tetano
Editor, Senior Moderator
Sci Rep
. 2024 Jun 24;14(1):14555.
doi: 10.1038/s41598-024-61244-7. Re-thinking all-cause COVID-19 hospitalizations as a surrogate measure for severe illness in observational surveillance studies
J Daniel Kelly[SUP] 1 2 3 4 [/SUP], Samuel Leonard[SUP] 5 [/SUP], W John Boscardin[SUP] 6 [/SUP], Katherine J Hoggatt[SUP] 5 7 [/SUP], Emily N Lum[SUP] 5 [/SUP], Charles C Austin[SUP] 8 [/SUP], Amy L Byers[SUP] 5 7 9 [/SUP], Phyllis C Tien[SUP] 5 7 [/SUP], Dawn M Bravata[SUP] 8 10 11 [/SUP], Salomeh Keyhani[SUP] 12 13 [/SUP]
Affiliations
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 < 0.001). The proportion of non-COVID-19-specific hospitalizations was higher in the later period (15-30 days: 55.0%) than the early (0-15 days: 22.5%) (p = 0.003). This study supports the outcome of COVID-19-specific hospitalization instead of all-cause hospitalization in observational studies. The earlier outcome period (0-15 days) was less susceptible to potential measurement bias.
. 2024 Jun 24;14(1):14555.
doi: 10.1038/s41598-024-61244-7. Re-thinking all-cause COVID-19 hospitalizations as a surrogate measure for severe illness in observational surveillance studies
J Daniel Kelly[SUP] 1 2 3 4 [/SUP], Samuel Leonard[SUP] 5 [/SUP], W John Boscardin[SUP] 6 [/SUP], Katherine J Hoggatt[SUP] 5 7 [/SUP], Emily N Lum[SUP] 5 [/SUP], Charles C Austin[SUP] 8 [/SUP], Amy L Byers[SUP] 5 7 9 [/SUP], Phyllis C Tien[SUP] 5 7 [/SUP], Dawn M Bravata[SUP] 8 10 11 [/SUP], Salomeh Keyhani[SUP] 12 13 [/SUP]
Affiliations
- PMID: 38914601
- DOI: 10.1038/s41598-024-61244-7
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 < 0.001). The proportion of non-COVID-19-specific hospitalizations was higher in the later period (15-30 days: 55.0%) than the early (0-15 days: 22.5%) (p = 0.003). This study supports the outcome of COVID-19-specific hospitalization instead of all-cause hospitalization in observational studies. The earlier outcome period (0-15 days) was less susceptible to potential measurement bias.