背景:在COVID-19的初始急性期之后,SARS-CoV-2感染患者的医疗保健资源使用逐步升级。
目的:本研究的目的是比较新诊断的长COVID和一般人群对卫生服务的需求,在两个时期使用类似的评估方案,并分析疫苗接种的影响。
方法:这项匹配的回顾性病例对照研究包括在大流行期间在医院微生物实验室使用逆转录聚合酶链反应或抗原测试诊断为急性SARS-CoV-2感染的男女患者,无论患者是否住院。我们包括来自2个医疗保健部门的所有年龄段的患者,涵盖了604,000名受试者。人口被分为两组,青少年(<18岁)和成年人(≥18岁)。SARS-CoV-2感染后随访6个月。以前的疫苗接种,新诊断,并记录医疗资源的使用情况。使用年龄匹配的前瞻性评分将患者与选择的对照组进行比较,性别,和Charlson指数.
结果:共纳入41,577例既往有COVID-19感染史的患者,与相同数量的控件。该队列包括33,249(80%)年龄≥18岁的成年人和8328(20%)年龄<18岁的年轻人。我们的分析在观察期间确定了40例新诊断。在6个月内,每100名患者的发病率为27.2,未接种疫苗的成年人为25.1(P=.09),而在年轻人中,接种疫苗者的相应比率为25.7,未接种疫苗者的相应比率为36.7(P<.001).总的来说,与匹配的对照组相比,患者新诊断的发生率明显较高.此外,接种疫苗的患者显示新诊断的发生率降低,特别是在女性(P<.001)和年轻患者(P<.001)中,无论接种疫苗的次数和自最后一次接种以来的持续时间如何.此外,在成人和青年群体中,医疗保健资源的使用都有所增加,尽管在接种疫苗的个体中发现的数字较低。在前O微米和O微米波之间的比较分析中,前者新诊断的发生率较高;然而,不同的诊断模式是明显的。具体来说,抑郁情绪(P=0.03),嗅觉缺失(P=0.003),脱发(P<.001),呼吸困难(<0.001),胸痛(P=.04),痛经(P<0.001),肌痛(P=.011),弱点(P<.001),心动过速(P=.015)在Omicron前期更为常见。同样,医疗保健资源的使用,包括初级保健,专家,紧急服务,在前O微米波中更为明显。
结论:SARS-CoV-2感染后新诊断的增加值得关注,因为它对卫生系统的潜在影响,这可能需要分配补充资源。缺乏疫苗接种保护对医疗保健系统提出了挑战。
BACKGROUND: Following the initial acute phase of COVID-19, health care resource use has escalated among individuals with SARS-CoV-2 infection.
OBJECTIVE: This study aimed to compare new diagnoses of long COVID and the demand for health services in the general population after the Omicron wave with those observed during the pre-Omicron waves, using similar assessment protocols for both periods and to analyze the influence of vaccination.
METHODS: This matched retrospective case-control study included patients of both sexes diagnosed with acute SARS-CoV-2 infection using reverse transcription polymerase chain reaction or antigen tests in the hospital microbiology laboratory during the pandemic period regardless of whether the patients were hospitalized. We included patients of all ages from 2 health care departments that cover 604,000 subjects. The population was stratified into 2 groups, youths (<18 years) and adults (≥18 years). Patients were followed-up for 6 months after SARS-CoV-2 infection. Previous vaccination, new diagnoses, and the use of health care resources were recorded. Patients were compared with controls selected using a prospective score matched for age, sex, and the Charlson index.
RESULTS: A total of 41,577 patients with a history of prior COVID-19 infection were included, alongside an equivalent number of controls. This cohort encompassed 33,249 (80%) adults aged ≥18 years and 8328 (20%) youths aged <18 years. Our analysis identified 40 new diagnoses during the observation period. The incidence rate per 100 patients over a 6-month period was 27.2 for vaccinated and 25.1 for unvaccinated adults (P=.09), while among youths, the corresponding rates were 25.7 for vaccinated and 36.7 for unvaccinated individuals (P<.001). Overall, the incidence of new diagnoses was notably higher in patients compared to matched controls. Additionally, vaccinated patients exhibited a reduced incidence of new diagnoses, particularly among women (P<.001) and younger patients (P<.001) irrespective of the number of vaccine doses administered and the duration since the last dose. Furthermore, an increase in the use of health care resources was observed in both adult and youth groups, albeit with lower figures noted in vaccinated individuals. In the comparative analysis between the pre-Omicron and Omicron waves, the incidence of new diagnoses was higher in the former; however, distinct patterns of diagnosis were evident. Specifically, depressed mood (P=.03), anosmia (P=.003), hair loss (P<.001), dyspnea (<0.001), chest pain (P=.04), dysmenorrhea (P<.001), myalgia (P=.011), weakness (P<.001), and tachycardia (P=.015) were more common in the pre-Omicron period. Similarly, health care resource use, encompassing primary care,
specialist, and emergency services, was more pronounced in the pre-Omicron wave.
CONCLUSIONS: The rise in new diagnoses following SARS-CoV-2 infection warrants attention due to its potential implications for health systems, which may necessitate the allocation of supplementary resources. The absence of vaccination protection presents a challenge to the health care system.