Center for Surveillance, Epidemiology, and Laboratory Services, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
National Center on Birth Defects and Developmental Disabilities, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Clin Infect Dis. 2023 Mar 4;76(5):871-880. doi: 10.1093/cid/ciac826.
Systemic inequities may place people with disabilities at higher risk of severe coronavirus disease 2019 (COVID-19) illness or lower likelihood to be discharged home after hospitalization. We examined whether severity of COVID-19 hospitalization outcomes and disposition differ by disability status and disability type.
In a retrospective analysis of April 2020-November 2021 hospital-based administrative data among 745 375 people hospitalized with COVID-19 from 866 US hospitals, people with disabilities (n = 120 360) were identified via ICD-10-CM codes. Outcomes compared by disability status included intensive care admission, invasive mechanical ventilation (IMV), in-hospital mortality, 30-day readmission, length of stay, and disposition (discharge to home, long-term care facility (LTCF), or skilled nursing facility (SNF).
People with disabilities had increased risks of IMV (adjusted risk ratio [aRR]: 1.05; 95% confidence interval [CI]: 1.03-1.08) and in-hospital mortality (1.04; 1.02-1.06) compared to those with no disability; risks were higher among people with intellectual and developmental disabilities (IDD) (IMV [1.34; 1.28-1.40], mortality [1.31; 1.26-1.37]), or mobility disabilities (IMV [1.13; 1.09-1.16], mortality [1.04; 1.01-1.07]). Risk of readmission was increased among people with any disability (1.23; 1.20-1.27) and each disability type. Risks of discharge to a LTCF (1.45, 1.39-1.51) or SNF (1.78, 1.74-1.81) were increased among community-dwelling people with each disability type.
Severity of COVID-19 hospitalization outcomes vary by disability status and type; IDD and mobility disabilities were associated with higher risks of severe outcomes. Disparities such as differences in discharge disposition by disability status require further study, which would be facilitated by standardized data on disability. Increased readmission across disability types indicates a need to improve discharge planning and support services.
系统性不平等可能使残疾人罹患严重 2019 冠状病毒病（COVID-19）或出院后回家的可能性降低。我们研究了 COVID-19 住院结局和处置是否因残疾状况和残疾类型而有所不同。
在对 2020 年 4 月至 2021 年 11 月期间来自美国 866 家医院的 745375 名 COVID-19 住院患者的基于医院的行政数据进行的回顾性分析中，通过 ICD-10-CM 代码确定了残疾人（n=120360 人）。通过残疾状况比较的结局包括重症监护病房收治、有创机械通气（invasive mechanical ventilation，IMV）、院内死亡率、30 天再入院、住院时间和处置（出院回家、长期护理机构（long-term care facility，LTCF）或康复护理机构（skilled nursing facility，SNF）。
与无残疾者相比，残疾人有更高的接受 IMV（校正风险比[aRR]：1.05；95%置信区间[CI]：1.03-1.08）和院内死亡率（1.04；1.02-1.06）的风险；智力和发育障碍（intellectual and developmental disabilities，IDD）（IMV[1.34；1.28-1.40]，死亡率[1.31；1.26-1.37]）或行动障碍（mobility disabilities）者的风险更高（IMV[1.13；1.09-1.16]，死亡率[1.04；1.01-1.07]）。任何残疾者（1.23；1.20-1.27）和每种残疾类型的再入院风险均增加。居住在社区的有各种残疾类型的人，入住 LTCF（1.45，1.39-1.51）或 SNF（1.78，1.74-1.81）的风险增加。
COVID-19 住院结局的严重程度因残疾状况和类型而异；IDD 和行动障碍与更严重结局的风险增加相关。残疾状况不同的出院处置差异等问题需要进一步研究，这将得益于残疾标准化数据。各种残疾类型的再入院率增加表明需要改进出院计划和支持服务。
