Factors associated with hospital admission and severe outcomes for older patients with COVID-19

Jiyu Kim; Caroline Blaum; Rosie Ferris; Mauricio Arcila-Mesa; Hyungrok Do; Claudia Pulgarin; Johanna Dolle; Jennifer Scherer; Roopa Kalyanaraman Marcello; Judy Zhong

doi:10.1111/jgs.17718

Factors associated with hospital admission and severe outcomes for older patients with COVID-19

J Am Geriatr Soc. 2022 Jul;70(7):1906-1917. doi: 10.1111/jgs.17718. Epub 2022 Feb 25.

Authors

Affiliations

¹ Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA.
² Division of Geriatric Medicine and Palliative Care, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA.
³ Quality Measurement and Research Group, National Center for Quality Assurance, Washington, District of Columbia, USA.
⁴ Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA.
⁵ Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, New York, USA.
⁶ Division of Nephrology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA.

Abstract

Background: Morbidity and death due to coronavirus disease 2019 (COVID-19) experienced by older adults in nursing homes have been well described, but COVID-19's impact on community-living older adults is less studied. Similarly, the previous ambulatory care experience of such patients has rarely been considered in studies of COVID-19 risks and outcomes.

Methods: To investigate the relationship of advanced age (65+), on risk factors associated with COVID-19 outcomes in community-living elders, we identified an electronic health records cohort of older patients aged 65+ with laboratory-confirmed COVID-19 with and without an ambulatory care visit in the past 24 months (n = 47,219) in the New York City (NYC) academic medical institutions and the NYC public hospital system from January 2020 to February 2021. The main outcomes are COVID-19 hospitalization; severe outcomes/Intensive care unit (ICU), intubation, dialysis, stroke, in-hospital death), and in-hospital death. The exposures include demographic characteristics, and those with ambulatory records, comorbidities, frailty, and laboratory results.

Results: The 31,770 patients with an ambulatory history had a median age of 74 years; were 47.4% male, 24.3% non-Hispanic white, 23.3% non-Hispanic black, and 18.4% Hispanic. With increasing age, the odds ratios and attributable fractions of sex, race-ethnicity, comorbidities, and biomarkers decreased except for dementia and frailty (Hospital Frailty Risk Score). Patients without ambulatory care histories, compared to those with, had significantly higher adjusted rates of COVID-19 hospitalization and severe outcomes, with strongest effect in the oldest group.

Conclusions: In this cohort of community-dwelling older adults, we provided evidence of age-specific risk factors for COVID-19 hospitalization and severe outcomes. Future research should explore the impact of frailty and dementia in severe COVID-19 outcomes in community-living older adults, and the role of engagement in ambulatory care in mitigating severe disease.

Keywords: COVID-19; age-specific risk factors; ambulatory care; community-living older adults.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Aged
COVID-19* / therapy
Dementia* / epidemiology
Female
Frailty* / epidemiology
Hospital Mortality
Hospitalization
Hospitals
Humans
Male
Retrospective Studies
Risk Factors
SARS-CoV-2

Abstract

Publication types

MeSH terms

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