Data for this retrospective cohort study were from the Optum® de-identified COVID-19 Electronic Health Record database from June 1 to December 9, 2020. Adults with first COVID-19 diagnosis or positive SARS-CoV-2 test in outpatient settings were identified. Cumulative incidence function analysis stratified by risk factors was used to estimate the 30-day incidence of COVID-19-related UMVs. Competing risk regression models were used to derive adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) for factors associated with UMVs.
Among 206,741 patients [58.8% female, 77.5% non-Hispanic Caucasian, mean (SD) age: 46.7 (17.8) years], the 30-day incidence was 9.4% (95% CI 9.3-9.6) for COVID-19-related emergency room (ER)/urgent care (UC)/hospitalizations and 3.8% (95% CI 3.7-3.9) for COVID-19-related hospitalizations. Likelihood of hospitalization increased with age and body mass index, with age the strongest risk factor (aHR 5.61; 95% CI 4.90-6.32 for patients ≥ 85 years). Increased likelihood of hospitalization was observed for first presentation in the ER/UC vs. non-ER/UC outpatient settings (aHR 2.35; 95% CI 2.22-2.47) and prior all-cause hospitalization (aHR 1.90; 95% CI 1.79-2.00). Clinical risk factors of hospitalizations included pregnancy, uncontrolled diabetes, chronic obstructive pulmonary disease, chronic kidney disease, and autoimmune disease. A study limitation is that data on COVID-19 severity and symptoms were not captured.
Predictors of COVID-19-related UMVs include older age, obesity, and several comorbidities. These findings may inform patient management and resource allocation following outpatient COVID-19 diagnosis.
这项回顾性队列研究的数据来自2020年6月1日至12月9日Optum®去识别的COVID-19电子健康记录数据库。确定了在门诊首次诊断为COVID-19或SARS-CoV-2检测阳性的成年人。使用按危险因素分层的累积发生率功能分析来估计COVID-19相关UMV的30天发生率。使用竞争风险回归模型得出与UMV相关因素的调整风险比(aHR)和95%置信区间(95%CI)。
在206,741名患者中[58.8%为女性,77.5%非西班牙裔高加索人,平均(SD)年龄:46.7(17.8)岁],COVID-19相关急诊室(ER)/紧急护理(UC)/住院的30天发病率为9.4%(95%CI9.3-9.6),COVID-19相关住院的30天发病率为3.8%(95%CI3.7-3.9).住院的可能性随着年龄和体重指数的增加而增加,年龄是最强的危险因素(aHR5.61;≥85岁患者的95%CI4.90-6.32)。在ER/UC中首次出现时观察到住院的可能性增加。非ER/UC门诊设置(aHR2.35;95%CI2.22-2.47)和先前的全因住院(aHR1.90;95%CI1.79-2.00)。住院的临床危险因素包括妊娠,不受控制的糖尿病,慢性阻塞性肺疾病,慢性肾病,和自身免疫性疾病。一项研究的局限性是,没有获得关于COVID-19严重程度和症状的数据。
与COVID-19相关的UMV的预测因素包括年龄较大,肥胖,和几种合并症。这些发现可能会为门诊COVID-19诊断后的患者管理和资源分配提供信息。