was compared between vaccinated and unvaccinated patients, and vaccinated patients were stratified by booster dosing. Secondary outcomes were mechanical ventilation (MV) duration ICU length of stay (LOS). MAIN RESULTS The study included 3,293 patients: 743 (22.6%) were fully vaccinated (54.6% with booster), 166 (5.0%) were partially vaccinated, and 2,384 (72.4%) were unvaccinated. Unvaccinated patients were more likely to require invasive MV (78.4% vs 68.2%), vasopressor use (71.1% vs 66.6%), and extracorporeal membrane oxygenation (2.1% vs 0.5%). In a propensity-matched analysis, in-hospital mortality was similar (31.8% vs 34.0%, adjusted odds ratio [OR], 1.25; 95% CI, 0.97-1.61), but median duration MV (7.6 vs 4.7 d; p < 0.001) and ICU LOS (6.6 vs 5.2 d; p < 0.001) were longer in unvaccinated compared to fully vaccinated patients. Among vaccinated patients, greater than or equal to 1 booster had lower in-hospital mortality (25.5% vs 40.9%; adjusted OR, 0.50; 95% CI, 0.0.36-0.68) and duration of MV (3.8 vs 5.6 d; p = 0.025). CONCLUSIONS Nearly one in four patients admitted to the ICU with COVID-19 after widespread COVID-19 vaccine availability represented a vaccine-breakthrough case. Mortality risk remains substantial in vaccinated patients and similar between vaccinated and unvaccinated patients after the onset of critical illness. However, COVID-19 vaccination is associated with reduced ICU resource utilization and booster dosing may increase survivability from COVID-19-related critical illness.
Collapse
Affiliation(s)
- Sean van Diepen
- Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
- The Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Finlay A McAlister
- The Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada
- The Alberta Strategy for Patient Oriented Research Support Unit, AB, Canada
- Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Luan Manh Chu
- The Alberta Strategy for Patient Oriented Research Support Unit, AB, Canada
- Provincial Research Data Services, Alberta Health Services, Edmonton, AB, Canada
| | - Erik Youngson
- The Alberta Strategy for Patient Oriented Research Support Unit, AB, Canada
- Provincial Research Data Services, Alberta Health Services, Edmonton, AB, Canada
| | - Padma Kaul
- The Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada
- The Alberta Strategy for Patient Oriented Research Support Unit, AB, Canada
| | - Sameer S Kadri
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD
| |
Collapse
|
7
|
Lix LM, Renoux C, Moriello C, Choi KL, Dormuth CR, Fisher A, Dahl M, Wu F, Asaf A, Paterson JM. Validity of diagnoses of SARS-CoV-2 infection in Canadian administrative health data: a multiprovince, population-based cohort study. CMAJ Open 2023; 11:E790-E798. [PMID: 37669811 PMCID: PMC10482491 DOI: 10.9778/cmajo.20220152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Accurate coding of diagnoses of SARS-CoV-2 infection in administrative data benefits population-based studies about the epidemiology, treatment and outcomes of COVID-19. We describe the validity of diagnoses of SARS-CoV-2 infection recorded in hospital discharge abstracts, emergency department records and outpatient physician service claims from 3 Canadian provinces. METHODS In this cohort study, population-based inpatient, emergency department and outpatient records were linked to SARS-CoV-2 polymerase chain reaction (PCR; reference standard) test results from British Columbia, Manitoba and Ontario for Apr. 1, 2020, to Mar. 31, 2021. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of diagnoses of SARS-CoV-2 infection were estimated for each quarter in the study period, overall and by province, age group and sex. RESULTS Our study encompassed more than 13 million SARS-CoV-2 PCR test results. Specificity and NPV of diagnoses of SARS-CoV-2 infection were consistently high (i.e., most estimates were > 95%). Overall sensitivity estimates were 86.2%, 60.4% and 20.3% in the first quarter for inpatient, emergency department and outpatient cohorts, and 66.2%, 47.5% and 25.0% in the last quarter, respectively. For inpatients, overall PPV estimates ranged from 50.0% to 66.4%. For emergency department patients, overall PPV estimates were 76.9% and 68.3% in the first and last quarters, respectively. For outpatients, PPV estimates were 6.8% and 29.1% in the first and last quarters, respectively. INTERPRETATION We found variations in the validity of diagnoses for SARS-CoV-2 infection recorded in different health care settings, geographic areas and over time. Our multiprovince validation study provides evidence about the potential use of inpatient and emergency department records as an alternative to population-based laboratory data for identification of patients with SARS-CoV-2 infection, but does not support the use of outpatient claims for this purpose.
