Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins Disability Health Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Disabil Health J. 2023 Apr;16(2):101441. doi: 10.1016/j.dhjo.2023.101441. Epub 2023 Jan 12.
People with disabilities might experience worse clinical outcomes of SARS-CoV-2 infection, but evidence is limited.
To investigate if people with disabilities requiring assistance are more likely to experience severe COVID-19 or death.
Data from the Johns Hopkins COVID-19 Precision Medicine Analytics Platform Registry (JH-CROWN) included 6494 adult patients diagnosed with COVID-19 and admitted between March 4, 2020-October 29, 2021. Severe COVID-19 and death were defined using the occurrence and timing of clinical events. Assistive needs due to disabilities were reported by patients or their proxies upon admission. Multivariable-adjusted Cox proportional hazards models were used to examine the associations between disability status and severe COVID-19 or death. Primary models adjusted for demographics and secondary models additionally adjusted for clinical covariates.
In this clinical cohort (47-73 years, 49% female, 39% Black), patients with disabilities requiring assistance had 1.35 times (95% confidence interval [CI]:1.01, 1.81) the hazard of severe COVID-19 among patients <65 years, but not among those ≥65 years, equating to an additional 17.5 severe COVID-19 cases (95% CI:7.7, 28.2) per 100 patients. A lower risk of mortality was found among patients <65 years, but this finding was not robust due to the small number of deaths.
People with disabilities requiring assistance aged <65 years are more likely to develop severe COVID-19. Although our study is limited by using a medical model of disability, these analyses intend to further our understanding of COVID-19 outcomes among people with disabilities. Also, standardized disability data collection within electronic health records is needed.
残疾人士可能经历更差的 SARS-CoV-2 感染临床结局，但证据有限。
调查是否需要辅助的残疾人士更可能经历严重 COVID-19 或死亡。
来自约翰霍普金斯 COVID-19 精准医学分析平台注册（JH-CROWN）的数据包括 6494 名成年 COVID-19 患者，诊断和住院时间为 2020 年 3 月 4 日至 2021 年 10 月 29 日。严重 COVID-19 和死亡通过临床事件的发生和时间定义。残疾导致的辅助需求由患者或其代理人在入院时报告。使用多变量调整 Cox 比例风险模型检查残疾状况与严重 COVID-19 或死亡之间的关联。初级模型调整了人口统计学因素，次级模型另外调整了临床协变量。
在这个临床队列中（年龄 47-73 岁，49%女性，39%黑人），<65 岁需要辅助的残疾患者严重 COVID-19 的风险是<65 岁无残疾患者的 1.35 倍（95%CI：1.01，1.81），相当于每 100 名患者增加 17.5 例严重 COVID-19（95%CI：7.7，28.2）。在<65 岁的患者中发现死亡率较低，但由于死亡人数较少，该发现不稳健。
<65 岁需要辅助的残疾人士更可能发生严重 COVID-19。尽管我们的研究受到残疾医学模型的限制，但这些分析旨在进一步了解残疾人士的 COVID-19 结局。还需要在电子健康记录中进行标准化的残疾数据收集。
