Brown Hilary K, Stukel Thérèse A, Chung Hannah, Lee Samantha, Lunsky Yona, Bell Chaim M, Bobos Pavlos, Cheung Angela M, Detsky Allan S, Goulding Susie, Herridge Margaret, Razak Fahad, Verma Amol A, Quinn Kieran L
Department of Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
J Gen Intern Med. 2025 Feb 25. doi: 10.1007/s11606-025-09396-8.
Emerging evidence shows the lasting impact of SARS-CoV-2 infection on health care use and needs. Policy-makers require data on population-level service use to understand patient needs and health system impacts following hospitalization for COVID-19.
To compare health service use within 12 months following hospitalization for COVID-19 among people with and without pre-existing disabilities, and to determine the extent to which such use is related to disability and other risk factors.
Population-based cohort study, Ontario, Canada.
Adults with and without disabilities hospitalized for COVID-19, 01/25/2020-02/28/2022.
We used Poisson regression to model adjusted rate ratios (aRR) of ambulatory care visits, diagnostic testing, emergency department (ED) visits, hospital admissions, and palliative care visits within 1-year post-discharge, comparing patients with and without disabilities. Models were adjusted sequentially for sociodemographic factors, comorbidities, and prior health service use. The importance of each set of covariates in its ability to explain observed associations was determined by calculating relative changes in disability parameter coefficients after each sequential risk-adjustment.
The cohort included 25,320 patients with disabilities and 15,953 without. In the year after hospitalization for COVID-19, people with disabilities had higher rates of ambulatory care visits, diagnostic tests, ED visits, hospital admissions, and palliative care visits. A significant proportion of these associations was explained by sociodemographic factors, comorbidities, and prior health service use. However, adjusted relative rates associated with disability remained elevated, even after adjustment, for ambulatory care visits (aRR 1.09, 95% CI 1.08, 1.10), diagnostic tests (aRR 1.14, 95% CI 1.12, 1.16), ED visits (aRR 1.25, 95% CI 1.21, 1.29), and hospital admissions (aRR 1.21, 95% CI 1.16, 1.29).
These findings support the need to develop and evaluate models of care for the post-COVID-19 condition that address the needs of people with disabilities.
新出现的证据表明，SARS-CoV-2感染对医疗保健使用和需求具有持久影响。政策制定者需要有关人群层面服务使用的数据，以了解COVID-19住院后患者的需求和对卫生系统的影响。
比较有和没有既往残疾的人群在COVID-19住院后12个月内的卫生服务使用情况，并确定这种使用与残疾和其他风险因素的相关程度。
基于人群的队列研究，加拿大安大略省。
2020年1月25日至2022年2月28日期间因COVID-19住院的有和没有残疾的成年人。
我们使用泊松回归对出院后1年内门诊就诊、诊断检测、急诊科就诊、住院和姑息治疗就诊的调整率比（aRR）进行建模，比较有和没有残疾的患者。模型依次针对社会人口学因素、合并症和既往卫生服务使用情况进行调整。通过计算每次顺序风险调整后残疾参数系数的相对变化，确定每组协变量在解释观察到的关联方面的重要性。
该队列包括25320名残疾患者和15953名非残疾患者。在COVID-19住院后的一年中，残疾患者的门诊就诊、诊断检测、急诊科就诊、住院和姑息治疗就诊率较高。这些关联中有很大一部分可由社会人口学因素、合并症和既往卫生服务使用情况来解释。然而，即使经过调整，与残疾相关的调整后相对率在门诊就诊（aRR 1.09，95%CI 1.08，1.10）、诊断检测（aRR 1.14，95%CI 1.12，1.16）、急诊科就诊（aRR 1.25，95%CI 1.21，1.29）和住院（aRR 1.21，95%CI 1.16，1.29）方面仍保持较高水平。
这些发现支持有必要开发和评估针对COVID-19后状况的护理模式，以满足残疾人士的需求。
