ICES Central (McNaughton, Austin, Sivaswamy, Fang, Abdel-Qadir, Daneman, Udell, Wodchis, Lee, Atzema); Sunnybrook Research Institute (McNaughton, Austin, Daneman, Mostarac, Atzema); Sunnybrook Health Sciences Centre (McNaughton, Daneman, Atzema); Department of Medicine (McNaughton, Abdel-Qadir, Daneman, Udell, Lee, Atzema), and Institute of Health Policy, Management and Evaluation (Austin, Abdel-Qadir, Udell, Wodchis, Atzema), University of Toronto; Peter Munk Cardiac Centre (Abdel-Qadir, Udell, Lee), Toronto General Hospital; Division of Cardiology (Abdel-Qadir, Udell), Women's College Hospital; Department of Medical Imaging (Lee), and Division of Cardiology (Abdel-Qadir, Udell, Lee), University Health Network, University of Toronto; Ted Rogers Centre for Heart Research (Abdel-Qadir, Lee); Institute for Better Health, Trillium Health Partners, Toronto, Ont.
CMAJ. 2022 Oct 17;194(40):E1368-E1376. doi: 10.1503/cmaj.220728.
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).
目前尚不清楚 SARS-CoV-2 感染后医疗保健使用的恢复期负担。我们通过比较社区居住的安大略省成年人中 SARS-CoV-2 感染阳性和阴性聚合酶链反应 (PCR) 检测结果，旨在量化 SARS-CoV-2 感染后社区居住成年人的恢复期医疗保健使用负担。
我们进行了一项回顾性队列研究，涉及安大略省社区居住的成年人，他们在 2020 年 1 月 1 日至 2021 年 3 月 31 日之间进行了 PCR 检测。随访从 PCR 检测后 56 天开始。我们使用全面的倾向评分进行了 1:1 匹配。我们比较了人均年医疗保健就诊率的平均值和第 99 个百分位数，并按性别使用负二项模型进行分层比较计数。
在 531702 名匹配的人群中，平均年龄为 44 岁（标准差 [SD] 17 岁），51%为女性。与 SARS-CoV-2 检测结果阴性的人相比，SARS-CoV-2 检测结果阳性的女性人均年整体医疗保健就诊次数平均多 1.98 次（95%CI1.63 至 2.29），多 0.31 次（95%CI0.05 至 0.56）家庭护理就诊次数和 0.81 次（95%CI0.69 至 0.93）长期护理天数。在人均年第 99 个百分位数时，检测结果阳性的女性住院天数多 6.48 天，家庭护理就诊次数多 28.37 次。与 SARS-CoV-2 检测结果阴性的人相比，SARS-CoV-2 检测结果阳性的男性人均年整体医疗保健就诊次数多 0.66 次（95%CI0.34 至 0.99），门诊就诊次数多 0.14 次（95%CI0.06 至 0.21），长期护理天数多 0.48 次（95%CI0.36 至 0.60），家庭护理就诊次数少 0.43 次（95%CI-0.67 至-0.21）。在第 99 个百分位数时，他们每年人均住院天数多 8.69 天，家庭护理（-27.31）和门诊（-0.87）就诊次数减少。
我们在一项匹配 SARS-CoV-2 检测阳性与阴性的分析中发现，SARS-CoV-2 PCR 检测阳性后医疗保健使用率显著升高。利益相关者可以利用这些发现为与 COVID-19 后状况（长 COVID）相关的医疗保健需求做好准备。
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