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1.
[Unspecified Source]; 2020.
Preprint in English | [Unspecified Source] | ID: ppcovidwho-292800

ABSTRACT

Importance The diagnostic tests for COVID-19 have a high false negative rate, but not everyone with an initial negative result is re-tested. Michigan Medicine, being one of the primary regional centers accepting COVID-19 cases, provided an ideal setting for studying COVID-19 repeated testing patterns during the first wave of the pandemic. Objective To identify the characteristics of patients who underwent repeated testing for COVID-19 and determine if repeated testing was associated with patient characteristics and with downstream outcomes among positive cases. Design This cross-sectional study described the pattern of testing for COVID-19 at Michigan Medicine. The main hypothesis under consideration is whether patient characteristics differed between those tested once and those who underwent multiple tests. We then restrict our attention to those that had at least one positive test and study repeated testing patterns in patients with severe COVID-19 related outcomes (testing positive, hospitalization and ICU care). Setting Demographic and clinical characteristics, test results, and health outcomes for 15,920 patients presenting to Michigan Medicine between March 10 and June 4, 2020 for a diagnostic test for COVID-19 were collected from their electronic medical records on June 24, 2020. Data on the number and types of tests administered to a given patient, as well as the sequences of patient-specific test results were derived from records of patient laboratory results. Participants Anyone tested between March 10 and June 4, 2020 at Michigan Medicine with a diagnostic test for COVID-19 in their Electronic Health Records were included in our analysis. Exposures Comparison of repeated testing across patient demographics, clinical characteristics, and patient outcomes Main Outcomes and Measures Whether patients underwent repeated diagnostic testing for SARS CoV-2 in Michigan Medicine Results Between March 10th and June 4th, 19,540 tests were ordered for 15,920 patients, with most patients only tested once (13596, 85.4%) and never testing positive (14753, 92.7%). There were 5 patients who got tested 10 or more times and there were substantial variations in test results within a patient. After fully adjusting for patient and neighborhood socioeconomic status (NSES) and demographic characteristics, patients with circulatory diseases (OR: 1.42;95% CI: (1.18, 1.72)), any cancer (OR: 1.14;95% CI: (1.01, 1.29)), Type 2 diabetes (OR: 1.22;95% CI: (1.06, 1.39)), kidney diseases (OR: 1.95;95% CI: (1.71, 2.23)), and liver diseases (OR: 1.30;95% CI: (1.11, 1.50)) were found to have higher odds of undergoing repeated testing when compared to those without. Additionally, as compared to non-Hispanic whites, non-Hispanic blacks were found to have higher odds (OR: 1.21;95% CI: (1.03, 1.43)) of receiving additional testing. Females were found to have lower odds (OR: 0.86;95% CI: (0.76, 0.96)) of receiving additional testing than males. Neighborhood poverty level also affected whether to receive additional testing. For 1% increase in proportion of population with annual income below the federal poverty level, the odds ratio of receiving repeated testing is 1.01 (OR: 1.01;95% CI: (1.00, 1.01)). Focusing on only those 1167 patients with at least one positive result in their full testing history, patient age in years (OR: 1.01;95% CI: (1.00, 1.03)), prior history of kidney diseases (OR: 2.15;95% CI: (1.36, 3.41)) remained significantly different between patients who underwent repeated testing and those who did not. After adjusting for both patient demographic factors and NSES, hospitalization (OR: 7.44;95% CI: (4.92, 11.41)) and ICU-level care (OR: 6.97;95% CI: (4.48, 10.98)) were significantly associated with repeated testing. Of these 1167 patients, 306 got repeated testing and 1118 tests were done on these 306 patients, of which 810 (72.5%) were done during inpatient stays, substantiating that most repeated tests for test positive patients were done during hospitalization or ICU care. Additionally, using repeated testing dat e estimate the "real world" false negative rate of the RT-PCR diagnostic test was 23.8% (95% CI: (19.5%, 28.5%)). Conclusions and Relevance This study sought to quantify the pattern of repeated testing for COVID-19 at Michigan Medicine. While most patients were tested once and received a negative result, a meaningful subset of patients (2324, 14.6% of the population who got tested) underwent multiple rounds of testing (5,944 tests were done in total on these 2324 patients, with an average of 2.6 tests per person), with 10 or more tests for five patients. Both hospitalizations and ICU care differed significantly between patients who underwent repeated testing versus those only tested once as expected. These results shed light on testing patterns and have important implications for understanding the variation of repeated testing results within and between patients.

