Investigating the long-term effects of COVID-19 infection on healthcare utilization in individuals with chronic obstructive pulmonary disease

Background — Individuals with chronic obstructive pulmonary disease (COPD) are at elevated risk of severe outcomes following COVID-19 infection.

Research questions — Does COVID-19 have a long-term impact on healthcare utilization (HCU) for individuals with COPD?

Study design and methods — We conducted a retrospective matched cohort study using health administrative data from Ontario Canada, between April 2020 and June 2022. Individuals with physician-diagnosed COPD who received a COVID-19 PCR test were included. COVID-19 positive and negative patients were matched on age, sex, vaccination status, PCR test date, and a propensity score. Patients were followed from the end of the acute infection period (12-weeks post-PCR) until the study end date. Per-person-year HCU rates were captured and compared. Analyses were stratified by COVID-19 variant eras (Wild-Type/Alpha/Beta, Delta, and Omicron) and vaccination status (0, 1, 2, and ≥3).

Results — We identified 31,540 matched pairs. Mean age was 66.4 years and 49.9% were male. Individuals with positive COVID-19 tests had 9% higher HCU rates than those who tested negative (rate ratio [RR]: 1.09 CI: 1.067-1.127). Stratifying by variant, Wild-Type/Alpha/Beta and Omicron variants had 16% (RR: 1.16, CI: 1.119-1.22) and 5% (RR: 1.051, CI: 1.01-1.092) higher HCU rates respectively. Individuals with ≥3 vaccinations did not have elevated rates of HCU (RR: 1.03, CI: 0.981-1.081) compared to those who tested negative.

Interpretation — COVID-19 positive COPD patients had significantly greater long-term HCU usage. Although Omicron has been considered milder than previous variants, it was still associated with significantly elevated long-term HCU. Individuals with ≥3 vaccinations who tested positive for COVID-19 had similar HCU rates to those who tested negative, suggesting that vaccinations can reduce long-term healthcare utilization.