Overall and cause-specific hospitalisation and death after COVID-19 hospitalisation in England: A cohort study using linked primary care, secondary care, and death registration data in the OpenSAFELY platform.
<h4>Background</h4>There is concern about medium to long-term adverse outcomes following acute Coronavirus Disease 2019 (COVID-19), but little relevant evidence exists. We aimed to investigate whether risks of hospital admission and death, overall and by specific cause, are raised follow...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2022-01-01
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| Series: | PLoS Medicine |
| Online Access: | https://doi.org/10.1371/journal.pmed.1003871 |
| _version_ | 1797736616576417792 |
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| author | Krishnan Bhaskaran Christopher T Rentsch George Hickman William J Hulme Anna Schultze Helen J Curtis Kevin Wing Charlotte Warren-Gash Laurie Tomlinson Chris J Bates Rohini Mathur Brian MacKenna Viyaasan Mahalingasivam Angel Wong Alex J Walker Caroline E Morton Daniel Grint Amir Mehrkar Rosalind M Eggo Peter Inglesby Ian J Douglas Helen I McDonald Jonathan Cockburn Elizabeth J Williamson David Evans John Parry Frank Hester Sam Harper Stephen Jw Evans Sebastian Bacon Liam Smeeth Ben Goldacre |
| author_facet | Krishnan Bhaskaran Christopher T Rentsch George Hickman William J Hulme Anna Schultze Helen J Curtis Kevin Wing Charlotte Warren-Gash Laurie Tomlinson Chris J Bates Rohini Mathur Brian MacKenna Viyaasan Mahalingasivam Angel Wong Alex J Walker Caroline E Morton Daniel Grint Amir Mehrkar Rosalind M Eggo Peter Inglesby Ian J Douglas Helen I McDonald Jonathan Cockburn Elizabeth J Williamson David Evans John Parry Frank Hester Sam Harper Stephen Jw Evans Sebastian Bacon Liam Smeeth Ben Goldacre |
| author_sort | Krishnan Bhaskaran |
| collection | DOAJ |
| description | <h4>Background</h4>There is concern about medium to long-term adverse outcomes following acute Coronavirus Disease 2019 (COVID-19), but little relevant evidence exists. We aimed to investigate whether risks of hospital admission and death, overall and by specific cause, are raised following discharge from a COVID-19 hospitalisation.<h4>Methods and findings</h4>With the approval of NHS-England, we conducted a cohort study, using linked primary care and hospital data in OpenSAFELY to compare risks of hospital admission and death, overall and by specific cause, between people discharged from COVID-19 hospitalisation (February to December 2020) and surviving at least 1 week, and (i) demographically matched controls from the 2019 general population; and (ii) people discharged from influenza hospitalisation in 2017 to 2019. We used Cox regression adjusted for age, sex, ethnicity, obesity, smoking status, deprivation, and comorbidities considered potential risk factors for severe COVID-19 outcomes. We included 24,673 postdischarge COVID-19 patients, 123,362 general population controls, and 16,058 influenza controls, followed for ≤315 days. COVID-19 patients had median age of 66 years, 13,733 (56%) were male, and 19,061 (77%) were of white ethnicity. Overall risk of hospitalisation or death (30,968 events) was higher in the COVID-19 group than general population controls (fully adjusted hazard ratio [aHR] 2.22, 2.14 to 2.30, p < 0.001) but slightly lower than the influenza group (aHR 0.95, 0.91 to 0.98, p = 0.004). All-cause mortality (7,439 events) was highest in the COVID-19 group (aHR 4.82, 4.48 to 5.19 versus general population controls [p < 0.001] and 1.74, 1.61 to 1.88 versus influenza controls [p < 0.001]). Risks for cause-specific outcomes were higher in COVID-19 survivors than in general population controls and largely similar or lower in COVID-19 compared with influenza patients. However, COVID-19 patients were more likely than influenza patients to be readmitted or die due to their initial infection or other lower respiratory tract infection (aHR 1.37, 1.22 to 1.54, p < 0.001) and to experience mental health or cognitive-related admission or death (aHR 1.37, 1.02 to 1.84, p = 0.039); in particular, COVID-19 survivors with preexisting dementia had higher risk of dementia hospitalisation or death (age- and sex-adjusted HR 2.47, 1.37 to 4.44, p = 0.002). Limitations of our study were that reasons for hospitalisation or death may have been misclassified in some cases due to inconsistent use of codes, and we did not have data to distinguish COVID-19 variants.<h4>Conclusions</h4>In this study, we observed that people discharged from a COVID-19 hospital admission had markedly higher risks for rehospitalisation and death than the general population, suggesting a substantial extra burden on healthcare. Most risks were similar to those observed after influenza hospitalisations, but COVID-19 patients had higher risks of all-cause mortality, readmission or death due to the initial infection, and dementia death, highlighting the importance of postdischarge monitoring. |
| first_indexed | 2024-03-12T13:16:29Z |
| format | Article |
| id | doaj.art-61356f1cd41b4cd4b2118d439abd79e5 |
| institution | Directory Open Access Journal |
| issn | 1549-1277 1549-1676 |
| language | English |
| last_indexed | 2024-03-12T13:16:29Z |
| publishDate | 2022-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS Medicine |