Collapse
Affiliation(s)
- Lisa M Lix
- Department of Community Health Sciences (Lix), University of Manitoba, Winnipeg, Man.; Lady Davis Institute (Renoux, Moriello); Departments of Neurology and Neurosurgery, and Epidemiology, Biostatistics and Occupational Health (Renoux), McGill University, Montréal, Que.; George & Fay Yee Centre for Healthcare Innovation (Choi), University of Manitoba, Winnipeg, Man.; Department of Anesthesiology, Pharmacology & Therapeutics (Dormuth, Fisher), University of British Columbia, Vancouver, BC; Manitoba Centre for Health Policy (Dahl), University of Manitoba, Winnipeg, Man.; ICES Central (Wu, Asaf, Paterson), Toronto, Ont.
| | - Christel Renoux
- Department of Community Health Sciences (Lix), University of Manitoba, Winnipeg, Man.; Lady Davis Institute (Renoux, Moriello); Departments of Neurology and Neurosurgery, and Epidemiology, Biostatistics and Occupational Health (Renoux), McGill University, Montréal, Que.; George & Fay Yee Centre for Healthcare Innovation (Choi), University of Manitoba, Winnipeg, Man.; Department of Anesthesiology, Pharmacology & Therapeutics (Dormuth, Fisher), University of British Columbia, Vancouver, BC; Manitoba Centre for Health Policy (Dahl), University of Manitoba, Winnipeg, Man.; ICES Central (Wu, Asaf, Paterson), Toronto, Ont
| | - Carolina Moriello
- Department of Community Health Sciences (Lix), University of Manitoba, Winnipeg, Man.; Lady Davis Institute (Renoux, Moriello); Departments of Neurology and Neurosurgery, and Epidemiology, Biostatistics and Occupational Health (Renoux), McGill University, Montréal, Que.; George & Fay Yee Centre for Healthcare Innovation (Choi), University of Manitoba, Winnipeg, Man.; Department of Anesthesiology, Pharmacology & Therapeutics (Dormuth, Fisher), University of British Columbia, Vancouver, BC; Manitoba Centre for Health Policy (Dahl), University of Manitoba, Winnipeg, Man.; ICES Central (Wu, Asaf, Paterson), Toronto, Ont
| | - Ko Long Choi
- Department of Community Health Sciences (Lix), University of Manitoba, Winnipeg, Man.; Lady Davis Institute (Renoux, Moriello); Departments of Neurology and Neurosurgery, and Epidemiology, Biostatistics and Occupational Health (Renoux), McGill University, Montréal, Que.; George & Fay Yee Centre for Healthcare Innovation (Choi), University of Manitoba, Winnipeg, Man.; Department of Anesthesiology, Pharmacology & Therapeutics (Dormuth, Fisher), University of British Columbia, Vancouver, BC; Manitoba Centre for Health Policy (Dahl), University of Manitoba, Winnipeg, Man.; ICES Central (Wu, Asaf, Paterson), Toronto, Ont
| | - Colin R Dormuth
- Department of Community Health Sciences (Lix), University of Manitoba, Winnipeg, Man.; Lady Davis Institute (Renoux, Moriello); Departments of Neurology and Neurosurgery, and Epidemiology, Biostatistics and Occupational Health (Renoux), McGill University, Montréal, Que.; George & Fay Yee Centre for Healthcare Innovation (Choi), University of Manitoba, Winnipeg, Man.; Department of Anesthesiology, Pharmacology & Therapeutics (Dormuth, Fisher), University of British Columbia, Vancouver, BC; Manitoba Centre for Health Policy (Dahl), University of Manitoba, Winnipeg, Man.; ICES Central (Wu, Asaf, Paterson), Toronto, Ont
