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. 2022 Aug 1;5(8):e2225657.
doi: 10.1001/jamanetworkopen.2022.25657.

Health Care Utilization in the 6 Months Following SARS-CoV-2 Infection

Sara Y Tartof  1   2 , Deborah E Malden  1   3 , In-Lu Amy Liu  1 , Lina S Sy  1 , Bruno J Lewin  1 , Joshua T B Williams  4 , Simon J Hambidge  4 , Jonathan D Alpern  5 , Matthew F Daley  6 , Jennifer C Nelson  7 , David McClure  8 , Ousseny Zerbo  9 , Michelle L Henninger  10 , Candace Fuller  11 , Eric Weintraub  12 , Sharon Saydah  13 , Lei Qian  1
Affiliations

Health Care Utilization in the 6 Months Following SARS-CoV-2 Infection

Sara Y Tartof et al. JAMA Netw Open. .

Abstract

Importance: After SARS-CoV-2 infection, many patients present with persistent symptoms for at least 6 months, collectively termed post-COVID conditions (PCC). However, the impact of PCC on health care utilization has not been well described.

Objectives: To estimate COVID-19-associated excess health care utilization following acute SARS-CoV-2 infection and describe utilization for select PCCs among patients who had positive SARS-CoV-2 test results (including reverse transcription-polymerase chain reaction and antigen tests) compared with control patients whose results were negative.

Design, setting, and participants: This matched retrospective cohort study included patients of all ages from 8 large integrated health care systems across the United States who completed a SARS-CoV-2 diagnostic test during March 1 to November 1, 2020. Patients were matched on age, sex, race and ethnicity, site, and date of SARS-CoV-2 test and were followed-up for 6 months. Data were analyzed from March 18, 2021, to June 8, 2022.

Exposure: SARS-CoV-2 infection.

Main outcomes and measures: Ratios of rate ratios (RRRs) for COVID-19-associated health care utilization were calculated with a difference-in-difference analysis using Poisson regression models. RRRs were estimated overall, by health care setting, by select population characteristics, and by 44 PCCs. COVID-19-associated excess health care utilization was estimated by health care setting.

Results: The final matched cohort included 127 859 patients with test results positive for SARS-CoV-2 and 127 859 patients with test results negative for SARS-CoV-2. The mean (SD) age of the study population was 41.2 (18.6) years, 68 696 patients in each group (53.7%) were female, and each group included 66 211 Hispanic patients (51.8%), 9122 non-Hispanic Asian patients (7.1%), 7983 non-Hispanic Black patients (6.2%), and 34 326 non-Hispanic White patients (26.9%). Overall, SARS-CoV-2 infection was associated with a 4% increase in health care utilization over 6 months (RRR, 1.04 [95% CI, 1.03-1.05]), predominantly for virtual encounters (RRR, 1.14 [95% CI, 1.12-1.16]), followed by emergency department visits (RRR, 1.08 [95% CI, 1.04-1.12]). COVID-19-associated utilization for 18 PCCs remained elevated 6 months from the acute stage of infection, with the largest increase in COVID-19-associated utilization observed for infectious disease sequelae (RRR, 86.00 [95% CI, 5.07-1458.33]), COVID-19 (RRR, 19.47 [95% CI, 10.47-36.22]), alopecia (RRR, 2.52 [95% CI, 2.17-2.92]), bronchitis (RRR, 1.85 [95% CI, 1.62-2.12]), pulmonary embolism or deep vein thrombosis (RRR, 1.74 [95% CI, 1.36-2.23]), and dyspnea (RRR, 1.73 [95% CI, 1.61-1.86]). In total, COVID-19-associated excess health care utilization amounted to an estimated 27 217 additional medical encounters over 6 months (212.9 [95% CI, 146.5-278.4] visits per 1000 patients).

Conclusions and relevance: This cohort study documented an excess health care burden of PCC in the 6 months after the acute stage of infection. As health care systems evolve during a highly dynamic and ongoing global pandemic, these data provide valuable evidence to inform long-term strategic resource allocation for patients previously infected with SARS-CoV-2.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Tartof reported receiving grants from Pfizer and Genentech outside the submitted work. Dr Sy reported receiving grants from Moderna, GlaxoSmithKline, Dynavax Technologies, and Seqirus outside the submitted work. Dr Nelson reported receiving grants from Moderna, personal fees from Elsevier, Southern California Permanente Medical Group, and Heard Pilgrim Health Care outside the submitted work. Dr Fuller reported being an employee of Harvard Pilgrim Health Care Institute outside the submitted work. Dr Qian reported receiving grants from Moderna, GlaxoSmithKline, Dynavax Technologies, and Genentech outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Weekly Health Care Encounter Rate 6 Months Before and After SARS-CoV-2 Testing
Figure 2.
Figure 2.. Health Care Utilization Associated With Positive SARS-CoV-2 Test Results vs Negative SARS-CoV-2 Test Results
The difference-in-difference parameter was calculated as the adjusted increase in encounter rate from posttest vs pretest periods associated with SARS-CoV-2 positivity by fitting Poisson regression models with robust error variance. RRR indicates relative rate ratio. aIncludes individuals who identified as American Indian or other or multiple races and ethnicities.
Figure 3.
Figure 3.. Health Care Utilization Associated With COVID-19 for Select Post–COVID-19 Conditions Compared With Patients with Negative SARS-CoV-2 Test Results
Outcomes presented are limited to those conditions that were statistically significant overall over 6 months (24 of 44 conditions evaluated), excluding infectious disease sequelae (relative rate ratio [RRR], 86.00; 95% CI, 5.07-1458.33) and COVID-19 (RRR, 19.47; 95% CI, 10.47-36.22), owing to scale. DVT indicates deep vein thrombosis; PE, pulmonary embolism.
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