Characteristics Associated With Disparities Among Older Adults in Coronavirus Disease 2019 Outcomes in an Academic Health Care System.
Characteristics Associated With Disparities Among Older Adults in Coronavirus Disease 2019 Outcomes in an Academic Health Care System.
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DOI：
10.1097/mlr.0000000000001701
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发表时间：
2022-05-01
期刊：
影响因子：
3
通讯作者：
Morrison RS
中科院分区：
文献类型：
--
作者：
Gelfman LP;Moreno J;Frydman JL;Singer J;Houldsworth J;Cordon-Cardo C;Mehrotra M;Chai E;Aldridge M;Morrison RS
需要更好地了解2019年冠状病毒病大流行，以确定老年人COVID-19结果的预测因素。研究预测COVID-19患者住院死亡率、ICU入院和再入院的患者和卫生系统因素。对西奈山卫生系统内五家纽约医院出院的年龄≥ 18岁的COVID-19患者进行的队列研究（2020年3月1日至2020年6月30日）。患者水平特征（年龄、性别、人种/种族、合并症/严重疾病、从专业护理机构（SNF）转移、SARS-CoV-2病毒载量、序贯器官衰竭评估（SOFA）评分、治疗）;医院特征。全因住院死亡率; ICU入院; 30天再入院在7，556例受试者中，平均年龄61.1 [62.0]岁; 1，556例（20.6%）死亡，949例（12.6%）入住ICU，227例（9.1%）30天再入院。年龄增加（55-64岁：OR，3.28; 95% CI，2.41-4.46; 65-74岁：OR，4.67; 95% CI，3.43-6.35; 75-84岁：OR，10.73; 95% CI，7.77-14.81; ≥ 85岁：OR，20.57; 95%CI，14.46-29.25）和合并症（OR，1.11; 95%CI，1.16，2.13）是院内死亡的独立危险因素。然而，老年人[（年龄55-64岁：OR，0.56; 95% CI，0.40-0.77），（65-74岁：OR，0.46; 95% CI，0.33-0.65），（75-84岁：OR，0.27; 95% CI，0.18-0.40），（年龄>85岁：OR，0.21; 95%CI，0.13-0.34）]和接受医疗补助的患者（OR，0.74; 95%CI，0.56，0.99）不太可能进入ICU。种族/民族、拥挤、人口密度和卫生系统普查与研究结果无关。年龄增长是死亡率的最大独立风险因素。合并症和严重疾病与死亡率独立相关。了解这些风险因素可以指导患有COVID-19的老年人的医疗决策。老年人和那些从SNF入院的人有一半的可能被送进ICU。这一发现需要进一步调查，以了解年龄和治疗偏好如何影响资源分配。
Improved understanding of coronavirus disease 2019 pandemic is needed to identify predictors of outcomes among older adults with COVID-19. To examine patient and health system factors predictive of in-hospital mortality, ICU admission and readmission among patients with COVID-19. Cohort study of patients aged ≥ 18 years with COVID-19 discharged from five New York hospitals within the Mount Sinai Health System (March 1, 2020 - June 30, 2020). Patient-level characteristics (age, sex, race/ethnicity, comorbidities/serious illness, transfer from skilled nursing facility (SNF), SARS-CoV-2 viral load, sequential organ failure assessment (SOFA) score, treatments); hospital characteristics. All-cause in-hospital mortality; ICU admission; 30-day readmission Among 7,556 subjects, mean age 61.1 [62.0] years; 1,556 (20.6%) died, 949 (12.6%) had an ICU admission, and 227 (9.1%) had a 30-day readmission. Increased age (aged 55–64: OR, 3.28; 95% CI, 2.41–4.46; aged 65–74: OR, 4.67; 95% CI, 3.43–6.35; aged 75–84: OR, 10.73; 95% CI, 7.77–14.81; aged ≥ 85: OR, 20.57; 95% CI, 14.46–29.25) and comorbidities (OR, 1.11; 95% CI, 1.16, 2.13) were independent risk factors for in-hospital mortality. Yet older adults [(aged 55–64 years: OR, 0.56; 95% CI, 0.40–0.77), (aged 65–74: OR, 0.46; 95% CI, 0.33–0.65), (aged 75–84: OR, 0.27; 95% CI, 0.18–0.40), (aged >85 years: OR, 0.21; 95% CI, 0.13–0.34)] and those with Medicaid (OR, 0.74; 95% CI, 0.56,0.99) were less likely to be admitted to the ICU. Race/ethnicity, crowding, population density, and health system census were not associated with study outcomes. Increased age was the single greatest independent risk factor for mortality. Comorbidities and serious illness were independently associated with mortality. Understanding these risk factors can guide medical decision-making for older adults with COVID-19. Older adults and those admitted from a SNF were half as likely to be admitted to the ICU. This finding requires further investigation to understand how age and treatment preferences factored into resource allocation.