| | - Anat Fisher
- Department of Community Health Sciences (Lix), University of Manitoba, Winnipeg, Man.; Lady Davis Institute (Renoux, Moriello); Departments of Neurology and Neurosurgery, and Epidemiology, Biostatistics and Occupational Health (Renoux), McGill University, Montréal, Que.; George & Fay Yee Centre for Healthcare Innovation (Choi), University of Manitoba, Winnipeg, Man.; Department of Anesthesiology, Pharmacology & Therapeutics (Dormuth, Fisher), University of British Columbia, Vancouver, BC; Manitoba Centre for Health Policy (Dahl), University of Manitoba, Winnipeg, Man.; ICES Central (Wu, Asaf, Paterson), Toronto, Ont
| | - Matthew Dahl
- Department of Community Health Sciences (Lix), University of Manitoba, Winnipeg, Man.; Lady Davis Institute (Renoux, Moriello); Departments of Neurology and Neurosurgery, and Epidemiology, Biostatistics and Occupational Health (Renoux), McGill University, Montréal, Que.; George & Fay Yee Centre for Healthcare Innovation (Choi), University of Manitoba, Winnipeg, Man.; Department of Anesthesiology, Pharmacology & Therapeutics (Dormuth, Fisher), University of British Columbia, Vancouver, BC; Manitoba Centre for Health Policy (Dahl), University of Manitoba, Winnipeg, Man.; ICES Central (Wu, Asaf, Paterson), Toronto, Ont
| | - Fangyun Wu
- Department of Community Health Sciences (Lix), University of Manitoba, Winnipeg, Man.; Lady Davis Institute (Renoux, Moriello); Departments of Neurology and Neurosurgery, and Epidemiology, Biostatistics and Occupational Health (Renoux), McGill University, Montréal, Que.; George & Fay Yee Centre for Healthcare Innovation (Choi), University of Manitoba, Winnipeg, Man.; Department of Anesthesiology, Pharmacology & Therapeutics (Dormuth, Fisher), University of British Columbia, Vancouver, BC; Manitoba Centre for Health Policy (Dahl), University of Manitoba, Winnipeg, Man.; ICES Central (Wu, Asaf, Paterson), Toronto, Ont
| | - Ayesha Asaf
- Department of Community Health Sciences (Lix), University of Manitoba, Winnipeg, Man.; Lady Davis Institute (Renoux, Moriello); Departments of Neurology and Neurosurgery, and Epidemiology, Biostatistics and Occupational Health (Renoux), McGill University, Montréal, Que.; George & Fay Yee Centre for Healthcare Innovation (Choi), University of Manitoba, Winnipeg, Man.; Department of Anesthesiology, Pharmacology & Therapeutics (Dormuth, Fisher), University of British Columbia, Vancouver, BC; Manitoba Centre for Health Policy (Dahl), University of Manitoba, Winnipeg, Man.; ICES Central (Wu, Asaf, Paterson), Toronto, Ont
| | - J Michael Paterson
