Differences in COVID-19 Outpatient Antiviral Treatment Among Adults Aged ≥65 Years by Age Group - National Patient-Centered Clinical Research Network, United States, April 2022-September 2023

Abstract

Adults aged ≥65 years experience the highest risk for COVID-19-related hospitalization and death, with risk increasing with increasing age; outpatient antiviral treatment reduces the risk for these severe outcomes. Despite the proven benefit of COVID-19 antiviral treatment, information on differences in use among older adults with COVID-19 by age group is limited. Nonhospitalized patients aged ≥65 years with COVID-19 during April 2022-September 2023 were identified from the National Patient-Centered Clinical Research Network. Differences in use of antiviral treatment among patients aged 65-74, 75-89, and ≥90 years were assessed. Multivariable logistic regression was used to estimate the association between age and nonreceipt of antiviral treatment. Among 393,390 persons aged ≥65 years, 45.9% received outpatient COVID-19 antivirals, including 48.4%, 43.5%, and 35.2% among those aged 65-75, 76-89, and ≥90 years, respectively. Patients aged 75-89 and ≥90 years had 1.17 (95% CI = 1.15-1.19) and 1.54 (95% CI = 1.49-1.61) times the adjusted odds of being untreated, respectively, compared with those aged 65-74 years. Among 12,543 patients with severe outcomes, 2,648 (21.1%) had received an outpatient COVID-19 antiviral medication, compared with 177,874 (46.7%) of 380,847 patients without severe outcomes. Antiviral use is underutilized among adults ≥65 years; the oldest adults are least likely to receive treatment. To prevent COVID-19-associated morbidity and mortality, increased use of COVID-19 antiviral medications among older adults is needed.

FIGURE

Percentage of adults aged ≥65 years with COVID-19 who received an outpatient antiviral medication* (A) and who were hospitalized^† (B), by age — National Patient-Centered Clinical Research Network, United States, April 2022–September 2023 * Patients with SARS-CoV-2 infection were identified using at least one of the following inclusion criteria: 1) laboratory-confirmed positive SARS-CoV-2 test result identified with Logical Observation Identifiers Names and Codes (LOINC); 2) an International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnostic code for COVID-19 (U07.1 or U07.2); or 3) prescription or administration of an outpatient COVID-19 treatment (nirmatrelvir-ritonavir, molnupiravir, monoclonal antibody, or remdesivir). The earliest COVID-19 infection diagnosis date by one of these three criteria was defined as the index date. ^† Hospitalizations were inpatient encounters within 16 days of the index date.