Impact of pre-existing disability on long-term health care use following hospitalization for COVID-19: A population-based cohort study

Background — Emerging evidence shows the lasting impact of SARS-CoV-2 infection on health care use and needs. Policy-makers require data on population-level service use to understand patient needs and health system impacts following hospitalization for COVID-19.

Objective — To compare health service use within 12 months following hospitalization for COVID-19 among people with and without pre-existing disabilities, and to determine the extent to which such use is related to disability and other risk factors.

Design — Population-based cohort study, Ontario, Canada.

Participants — Adults with and without disabilities hospitalized for COVID-19, 01/25/2020–02/28/2022.

Main measures — We used Poisson regression to model adjusted rate ratios (aRR) of ambulatory care visits, diagnostic testing, emergency department (ED) visits, hospital admissions, and palliative care visits within 1-year post-discharge, comparing patients with and without disabilities. Models were adjusted sequentially for sociodemographic factors, comorbidities, and prior health service use. The importance of each set of covariates in its ability to explain observed associations was determined by calculating relative changes in disability parameter coefficients after each sequential risk-adjustment.

Key results — The cohort included 25,320 patients with disabilities and 15,953 without. In the year after hospitalization for COVID-19, people with disabilities had higher rates of ambulatory care visits, diagnostic tests, ED visits, hospital admissions, and palliative care visits. A significant proportion of these associations was explained by sociodemographic factors, comorbidities, and prior health service use. However, adjusted relative rates associated with disability remained elevated, even after adjustment, for ambulatory care visits (aRR 1.09, 95% CI 1.08, 1.10), diagnostic tests (aRR 1.14, 95% CI 1.12, 1.16), ED visits (aRR 1.25, 95% CI 1.21, 1.29), and hospital admissions (aRR 1.21, 95% CI 1.16, 1.29).

Conclusions — These findings support the need to develop and evaluate models of care for the post-COVID-19 condition that address the needs of people with disabilities.