- Department of Community Health Sciences (Lix), University of Manitoba, Winnipeg, Man.; Lady Davis Institute (Renoux, Moriello); Departments of Neurology and Neurosurgery, and Epidemiology, Biostatistics and Occupational Health (Renoux), McGill University, Montréal, Que.; George & Fay Yee Centre for Healthcare Innovation (Choi), University of Manitoba, Winnipeg, Man.; Department of Anesthesiology, Pharmacology & Therapeutics (Dormuth, Fisher), University of British Columbia, Vancouver, BC; Manitoba Centre for Health Policy (Dahl), University of Manitoba, Winnipeg, Man.; ICES Central (Wu, Asaf, Paterson), Toronto, Ont
| |
Collapse
|
8
|
Bagshaw SM, Abbott A, Beesoon S, Bowker SL, Zuege DJ, Thanh NX. A population-based assessment of avoidable hospitalizations and resource use of non-vaccinated patients with COVID-19. Can J Public Health 2023; 114:547-554. [PMID: 37165140 PMCID: PMC10171151 DOI: 10.17269/s41997-023-00777-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 04/13/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic has precipitated a prolonged public health crisis. Numerous public health protections were widely implemented. The availability of effective and safe vaccines for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presented an opportunity to resolve this crisis; however, vaccine uptake was slow and inconsistent. This study evaluated the potential for preventable hospitalizations and avoidable resource use among eligible non-vaccinated persons hospitalized for COVID-19 had these persons been vaccinated. METHODS This was a retrospective, population-based cohort study. The population-at-risk were persons aged ≥ 12 years in Alberta (mid-year 2021 population ~ 4.4 million). The primary exposure was vaccination status. The primary outcome was hospitalization with confirmed SARS-CoV-2, and secondary outcomes included avoidable hospitalizations, avoidable hospital bed-days, and the potential cost avoidance related to COVID-19. The study inception period was 27 September 2021 to 25 January 2022. Data on COVID-19 hospitalizations, vaccination status, health services, and costs were obtained from the Government of Alberta and from the Discharge Abstract Database. RESULTS Hospitalizations occurred in 3835, 1907, and 481 persons who were non-vaccinated, fully vaccinated, and boosted (risk of hospitalization/100,000 population: 886, 92, and 43), respectively. For non-vaccinated persons compared with fully vaccinated and boosted persons, the risk ratios (95%CI) of hospitalization were 9.7 (7.9-11.8) and 20.6 (17.9-23.6), respectively. For non-vaccinated persons, estimates of avoidable hospitalizations and bed-days used were 3439 and 36,331 if fully vaccinated and 3764 and 40,185 if boosted. Estimates of cost avoidance for non-vaccinated persons were $101.46 million if fully vaccinated and $110.24 million if boosted. CONCLUSION Eligible non-vaccinated persons with COVID-19 had tenfold and 21-fold higher risks of hospitalization relative to whether they had been fully vaccinated or boosted, resulting in considerable avoidable hospital bed-days and costs.
Collapse
Affiliation(s)
- Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, AB, Canada.
- Critical Care Strategic Clinical Network, Alberta Health Services, Alberta, Canada.
