1. Re-thinking all-cause COVID-19 hospitalizations as a surrogate measure for severe illness in observational surveillance studies
- Author
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Kelly, J Daniel, Leonard, Samuel, Boscardin, W John, Hoggatt, Katherine J, Lum, Emily N, Austin, Charles C, Byers, Amy L, Tien, Phyllis C, Bravata, Dawn M, and Keyhani, Salomeh
- Subjects
Health Services and Systems ,Biomedical and Clinical Sciences ,Clinical Sciences ,Health Sciences ,Infectious Diseases ,Coronaviruses ,Emerging Infectious Diseases ,Infection ,Good Health and Well Being ,Humans ,COVID-19 ,Hospitalization ,Male ,Female ,Middle Aged ,Retrospective Studies ,Aged ,SARS-CoV-2 ,Adult ,Severity of Illness Index ,United States - Abstract
All-cause COVID-19 hospitalization ≤ 30 days of infection is a common outcome for severe illness in observational/surveillance studies. Milder COVID-19 disease and COVID-19-specific measurements calls for an evaluation of this endpoint. This was a descriptive, retrospective cohort study of adults ≥ 18 who were established in primary care at Veteran Health Administration (VHA) facilities. The outcome was hospitalization within 30 days of a laboratory-confirmed, symptomatic SARS-CoV-2 infection. Between December 15, 2021 and May 1, 2022, a simple random sample of all VA facilities, excluding Puerto Rico or Philippines, was drawn to identify these hospitalized cases and determine whether hospitalization was due to COVID-19-specific causes. A chart review was conducted to record the inpatient clinical team's diagnosis and whether the inpatient team classified the diagnosis as COVID-19 related or not. These data were used to classify hospitalizations as either due to COVID-19-specific causes (direct manifestations of SARS-CoV-2 infection) or non-COVID-19-specific hospitalizations (incidental SARS-CoV-2 infection), A simple random sample of 9966 (12.3%) all-cause hospitalizations (95% CI: 12.1%, 12.5%) was used to select 300 representative patients. Of these, 226/300 (75.3%) were determined to be COVID-19-specific. COVID-19 pneumonia was most common (147/226, 65.0%). The highest proportion of COVID-19-specific hospitalizations occurred among unvaccinated (85.0%), followed by vaccinated but not boosted (73.7%) and boosted (59.4%) (p
- Published
- 2024