2.
JAMA Netw Open ; 4(11): e2135379, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1520147

ABSTRACT

Importance: There is a need for studies to evaluate the risk factors for COVID-19 and mortality among the entire Medicare long-term dialysis population using Medicare claims data. Objective: To identify risk factors associated with COVID-19 and mortality in Medicare patients undergoing long-term dialysis. Design, Setting, and Participants: This retrospective, claims-based cohort study compared mortality trends of patients receiving long-term dialysis in 2020 with previous years (2013-2019) and fit Cox regression models to identify risk factors for contracting COVID-19 and postdiagnosis mortality. The cohort included the national population of Medicare patients receiving long-term dialysis in 2020, derived from clinical and administrative databases. COVID-19 was identified through Medicare claims sources. Data were analyzed on May 17, 2021. Main Outcomes and Measures: The 2 main outcomes were COVID-19 and all-cause mortality. Associations of claims-based risk factors with COVID-19 and mortality were investigated prediagnosis and postdiagnosis. Results: Among a total of 498 169 Medicare patients undergoing dialysis (median [IQR] age, 66 [56-74] years; 215 935 [43.1%] women and 283 227 [56.9%] men), 60 090 (12.1%) had COVID-19, among whom 15 612 patients (26.0%) died. COVID-19 rates were significantly higher among Black (21 787 of 165 830 patients [13.1%]) and Hispanic (13 530 of 86 871 patients [15.6%]) patients compared with non-Black patients (38 303 of 332 339 [11.5%]), as well as patients with short (ie, 1-89 days; 7738 of 55 184 patients [14.0%]) and extended (ie, ≥90 days; 10 737 of 30 196 patients [35.6%]) nursing home stays in the prior year. Adjusting for all other risk factors, residing in a nursing home 1 to 89 days in the prior year was associated with a higher hazard for COVID-19 (hazard ratio [HR] vs 0 days, 1.60; 95% CI 1.56-1.65) and for postdiagnosis mortality (HR, 1.31; 95% CI, 1.25-1.37), as was residing in a nursing home for an extended stay (COVID-19: HR, 4.48; 95% CI, 4.37-4.59; mortality: HR, 1.12; 95% CI, 1.07-1.16). Black race (HR vs non-Black: HR, 1.25; 95% CI, 1.23-1.28) and Hispanic ethnicity (HR vs non-Hispanic: HR, 1.68; 95% CI, 1.64-1.72) were associated with significantly higher hazards of COVID-19. Although home dialysis was associated with lower COVID-19 rates (HR, 0.77; 95% CI, 0.75-0.80), it was associated with higher mortality (HR, 1.18; 95% CI, 1.11-1.25). Conclusions and Relevance: These results shed light on COVID-19 risk factors and outcomes among Medicare patients receiving long-term chronic dialysis and could inform policy decisions to mitigate the significant extra burden of COVID-19 and death in this population.


Subject(s)
COVID-19/etiology , Kidney Diseases/mortality , Medicare , Renal Dialysis , Aged , COVID-19/epidemiology , COVID-19/mortality , Female , Humans , Kidney Diseases/epidemiology , Kidney Diseases/therapy , Male , Middle Aged , Nursing Homes , Proportional Hazards Models , Retrospective Studies , Risk Factors , SARS-CoV-2 , United States/epidemiology
3.
PLoS One ; 16(10): e0258278, 2021.
Article in English | MEDLINE | ID: covidwho-1456094

ABSTRACT

BACKGROUND: Understanding risk factors for short- and long-term COVID-19 outcomes have implications for current guidelines and practice. We study whether early identified risk factors for COVID-19 persist one year later and through varying disease progression trajectories. METHODS: This was a retrospective study of 6,731 COVID-19 patients presenting to Michigan Medicine between March 10, 2020 and March 10, 2021. We describe disease progression trajectories from diagnosis to potential hospital admission, discharge, readmission, or death. Outcomes pertained to all patients: rate of medical encounters, hospitalization-free survival, and overall survival, and hospitalized patients: discharge versus in-hospital death and readmission. Risk factors included patient age, sex, race, body mass index, and 29 comorbidity conditions. RESULTS: Younger, non-Black patients utilized healthcare resources at higher rates, while older, male, and Black patients had higher rates of hospitalization and mortality. Diabetes with complications, coagulopathy, fluid and electrolyte disorders, and blood loss anemia were risk factors for these outcomes. Diabetes with complications, coagulopathy, fluid and electrolyte disorders, and blood loss were associated with lower discharge and higher inpatient mortality rates. CONCLUSIONS: This study found differences in healthcare utilization and adverse COVID-19 outcomes, as well as differing risk factors for short- and long-term outcomes throughout disease progression. These findings may inform providers in emergency departments or critical care settings of treatment priorities, empower healthcare stakeholders with effective disease management strategies, and aid health policy makers in optimizing allocations of medical resources.


Subject(s)
COVID-19/epidemiology , Hospitalization , Patient Acceptance of Health Care/statistics & numerical data , Adolescent , COVID-19/diagnosis , Female , Hospital Mortality , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Risk Factors
4.
J Clin Med ; 10(19)2021 Sep 24.
Article in English | MEDLINE | ID: covidwho-1438639

ABSTRACT

Testing for SARS-CoV-2 antibodies is commonly used to determine prior COVID-19 infections and to gauge levels of infection- or vaccine-induced immunity. Michigan Medicine, a primary regional health center, provided an ideal setting to understand serologic testing patterns over time. Between 27 April 2020 and 3 May 2021, characteristics for 10,416 individuals presenting for SARS-CoV-2 antibody tests (10,932 tests in total) were collected. Relative to the COVID-19 vaccine roll-out date, 14 December 2020, the data were split into a pre- (8026 individuals) and post-vaccine launch (2587 individuals) period and contrasted with untested individuals to identify factors associated with tested individuals and seropositivity. Exploratory analysis of vaccine-mediated seropositivity was performed in 347 fully vaccinated individuals. Predictors of tested individuals included age, sex, smoking, neighborhood variables, and pre-existing conditions. Seropositivity in the pre-vaccine launch period was 9.2% and increased to 46.7% in the post-vaccine launch period. In the pre-vaccine launch period, seropositivity was significantly associated with age (10 year; OR = 0.80 (0.73, 0.89)), ever-smoker status (0.49 (0.35, 0.67)), respiratory disease (4.38 (3.13, 6.12)), circulatory disease (2.09 (1.48, 2.96)), liver disease (2.06 (1.11, 3.84)), non-Hispanic Black race/ethnicity (2.18 (1.33, 3.58)), and population density (1.10 (1.03, 1.18)). Except for the latter two, these associations remained statistically significant in the post-vaccine launch period. The positivity rate of fully vaccinated individual was 296/347(85.3% (81.0%, 88.8%)).

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