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
| | - Annalise Abbott
- Department of Surgery, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Sanjay Beesoon
- Department of Surgery, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
- Community Engagement, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Surgery Strategic Clinical Network, Alberta Health Services, Alberta, Canada
| | - Samantha L Bowker
- Critical Care Strategic Clinical Network, Alberta Health Services, Alberta, Canada
| | - Danny J Zuege
- Critical Care Strategic Clinical Network, Alberta Health Services, Alberta, Canada
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Nguyen X Thanh
- Critical Care Strategic Clinical Network, Alberta Health Services, Alberta, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Surgery Strategic Clinical Network, Alberta Health Services, Alberta, Canada
| |
Collapse
|
9
|
Whittaker R, Toikkanen S, Dean K, Lyngstad TM, Buanes EA, Kløvstad H, Paulsen TH, Seppälä E. A comparison of two registry-based systems for the surveillance of persons hospitalised with COVID-19 in Norway, February 2020 to May 2022. Euro Surveill 2023; 28:2200888. [PMID: 37589591 PMCID: PMC10436689 DOI: 10.2807/1560-7917.es.2023.28.33.2200888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/05/2023] [Indexed: 08/18/2023] Open
Abstract
BackgroundThe surveillance of persons hospitalised with COVID-19 has been essential to ensure timely and appropriate public health response. Ideally, surveillance systems should distinguish persons hospitalised with COVID-19 from those hospitalised due to COVID-19.AimWe compared data in two national electronic health registries in Norway to critically appraise and inform the further development of the surveillance of persons hospitalised with COVID-19.MethodWe included hospitalised COVID-19 patients registered in the Norwegian Patient Registry (NPR) or the Norwegian Pandemic Registry (NoPaR) with admission dates between 17 February 2020 and 1 May 2022. We linked patients, identified overlapping hospitalisation periods and described the overlap between the registries. We described the prevalence of International Classification of Diseases (ICD-10) diagnosis codes and their combinations by main cause of admission (clinically assessed as COVID-19 or other), age and time.ResultsIn the study period, 19,486 admissions with laboratory-confirmed COVID-19 were registered in NoPaR and 21,035 with the corresponding ICD-10 code U07.1 in NPR. Up to late 2021, there was a 90-100% overlap between the registries, which thereafter decreased to < 75%. The prevalence of ICD-10 codes varied by reported main cause, age and time.ConclusionChanges in patient cohorts, virus characteristics and the management of COVID-19 patients from late 2021 impacted the registration of patients and coding practices in the registries. Using ICD-10 codes for the surveillance of persons hospitalised due to COVID-19 requires age- and time-specific definitions and ongoing validation to consider temporal changes in patient cohorts and virus characteristics.
Collapse
Affiliation(s)
- Robert Whittaker
- Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Oslo, Norway
| | - Salla Toikkanen
- Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Oslo, Norway
| | - Katharine Dean
- Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Oslo, Norway
| | - Trude Marie Lyngstad
- Department of Infection Control and Preparedness, Norwegian Institute of Public Health, Oslo, Norway
| | - Eirik Alnes Buanes
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
- Norwegian Intensive Care and Pandemic Registry, Haukeland University Hosspital, Bergen, Norway
| | - Hilde Kløvstad
- Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Oslo, Norway
| | - Trine Hessevik Paulsen
- Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Oslo, Norway
| | - Elina Seppälä
- Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
10
|
Setayeshgar S, Wilton J, Sbihi H, Zandy M, Janjua N, Choi A, Smolina K. Comparison of influenza and COVID-19 hospitalisations in British Columbia, Canada: a population-based study. BMJ Open Respir Res 2023; 10:10/1/e001567. [PMID: 36731922 PMCID: PMC9895913 DOI: 10.1136/bmjresp-2022-001567] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/23/2023] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION We compared the population rate of COVID-19 and influenza hospitalisations by age, COVID-19 vaccine status and pandemic phase, which was lacking in other studies. METHOD We conducted a population-based study using hospital data from the province of British Columbia (population 5.3 million) in Canada with universal healthcare coverage. We created two cohorts of COVID-19 hospitalisations based on date of admission: annual cohort (March 2020 to February 2021) and peak cohort (Omicron era; first 10 weeks of 2022). For comparison, we created influenza annual and peak cohorts using three historical periods years to capture varying severity and circulating strains: 2009/2010, 2015/2016 and 2016/2017. We estimated hospitalisation rates per 100 000 population. RESULTS COVID-19 and influenza hospitalisation rates by age group were 'J' shaped. The population rate of COVID-19 hospital admissions in the annual cohort (mostly unvaccinated; public health restrictions in place) was significantly higher than influenza among individuals aged 30-69 years, and comparable to the severe influenza year (2016/2017) among 70+. In the peak COVID-19 cohort (mostly vaccinated; few restrictions in place), the hospitalisation rate was comparable with influenza 2016/2017 in all age groups, although rates among the unvaccinated population were still higher than influenza among 18+. Among people aged 5-17 years, COVID-19 hospitalisation rates were lower than/comparable to influenza years in both cohorts. The COVID-19 hospitalisation rate among 0-4 years old, during Omicron, was higher than influenza 2015/2016 and 2016/2017 and lower than 2009/2010 pandemic. CONCLUSIONS During first Omicron wave, COVID-19 hospitalisation rates were significantly higher than historical influenza hospitalisation rates for unvaccinated adults but were comparable to influenza for vaccinated adults. For children, in the context of high infection levels, hospitalisation rates for COVID-19 were lower than 2009/2010 H1N1 influenza and comparable (higher for 0-4) to non-pandemic years, regardless of the vaccine status.
