ABSTRACT
Rationale: The long-term consequences of SARS-CoV-2 infection on patients' health are increasingly recognized. It is unknown if these consequences are common to all severe viral infections or are specific to SARS-CoV-2. A syndrome of persistent exertional dyspnea has been described after influenza infection. Here, we describe patterns in healthcare expenditures for patients hospitalized for either influenza or COVID-19. Methods: We used an all-payer administrative dataset comprised of coding and billing data from over 600 healthcare entities in the United States that use a financial analytics platform by Strata Decision Technology, a private company. The de-identified analytic sample included patients aged 18 years or older who were admitted to a hospital between January 2018 and February 2021 with either an ICD-10 code for COVID-19 (COVID-19 hospitalizations) or for influenza (influenza hospitalizations). Linear regression models were used to evaluate the relationship between infection type (COVID-19 or influenza) and total post-acute healthcare expenditures (post-acute expenditures), defined as cumulative charges 1 month or more after hospitalization. The dependent variable was log-transformed post-acute expenditures and the independent variables included health system classification (academic, multi-site, single site community, and children's) and size (based on operating budget), pre-hospitalization charges, date of admission (spline), gender, and US census region. Analyses were stratified by age (18-44, 45-64, and 65+) and need for ventilation during acute hospitalization. Results: Of the 98222 patients included in our analysis, 83278 (84.8%) were COVID-19 hospitalizations and 14944 (15.2%) were influenza hospitalizations. This patient cohort was 52% female, and contained 36039 (36.7%) patients from the Midwest, 20102 (20.5%) from the Northeast, 32031 (32.6%) from the West, and 9514 (9.7%) from the South. Mean length of stay was 6.78 days. Patients with COVID-19 were more likely to receive mechanical ventilation during hospitalization (3.8%) than patients with influenza (1.8%). Compared to influenza, linear model results suggest that COVID-19 was associated with similar or lower postacute expenditures (see table 1). Results are presented separately by ventilation status to accommodate potentially differential relationships between infection severity, post-acute expenditures, and length of stay in the two patient populations. Conclusion: In previously hospitalized patients, post-acute expenditures are similar between COVID-19 (March 2020-February 2021) and influenza (January 2018- February 2021). Despite the high burden of healthcare utilization related to post-acute sequelae of COVID-19, these findings suggest that individual healthcare expenditures after acute COVID-19 infection are similar to severe influenza infection.
ABSTRACT
RationaleNovel Coronavirus-19(CoV-19) emerged in late 2019, leading to a global pandemic with over 1.5 million deaths worldwide and over 300,000 in the United States as of December 2020. Early data from China and the United States showed an increase risk in mortality in those individuals with comorbidities including chronic lung disease. Given the increase prevalence of chronic obstructive pulmonary disease (COPD) worldwide there was concern of increase mortality in this vulnerable population. We describe the Northwestern Medicine (NM) Hospital system experience with individuals with COPD. MethodsPatient data was obtained via the Northwestern Medicine Enterprise Data Warehouse (NMEDW), which is obtained via ten hospitals in the greater Chicagoland area that supply daily data to the NMEDW. Individuals who had a hospital encounter were identified with an ICD-10 coding for CoV-19 via the NM system between March 1, 2020 and July 16, 2020. Individuals would also be identified to have COPD via ICD-9 and ICD-10 coding. A simple chi-square analysis was done between characteristics using RStudio. ResultsA total of 5,585 individuals, with a CoV-19 diagnosis, were identified, of which 4,723 had a hospital encounter. Of those, a total of 296 patients were identified to have a COPD diagnosis. Of 4,427 without COPD, 53.1% were female, 17.9% Black, 38.2% Hispanic, 5.3% were current smokers, 47.3% required hospitalization, 13.9% required ICU admission, 8.1% required mechanical ventilation, and had a mortality rate of 3.8%. Of 296 patients with a COPD, 52.0% were female, 23.6% were black, 9.1% were Hispanic, 11.8% were current smokers, 84.1% required hospitalization, 31.8% required ICU admission, 19.6% required mechanical ventilation, and had a mortality rate of 14.2%. Table 1 below shows full characteristics of patients with CoV-19 diagnosis. ConclusionsInitial data of disease severity due to CoV-19 brought concerns about patients with COPD diagnosis and their increased risk of morbidity and mortality. We showcase NM system experience with individuals with COPD, that highlight higher rates of hospitalization, ICU stay, mechanical ventilation, investigational use of medication, and mortality. Given the discrepancy in age between groups, we acknowledge that it likely is a potential confounding variable for our outcomes. Further research into the severity of COPD and the outcomes of individuals with CoV-19 is required. .