One-Year Adverse Outcomes Among US Adults With Post–COVID-19 Condition vs Those Without COVID-19 in a Large Commercial Insurance Database
The study titled “One-Year Adverse Outcomes Among US Adults With Post–COVID-19 Condition vs Those Without COVID-19 in a Large Commercial Insurance Database” focused on the long-term outcomes of individuals with postacute sequelae of SARS-CoV-2 infection, also known as post–COVID-19 condition (PCC). Its objective was to quantify the 1-year outcomes among individuals meeting a PCC definition compared to a control group without COVID-19.
The cohort study included members of commercial health plans, using national insurance claims data enhanced with laboratory results and mortality data. The study sample consisted of adults with a claims-based definition for PCC and a 2:1 matched control cohort without evidence of COVID-19 from April 1, 2020, to July 31, 2021.
Main outcomes assessed were adverse outcomes, including cardiovascular and respiratory outcomes and mortality, over a 12-month period. The study population included 13,435 individuals with PCC and 26,870 individuals without evidence of COVID-19. The PCC cohort experienced increased healthcare utilization for a range of adverse outcomes such as cardiac arrhythmias, pulmonary embolism, ischemic stroke, coronary artery disease, heart failure, chronic obstructive pulmonary disease (COPD), and asthma. Moreover, 2.8% of individuals with PCC died versus 1.2% of controls, indicating an excess death rate of 16.4 per 1000 individuals.
The study concluded that the PCC cohort surviving the acute phase of illness showed increased rates of adverse outcomes over a year, emphasizing the need for continued monitoring of at-risk individuals, particularly regarding cardiovascular and pulmonary management. The study’s comprehensive follow-up provided valuable insights for managing care coordination efforts for individuals with PCC.
The data was sourced from the HealthCore Integrated Research Environment, covering medical, pharmacy, and laboratory data from 14 commercial health plans across the US. The study complied with the Health Insurance Portability and Accountability Act, using only deidentified data. The PCC cohort was identified based on a claims-based definition for PCC, including criteria from the Centers for Disease Control and Prevention and other peer-reviewed publications.
The study’s methodology included creating a matched cohort of individuals without COVID-19 to compare actual versus expected rates for post-index outcomes. A 1:2 propensity score match was performed using multivariate logistic regression, considering various baseline characteristics and health care utilization and costs.
Outcomes of interest were primarily cardiovascular disorders and chronic respiratory disorders, along with mortality, all ascertained using ICD-10 codes and additional utilization information, including hospitalizations. Statistical analysis was conducted using descriptive statistics, t-tests, Pearson χ2 tests, and Kaplan-Meier survival estimates for mortality.