Collapse
Affiliation(s)
- Solmaz Setayeshgar
- Data and Analytic Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - James Wilton
- Data and Analytic Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Hind Sbihi
- Data and Analytic Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada,School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Moe Zandy
- Public Health Surveillance Unit, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Naveed Janjua
- Data and Analytic Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada,School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexandra Choi
- Office of the Chief Medical Health Officer, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Kate Smolina
- Data and Analytic Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada,School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
11
|
Butler AM, Burcu M, Christian JB, Tian F, Andersen KM, Blumentals WA, Joynt Maddox KE, Alexander GC. Noninterventional studies in the COVID-19 era: methodological considerations for study design and analysis. J Clin Epidemiol 2023; 153:91-101. [PMID: 36400263 DOI: 10.1016/j.jclinepi.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 10/27/2022] [Accepted: 11/09/2022] [Indexed: 11/19/2022]
Abstract
The global COVID-19 pandemic has generated enormous morbidity and mortality, as well as large health system disruptions including changes in use of prescription medications, outpatient encounters, emergency department admissions, and hospitalizations. These pandemic-related disruptions are reflected in real-world data derived from electronic medical records, administrative claims, disease or medication registries, and mobile devices. We discuss how pandemic-related disruptions in healthcare utilization may impact the conduct of noninterventional studies designed to characterize the utilization and estimate the effects of medical interventions on health-related outcomes. Using hypothetical studies, we highlight consequences that the pandemic may have on study design elements including participant selection and ascertainment of exposures, outcomes, and covariates. We discuss the implications of these pandemic-related disruptions on possible threats to external validity (participant selection) and internal validity (for example, confounding, selection bias, missing data bias). These concerns may be amplified in populations disproportionately impacted by COVID-19, such as racial/ethnic minorities, rural residents, or people experiencing poverty. We propose a general framework for researchers to carefully consider during the design and analysis of noninterventional studies that use real-world data from the COVID-19 era.
Collapse
|
12
|
Luccarelli J, Kalinich M, McCoy TH, Fricchione G, Smith F, Beach SR. Co-Occurring Catatonia and COVID-19 Diagnoses Among Hospitalized Individuals in 2020: A National Inpatient Sample Analysis. J Acad Consult Liaison Psychiatry 2022; 64:209-217. [PMID: 36592693 PMCID: PMC9872966 DOI: 10.1016/j.jaclp.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/30/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND COVID-19 is associated with a range of neuropsychiatric manifestations. While case reports and case series have reported catatonia in the setting of COVID-19 infection, its rate has been poorly characterized. OBJECTIVE This study reports the co-occurrence of catatonia and COVID-19 diagnoses among acute care hospital discharges in the United States in 2020. METHODS The National Inpatient Sample, an all-payors database of acute care hospital discharges, was queried for patients of any age discharged with a diagnosis of catatonia and COVID-19 in 2020. RESULTS Among 32,355,827 hospitalizations in the 2020 National Inpatient Sample, an estimated 15,965 (95% confidence interval: 14,992-16,938) involved a diagnosis of catatonia without COVID-19 infection, 1,678,385 (95% confidence interval: 1,644,738-1,712,022) involved a diagnosis of COVID-19 without a co-occurring catatonia diagnosis, and 610 (95% confidence interval: 578-642) involved both catatonia and COVID-19 infection. In an adjusted model, a diagnosis of COVID-19, but not a diagnosis of catatonia or the combination of catatonia and COVID-19, was associated with increased mortality. Patients with catatonia and COVID-19 were frequently diagnosed with encephalopathy and delirium codes. CONCLUSIONS Catatonia and COVID-19 were rarely co-diagnosed in 2020, and catatonia diagnosis was not associated with increased mortality in patients with COVID-19. Further research is needed to better characterize the phenomenology of catatonia in the setting of COVID-19 infection and its optimal treatment.
