Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
BMJ. 2023 Aug 9;382:e076222. doi: 10.1136/bmj-2023-076222.
To characterize the long term risk of death and hospital readmission after an index admission with covid-19 among Medicare fee-for-service beneficiaries, and to compare these outcomes with historical control patients admitted to hospital with influenza.
Retrospective cohort study.
United States.
883 394 Medicare fee-for-service beneficiaries age ≥65 years discharged alive after an index hospital admission with covid-19 between 1 March 2020 and 31 August 2022, compared with 56 409 historical controls discharged alive after a hospital admission with influenza between 1 March 2018 and 31 August 2019. Weighting methods were used to account for differences in observed characteristics.
All cause death within 180 days of discharge. Secondary outcomes included first all cause readmission and a composite of death or readmission within 180 days.
The covid-19 cohort compared with the influenza cohort was younger (77.9 78.9 years, standardized mean difference -0.12) and had a lower proportion of women (51.7% 57.3%, -0.11). Both groups had a similar proportion of black beneficiaries (10.3% 8.1%, 0.07) and beneficiaries with dual Medicaid-Medicare eligibility status (20.1% 19.2%; 0.02). The covid-19 cohort had a lower comorbidity burden, including atrial fibrillation (24.3% 29.5%, -0.12), heart failure (43.4% 49.9%, -0.13), and chronic obstructive pulmonary disease (39.2% 52.9%, -0.27). After weighting, the covid-19 cohort had a higher risk (ie, cumulative incidence) of all cause death at 30 days (10.9% 3.9%; standardized risk difference 7.0%, 95% confidence interval 6.8% to 7.2%), 90 days (15.5% 7.1%; 8.4%, 8.2% to 8.7%), and 180 days (19.1% 10.5%; 8.6%, 8.3% to 8.9%) compared with the influenza cohort. The covid-19 cohort also experienced a higher risk of hospital readmission at 30 days (16.0% 11.2%; 4.9%, 4.6% to 5.1%) and 90 days (24.1% 21.3%; 2.8%, 2.5% to 3.2%) but a similar risk at 180 days (30.6% 30.6%;-0.1%, -0.5% to 0.3%). Over the study period, the 30 day risk of death for patients discharged after a covid-19 admission decreased from 17.9% to 7.2%.
Medicare beneficiaries who were discharged alive after a covid-19 hospital admission had a higher post-discharge risk of death compared with historical influenza controls; this difference, however, was concentrated in the early post-discharge period. The risk of death for patients discharged after a covid-19 related hospital admission substantially declined over the course of the pandemic.
描述在 2020 年 3 月 1 日至 2022 年 8 月 31 日期间因新冠肺炎初次入院并存活出院的 Medicare 按服务项目付费受益人的长期死亡和再次入院风险，并与在 2018 年 3 月 1 日至 2019 年 8 月 31 日期间因流感初次入院并存活出院的历史对照患者进行比较。
回顾性队列研究。
美国。
2020 年 3 月 1 日至 2022 年 8 月 31 日期间，在初次因新冠肺炎住院并存活出院的 Medicare 按服务项目付费受益人中，有 883394 名年龄≥65 岁的患者与在 2018 年 3 月 1 日至 2019 年 8 月 31 日期间因流感初次入院并存活出院的 56409 名历史对照患者进行比较。使用加权方法来解释观察到的特征差异。
出院后 180 天内的全因死亡。次要结局包括首次全因再次入院和死亡或再次入院的复合结局。
与流感组相比，新冠肺炎组更年轻（77.9±78.9 岁，标准化均数差值-0.12），女性比例较低（51.7% vs 57.3%，-0.11）。两组黑受益人的比例（10.3% vs 8.1%，0.07）和具有双重医疗补助-医疗保险资格的受益人的比例（20.1% vs 19.2%，0.02）相似。新冠肺炎组的合并症负担较低，包括心房颤动（24.3% vs 29.5%，-0.12）、心力衰竭（43.4% vs 49.9%，-0.13）和慢性阻塞性肺疾病（39.2% vs 52.9%，-0.27）。加权后，新冠肺炎组在 30 天（10.9% vs 3.9%；标准化风险差异 7.0%，95%置信区间 6.8%至 7.2%）、90 天（15.5% vs 7.1%；8.4%，8.2%至 8.7%）和 180 天（19.1% vs 10.5%；8.6%，8.3%至 8.9%）的全因死亡风险更高。与流感组相比，新冠肺炎组在 30 天（16.0% vs 11.2%；4.9%，4.6%至 5.1%）和 90 天（24.1% vs 21.3%；2.8%，2.5%至 3.2%）的再次入院风险更高，但在 180 天的风险相似（30.6% vs 30.6%；-0.1%，-0.5%至 0.3%）。在研究期间，新冠肺炎患者出院后 30 天的死亡风险从 17.9%降至 7.2%。
与历史流感对照组相比，因新冠肺炎初次住院并存活出院的 Medicare 受益人在出院后有更高的死亡风险；然而，这种差异主要集中在出院后的早期阶段。与新冠肺炎相关的住院患者在整个疫情期间的死亡风险显著下降。
