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- Title
Severity of Coronavirus Disease 2019 Hospitalization Outcomes and Patient Disposition Differ by Disability Status and Disability Type.
- Authors
Clarke, Kristie E N; Hong, Kai; Schoonveld, Megan; Greenspan, Arlene I; Montgomery, Martha; Thierry, JoAnn M
- Abstract
Background Systemic inequities may place people with disabilities at higher risk of severe coronavirus disease 2019 (COVID-19) illness or lower likelihood to be discharged home after hospitalization. We examined whether severity of COVID-19 hospitalization outcomes and disposition differ by disability status and disability type. Methods In a retrospective analysis of April 2020–November 2021 hospital-based administrative data among 745 375 people hospitalized with COVID-19 from 866 US hospitals, people with disabilities (n = 120 360) were identified via ICD-10-CM codes. Outcomes compared by disability status included intensive care admission, invasive mechanical ventilation (IMV), in-hospital mortality, 30-day readmission, length of stay, and disposition (discharge to home, long-term care facility (LTCF), or skilled nursing facility (SNF). Results People with disabilities had increased risks of IMV (adjusted risk ratio [aRR]: 1.05; 95% confidence interval [CI]: 1.03–1.08) and in-hospital mortality (1.04; 1.02–1.06) compared to those with no disability; risks were higher among people with intellectual and developmental disabilities (IDD) (IMV [1.34; 1.28–1.40], mortality [1.31; 1.26–1.37]), or mobility disabilities (IMV [1.13; 1.09–1.16], mortality [1.04; 1.01–1.07]). Risk of readmission was increased among people with any disability (1.23; 1.20–1.27) and each disability type. Risks of discharge to a LTCF (1.45, 1.39–1.51) or SNF (1.78, 1.74–1.81) were increased among community-dwelling people with each disability type. Conclusions Severity of COVID-19 hospitalization outcomes vary by disability status and type; IDD and mobility disabilities were associated with higher risks of severe outcomes. Disparities such as differences in discharge disposition by disability status require further study, which would be facilitated by standardized data on disability. Increased readmission across disability types indicates a need to improve discharge planning and support services.
- Subjects
UNITED States; HOSPITALS; LENGTH of stay in hospitals; RELATIVE medical risk; NOSOLOGY; CONFIDENCE intervals; MULTIVARIATE analysis; DISABILITY evaluation; RETROSPECTIVE studies; PATIENT readmissions; REGRESSION analysis; SEVERITY of illness index; ARTIFICIAL respiration; NURSING care facilities; HOSPITAL mortality; HOSPITAL care; DESCRIPTIVE statistics; PEOPLE with disabilities; HEALTH equity; ODDS ratio; COVID-19 pandemic
- Publication
Clinical Infectious Diseases, 2023, Vol 76, Issue 5, p871
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciac826