Kone Anna Pefoyo, Martin Lynn, Scharf Deborah, Gabriel Helen, Dean Tamara, Costa Idevania, Saskin Refik, Palma Luis, Wodchis Walter P
Department of Health Sciences, Lakehead University, Thunder Bay, Canada.
Behavioural Research and Northern Community Health Evaluative Services (Branches) Lab, Lakehead University, Canada.
Dialogues Health. 2023 Dec;2:100128. doi: 10.1016/j.dialog.2023.100128. Epub 2023 Mar 28.
This study examined the impact of multimorbidity on severe COVID-19 outcomes in community and long-term care (LTC) settings, alone and in interaction with age and sex.
We conducted a retrospective cohort study of all Ontarians who tested positive for COVID-19 between January-2020 and May-2021 with follow-up until June 2021. We used cox regression to evaluate the adjusted impact of multimorbidity, individual characteristics, and interactions on time to hospitalization and death (any cause).
24.5% of the cohort had 2 or more pre-existing conditions. Multimorbidity was associated with 28% to 170% shorter time to hospitalization and death, respectively. However, predictors of hospitalization and death differed for people living in community and LTC. In community, increasing multimorbidity and age predicted shortened time to hospitalization and death. In LTC, we found none of the predictors examined were associated with time to hospitalization, except for increasing age that predicted reduced time to death up to 40.6 times. Sex was a predictor across all settings and outcomes: among male the risk of hospitalization or death was higher shortly after infection (e.g. HR for males at 14 days = 30.3) while among female risk was higher for both outcome in the longer term (e.g. HR for males at 150 days = 0.16). Age and sex modified the impact of multimorbidity in the community.
Community-focused public health measures should be targeted and consider sociodemographic and clinical characteristics such as multimorbidity. In LTC settings, further research is needed to identify factors that may contribute to improved outcomes.
本研究考察了多种疾病共存对社区和长期护理（LTC）机构中重症 COVID-19 结局的影响，以及单独或与年龄和性别相互作用时的影响。
我们对 2020 年 1 月至 2021 年 5 月期间 COVID-19 检测呈阳性的所有安大略省居民进行了一项回顾性队列研究，并随访至 2021 年 6 月。我们使用 Cox 回归来评估多种疾病共存、个体特征以及相互作用对住院时间和死亡时间（任何原因）的调整影响。
该队列中有 24.5%的人有 2 种或更多的既往疾病。多种疾病共存分别与住院时间和死亡时间缩短 28%至 170%相关。然而，社区和长期护理机构中住院和死亡的预测因素有所不同。在社区中，多种疾病共存情况增加和年龄增长预示着住院时间和死亡时间缩短。在长期护理机构中，我们发现除了年龄增长预示着死亡时间最多缩短 40.6 倍外，所考察的预测因素均与住院时间无关。性别是所有环境和结局的预测因素：在男性中，感染后不久住院或死亡的风险较高（例如，14 天时男性的风险比 = 30.3），而在女性中，两种结局在较长时期内的风险都较高（例如，150 天时男性的风险比 = 0.16）。年龄和性别改变了社区中多种疾病共存的影响。
以社区为重点的公共卫生措施应具有针对性，并考虑多种疾病共存等社会人口学和临床特征。在长期护理机构中，需要进一步研究以确定可能有助于改善结局的因素。