| spelling | doaj.art-61356f1cd41b4cd4b2118d439abd79e52023-08-27T05:31:21ZengPublic Library of Science (PLoS)PLoS Medicine1549-12771549-16762022-01-01191e100387110.1371/journal.pmed.1003871Overall and cause-specific hospitalisation and death after COVID-19 hospitalisation in England: A cohort study using linked primary care, secondary care, and death registration data in the OpenSAFELY platform.Krishnan BhaskaranChristopher T RentschGeorge HickmanWilliam J HulmeAnna SchultzeHelen J CurtisKevin WingCharlotte Warren-GashLaurie TomlinsonChris J BatesRohini MathurBrian MacKennaViyaasan MahalingasivamAngel WongAlex J WalkerCaroline E MortonDaniel GrintAmir MehrkarRosalind M EggoPeter InglesbyIan J DouglasHelen I McDonaldJonathan CockburnElizabeth J WilliamsonDavid EvansJohn ParryFrank HesterSam HarperStephen Jw EvansSebastian BaconLiam SmeethBen Goldacre<h4>Background</h4>There is concern about medium to long-term adverse outcomes following acute Coronavirus Disease 2019 (COVID-19), but little relevant evidence exists. We aimed to investigate whether risks of hospital admission and death, overall and by specific cause, are raised following discharge from a COVID-19 hospitalisation.<h4>Methods and findings</h4>With the approval of NHS-England, we conducted a cohort study, using linked primary care and hospital data in OpenSAFELY to compare risks of hospital admission and death, overall and by specific cause, between people discharged from COVID-19 hospitalisation (February to December 2020) and surviving at least 1 week, and (i) demographically matched controls from the 2019 general population; and (ii) people discharged from influenza hospitalisation in 2017 to 2019. We used Cox regression adjusted for age, sex, ethnicity, obesity, smoking status, deprivation, and comorbidities considered potential risk factors for severe COVID-19 outcomes. We included 24,673 postdischarge COVID-19 patients, 123,362 general population controls, and 16,058 influenza controls, followed for ≤315 days. COVID-19 patients had median age of 66 years, 13,733 (56%) were male, and 19,061 (77%) were of white ethnicity. Overall risk of hospitalisation or death (30,968 events) was higher in the COVID-19 group than general population controls (fully adjusted hazard ratio [aHR] 2.22, 2.14 to 2.30, p < 0.001) but slightly lower than the influenza group (aHR 0.95, 0.91 to 0.98, p = 0.004). All-cause mortality (7,439 events) was highest in the COVID-19 group (aHR 4.82, 4.48 to 5.19 versus general population controls [p < 0.001] and 1.74, 1.61 to 1.88 versus influenza controls [p < 0.001]). Risks for cause-specific outcomes were higher in COVID-19 survivors than in general population controls and largely similar or lower in COVID-19 compared with influenza patients. However, COVID-19 patients were more likely than influenza patients to be readmitted or die due to their initial infection or other lower respiratory tract infection (aHR 1.37, 1.22 to 1.54, p < 0.001) and to experience mental health or cognitive-related admission or death (aHR 1.37, 1.02 to 1.84, p = 0.039); in particular, COVID-19 survivors with preexisting dementia had higher risk of dementia hospitalisation or death (age- and sex-adjusted HR 2.47, 1.37 to 4.44, p = 0.002). Limitations of our study were that reasons for hospitalisation or death may have been misclassified in some cases due to inconsistent use of codes, and we did not have data to distinguish COVID-19 variants.<h4>Conclusions</h4>In this study, we observed that people discharged from a COVID-19 hospital admission had markedly higher risks for rehospitalisation and death than the general population, suggesting a substantial extra burden on healthcare. Most risks were similar to those observed after influenza hospitalisations, but COVID-19 patients had higher risks of all-cause mortality, readmission or death due to the initial infection, and dementia death, highlighting the importance of postdischarge monitoring.https://doi.org/10.1371/journal.pmed.1003871 |
| spellingShingle | Krishnan Bhaskaran Christopher T Rentsch George Hickman William J Hulme Anna Schultze Helen J Curtis Kevin Wing Charlotte Warren-Gash Laurie Tomlinson Chris J Bates Rohini Mathur Brian MacKenna Viyaasan Mahalingasivam Angel Wong Alex J Walker Caroline E Morton Daniel Grint Amir Mehrkar Rosalind M Eggo Peter Inglesby Ian J Douglas Helen I McDonald Jonathan Cockburn Elizabeth J Williamson David Evans John Parry Frank Hester Sam Harper Stephen Jw Evans Sebastian Bacon Liam Smeeth Ben Goldacre Overall and cause-specific hospitalisation and death after COVID-19 hospitalisation in England: A cohort study using linked primary care, secondary care, and death registration data in the OpenSAFELY platform. PLoS Medicine |
| title | Overall and cause-specific hospitalisation and death after COVID-19 hospitalisation in England: A cohort study using linked primary care, secondary care, and death registration data in the OpenSAFELY platform. |
| title_full | Overall and cause-specific hospitalisation and death after COVID-19 hospitalisation in England: A cohort study using linked primary care, secondary care, and death registration data in the OpenSAFELY platform. |
| title_fullStr | Overall and cause-specific hospitalisation and death after COVID-19 hospitalisation in England: A cohort study using linked primary care, secondary care, and death registration data in the OpenSAFELY platform. |
| title_full_unstemmed | Overall and cause-specific hospitalisation and death after COVID-19 hospitalisation in England: A cohort study using linked primary care, secondary care, and death registration data in the OpenSAFELY platform. |
| title_short | Overall and cause-specific hospitalisation and death after COVID-19 hospitalisation in England: A cohort study using linked primary care, secondary care, and death registration data in the OpenSAFELY platform. |
| title_sort | overall and cause specific hospitalisation and death after covid 19 hospitalisation in england a cohort study using linked primary care secondary care and death registration data in the opensafely platform |
| url | https://doi.org/10.1371/journal.pmed.1003871 |
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