Collapse
Affiliation(s)
- James Luccarelli
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA,Send correspondence and reprint requests to James Luccarelli, MD, DPhil, Massachusetts General Hospital, 32 Fruit Street Yawkey 6A, Boston, MA 02114
| | - Mark Kalinich
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Thomas H. McCoy
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Gregory Fricchione
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Felicia Smith
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Scott R. Beach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| |
Collapse
|
13
|
Bagshaw SM, Abbott A, Beesoon S, Zuege DJ, Wasylak T, Manns B, Nguyen TX. Avoidable intensive care unit resource use and costs of unvaccinated patients with COVID-19: a historical population-based cohort study. Can J Anaesth 2022; 69:1399-1404. [PMID: 35879485 PMCID: PMC9313940 DOI: 10.1007/s12630-022-02299-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/22/2022] [Accepted: 04/30/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE SARS-CoV-2 vaccines have been proven effective at preventing poor outcomes from COVID-19; however, voluntary vaccination rates have been suboptimal. We assessed the potential avoidable intensive care unit (ICU) resource use and associated costs had unvaccinated or partially vaccinated patients hospitalized with COVID-19 been fully vaccinated. METHODS We conducted a retrospective, population-based cohort study of persons aged 12 yr or greater in Alberta (2021 population ~ 4.4 million) admitted to any ICU with COVID-19 from 6 September 2021 to 4 January 2022. We used publicly available aggregate data on COVID-19 infections, vaccination status, and health services use. Intensive care unit admissions, bed-days, lengths of stay, and costs were estimated for patients with COVID-19 and stratified by vaccination status. RESULTS In total, 1,053 patients admitted to the ICU with COVID-19 were unvaccinated, 42 were partially vaccinated, and 173 were fully vaccinated (cumulative incidence 230.6, 30.8, and 5.5 patients/100,000 population, respectively). Cumulative incidence rate ratios of ICU admission were 42.2 (95% confidence interval [CI], 39.7 to 44.9) for unvaccinated patients and 5.6 (95% CI, 4.1 to 7.6) for partially vaccinated patients when compared with fully vaccinated patients. During the study period, 1,028 avoidable ICU admissions and 13,015 bed-days were recorded for unvaccinated patients and the total avoidable costs were CAD 61.3 million. The largest opportunity to avoid ICU bed-days and costs was in unvaccinated patients aged 50 to 69 yr. CONCLUSIONS Unvaccinated patients with COVID-19 had substantially greater rates of ICU admissions, ICU bed-days, and ICU-related costs than vaccinated patients did. This increased resource use would have been potentially avoidable had these unvaccinated patients been vaccinated against SARS-CoV-2.
Collapse
Affiliation(s)
- Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, 2-124E Clinical Sciences Building, 8440-112 St NW, Edmonton, AB, T6G 2B7, Canada.
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada.
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
| | - Annalise Abbott
- Surgery Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Sanjay Beesoon
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Surgery Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
| | - Danny J Zuege
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Tracy Wasylak
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Surgery Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Braden Manns
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Surgery Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Thanh X Nguyen
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Surgery Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
| |
Collapse
|