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Source: https://www.cidrap.umn.edu/news-pers...ay-readmission
COVID patients with disability prone to longer hospital stay, readmission
Filed Under:
COVID-19
Mary Van Beusekom | News Writer | CIDRAP News
| Jan 31, 2022
Hospitalized COVID-19 patients with a disability were more likely than peers without a disability to have a longer hospital stay and be readmitted—but were no more likely to die in the hospital or be admitted to an intensive care unit (ICU), finds a retrospective study today in the Canadian Medical Association Journal (CMAJ).
University of Toronto researchers led the study of 1,279 adults diagnosed as having COVID-19 and released from one of seven hospitals in Ontario from Jan 1 to Nov 30, 2020—well before the recent highly transmissible Delta and Omicron variants were circulating.
The team compared rates of in-hospital death, ICU admission, hospital length of stay, and unplanned 30-day readmission among those with and without a physical disability, impaired hearing or vision, traumatic brain injury (TBI), or intellectual or developmental disability.
"Consideration of disability-related needs has largely been absent from the COVID-19 response, with vaccine eligibility driven primarily by age and medical comorbidity, limited accommodations made for patients with disabilities who are in hospital, and disability data often not being captured in surveillance programs," the researchers wrote.
36% longer hospital stays, 77% more readmissions
Of the 1,279 hospitalized COVID-19 patients, median age was 66 years, 58% were men, and 22.3% had a disability, including physical disability (74.4%), traumatic brain injury or intellectual or developmental disability (8.4%), impaired hearing or vision (6.3%), or multiple disabilities (10.9%).
Patients with a disability were older than those without a disability and more likely to be women, live in long-term care facilities, and have chronic conditions. They also had a higher predicted baseline risk of death.
After adjustment, patients with a disability had 36% longer hospital stays than those without a disability (rate ratio, 1.36) and were 77% more likely to be rehospitalized (relative risk, 1.77). There were, however, no statistically significant differences between the two groups for in-hospital death or ICU admission.
The highest risk for poor outcomes was among patients with TBI, intellectual or developmental disabilities, and multiple disabilities.
In age-stratified analyses, the investigators saw longer hospital stays among patients with a disability than in those without in both patients younger than 65 years and older subgroups, while younger patients with a disability had the highest risk of rehospitalization.
In a CMAJ news release, Sandi Bell, chair of the Accessibility for Ontarians with Disabilities Act Health Care Standards Development Committee, said that 2.5 million Ontarians have disabilities.
"Yet throughout COVID-19, people with disabilities have been made to feel invisible," said Bell, who was not part of the study team. "We have become even more vulnerable, as maneuvering [through] the health care system has been difficult, confusing and scary. There is genuine demand for this type of data to help prioritize the needs of people with disabilities, which is what we believe Canadians would want to see."
Slower recovery, vulnerability to recurrent illness
The study authors noted that while people with disabilities have different activity limitations, they are more likely than others to contract COVID-19 because of factors that include coping with poverty, needing close-contact care, residing in congregate care settings, living in minority communities, and, in some people, having different abilities to comply with public health rules and recommendations. Once infected, they are prone to worse outcomes because of their high rate of underlying medical conditions.
"Longer hospital stays and higher risk of readmission among patients with disabilities may reflect slower recovery and increased vulnerability to recurrent illness because of physiologic differences," the researchers wrote.
The authors called for prioritization of people with disabilities for COVID-19 vaccination, accommodations for those who need support people, implementation of clinician training, minimization of care disruptions amid crises such as the pandemic, introduction of patient-oriented hospital release planning, and inclusion of disability-related data in COVID-19 surveillance.
"Future research should also evaluate the intersection of disability with gender, experiences of racism, and other social determinants of health, which may further affect COVID-19 outcomes," the researchers concluded. "Such efforts should be prioritized in the pandemic response to ensure equitable care for patients with disabilities who have COVID-19."
COVID patients with disability prone to longer hospital stay, readmission
Filed Under:
COVID-19
Mary Van Beusekom | News Writer | CIDRAP News
| Jan 31, 2022
Hospitalized COVID-19 patients with a disability were more likely than peers without a disability to have a longer hospital stay and be readmitted—but were no more likely to die in the hospital or be admitted to an intensive care unit (ICU), finds a retrospective study today in the Canadian Medical Association Journal (CMAJ).
University of Toronto researchers led the study of 1,279 adults diagnosed as having COVID-19 and released from one of seven hospitals in Ontario from Jan 1 to Nov 30, 2020—well before the recent highly transmissible Delta and Omicron variants were circulating.
The team compared rates of in-hospital death, ICU admission, hospital length of stay, and unplanned 30-day readmission among those with and without a physical disability, impaired hearing or vision, traumatic brain injury (TBI), or intellectual or developmental disability.
"Consideration of disability-related needs has largely been absent from the COVID-19 response, with vaccine eligibility driven primarily by age and medical comorbidity, limited accommodations made for patients with disabilities who are in hospital, and disability data often not being captured in surveillance programs," the researchers wrote.
36% longer hospital stays, 77% more readmissions
Of the 1,279 hospitalized COVID-19 patients, median age was 66 years, 58% were men, and 22.3% had a disability, including physical disability (74.4%), traumatic brain injury or intellectual or developmental disability (8.4%), impaired hearing or vision (6.3%), or multiple disabilities (10.9%).
Patients with a disability were older than those without a disability and more likely to be women, live in long-term care facilities, and have chronic conditions. They also had a higher predicted baseline risk of death.
After adjustment, patients with a disability had 36% longer hospital stays than those without a disability (rate ratio, 1.36) and were 77% more likely to be rehospitalized (relative risk, 1.77). There were, however, no statistically significant differences between the two groups for in-hospital death or ICU admission.
The highest risk for poor outcomes was among patients with TBI, intellectual or developmental disabilities, and multiple disabilities.
In age-stratified analyses, the investigators saw longer hospital stays among patients with a disability than in those without in both patients younger than 65 years and older subgroups, while younger patients with a disability had the highest risk of rehospitalization.
In a CMAJ news release, Sandi Bell, chair of the Accessibility for Ontarians with Disabilities Act Health Care Standards Development Committee, said that 2.5 million Ontarians have disabilities.
"Yet throughout COVID-19, people with disabilities have been made to feel invisible," said Bell, who was not part of the study team. "We have become even more vulnerable, as maneuvering [through] the health care system has been difficult, confusing and scary. There is genuine demand for this type of data to help prioritize the needs of people with disabilities, which is what we believe Canadians would want to see."
Slower recovery, vulnerability to recurrent illness
The study authors noted that while people with disabilities have different activity limitations, they are more likely than others to contract COVID-19 because of factors that include coping with poverty, needing close-contact care, residing in congregate care settings, living in minority communities, and, in some people, having different abilities to comply with public health rules and recommendations. Once infected, they are prone to worse outcomes because of their high rate of underlying medical conditions.
"Longer hospital stays and higher risk of readmission among patients with disabilities may reflect slower recovery and increased vulnerability to recurrent illness because of physiologic differences," the researchers wrote.
The authors called for prioritization of people with disabilities for COVID-19 vaccination, accommodations for those who need support people, implementation of clinician training, minimization of care disruptions amid crises such as the pandemic, introduction of patient-oriented hospital release planning, and inclusion of disability-related data in COVID-19 surveillance.
"Future research should also evaluate the intersection of disability with gender, experiences of racism, and other social determinants of health, which may further affect COVID-19 outcomes," the researchers concluded. "Such efforts should be prioritized in the pandemic response to ensure equitable care for patients with disabilities who have COVID-19."
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