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A real world analysis of COVID-19 impact on hospitalizations in older adults with chronic conditions from an Italian region.

ABSTRACT: Healthcare delivery reorganization during the COVID-19 emergency may have had a significant impact on access to care for older adults with chronic conditions. We investigated such impact among all adults with chronic conditions aged ≥ 65 years, identified through the electronic health databases of two local health agencies-ATS Brianza and ATS Bergamo-from the Lombardy region, Italy. We considered hospitalizations for 2020 compared to the average 2017-2019 and quantified differences using rate ratios (RRs). Overall, in 2017-2019 there were a mean of 374,855 older adults with ≥ 1 chronic condition per year in the two ATS and 405,371 in 2020. Hospitalizations significantly decreased from 84,624 (225.8/1000) in 2017-2019 to 78,345 (193.3/1000) in 2020 (RR 0.86). Declines were reported in individuals with many chronic conditions and for most Major Diagnostic Categories, except for diseases of the respiratory system. The strongest reductions were observed in hospitalizations for individuals with active tumours, particularly for surgical ones. Hospitalization rates increased in individuals with diabetes, likely due to COVID-19-related diseases. Although determinants of the decrease in demand and supply for care among chronic older adults are to be further explored, this raises awareness on their impacts on chronic patients' health in the medium and long run.

SUBMITTER: Bosetti C

PROVIDER: S-EPMC9374749 | biostudies-literature | 2022 Aug

REPOSITORIES: biostudies-literature

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A real world analysis of COVID-19 impact on hospitalizations in older adults with chronic conditions from an Italian region.

Bosetti Cristina C Rognoni Magda M Ciampichini Roberta R Paroni Luca L Scala Marco M d'Oro Luca Cavalieri LC Zucchi Alberto A Amerio Andrea A Iacoviello Licia L Ghislandi Simone S Odone Anna A Stuckler David D Gallus Silvano S

Scientific reports 20220812 1

Healthcare delivery reorganization during the COVID-19 emergency may have had a significant impact on access to care for older adults with chronic conditions. We investigated such impact among all adults with chronic conditions aged ≥ 65 years, identified through the electronic health databases of two local health agencies-ATS Brianza and ATS Bergamo-from the Lombardy region, Italy. We considered hospitalizations for 2020 compared to the average 2017-2019 and quantified differences using rate ra ...[more]

PMID: 35962037

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Project description:Background/purposeExtreme events such as hurricanes adversely impact healthcare systems and the communities they serve. The degree to which hurricanes affect healthcare use among high need groups such as older adults with chronic conditions has not been well examined, nor has the impact of hurricane severity on health outcomes. We characterized hospitalizations among older adults by chronic condition after eight large-scale hurricanes in the United States.MethodsUsing a combination of administrative healthcare data and the Federal Emergency Management Agency's Disaster Declaration database we conducted a self-controlled case series analysis. We identified Medicare beneficiaries who were exposed to one of eight hurricanes and compared hospitalizations in the 30-days after a hurricane to hospitalizations in the rest of the calendar year of the hurricane. We examined hospitalizations (1) in total, (2) separately for diabetes, congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) admissions, and (3) by hurricane damage category.ResultsAmong all older adults exposed, hospitalizations in the 30-day period after each disaster increased for all three chronic conditions; diabetes (incidence rate ratio [IRR] = 1.06, 95% confidence interval [CI] 1.03, 1.10), COPD (IRR = 1.06, 95% CI 1.04, 1.08), and CHF (IRR = 1.19, 95% CI 1.17, 1.21. In the 30-to-60-day period hospitalizations also increased for each chronic condition; diabetes (IRR = 1.06, 95% CI 1.03, 1.10), COPD (IRR = 1.12, 95% CI 1.10, 1.15), and CHF (IRR = 1.32, 95% CI 1.30, 1.34). Substantial differences in hospitalizations were observed according to individual hurricane and by the chronic disease examined.ConclusionExposure to hurricanes is associated with an increase in hospitalizations for chronic conditions across all hurricane damage categories. As disasters are expected to increase in strength and frequency, our results underscore the need for response strategies and health policy planning for healthcare systems designed to address the health needs of older Americans with chronic conditions.

Project description:Randomized trials of anti-hypertensive treatment demonstrating reduced risk of cardiovascular events in older adults included participants with less comorbidity than clinical populations. Whether these results generalize to all older adults, most of whom have multiple chronic conditions, is uncertain.To determine the association between anti-hypertensive medications and CV events and mortality in a nationally representative population of older adults.Competing risk analysis with propensity score adjustment and matching in the Medicare Current Beneficiary Survey cohort over three-year follow-up through 2010.4,961 community-living participants with hypertension.Anti-hypertensive medication intensity, based on standardized daily dose for each anti-hypertensive medication class participants used.Cardiovascular events (myocardial infarction, unstable angina, cardiac revascularization, stroke, and hospitalizations for heart failure) and mortality.Of 4,961 participants, 14.1% received no anti-hypertensives; 54.6% received moderate, and 31.3% received high, anti-hypertensive intensity. During follow-up, 1,247 participants (25.1%) experienced cardiovascular events; 837 participants (16.9%) died. Of deaths, 430 (51.4%) occurred in participants who experienced cardiovascular events during follow-up. In the propensity score adjusted cohort, after adjusting for propensity score and other covariates, neither moderate (adjusted hazard ratio, 1.08 [95% CI, 0.89-1.32]) nor high (1.16 [0.94-1.43]) anti-hypertensive intensity was associated with experiencing cardiovascular events. The hazard ratio for death among all participants was 0.79 [0.65-0.97] in the moderate, and 0.72 [0.58-0.91] in the high intensity groups compared with those receiving no anti-hypertensives. Among participants who experienced cardiovascular events, the hazard ratio for death was 0.65 [0.48-0.87] and 0.58 [0.42-0.80] in the moderate and high intensity groups, respectively. Results were similar in the propensity score-matched subcohort.In this nationally representative cohort of older adults, anti-hypertensive treatment was associated with reduced mortality but not cardiovascular events. Whether RCT results generalize to older adults with multiple chronic conditions remains uncertain.

Project description:Rationale: Extreme heat exposure is a well-known cause of mortality among older adults. However, the impacts of exposure on respiratory morbidity across U.S. cities and population subgroups are not well understood. Objectives: A nationwide study was conducted to determine the impact of high heat on respiratory disease hospitalizations among older adults (≥65 yr of age) living in the 120 largest U.S. cities between 2000 and 2017. Methods: Daily rates of inpatient respiratory hospitalizations were examined with respect to variations in ZIP code-level daily mean temperature or heat index. For each city, we estimated cumulative associations (lag days 0-6) between warm-season heat (June to September) and cause-specific respiratory hospitalizations using time-stratified conditional quasi-Poisson regression with distributed lag nonlinear models. We estimated nationwide associations using multivariate meta-regression and updated city-specific associations via best linear unbiased prediction. With stratified models, we explored effect modification by age, sex, and race (Black or White). Results are reported as percentage change in hospitalizations at high temperatures (95th percentile) compared with median temperatures for each outcome, demographic group, and metropolitan area. Results: We identified 3,275,033 respiratory hospitalizations among Medicare beneficiaries across 120 large U.S. cites between 2000 and 2017. Nationwide, 7-day cumulative associations at high temperatures resulted in a 1.2% (95% confidence interval, 0.4-2.0%) increase in hospitalizations for primary diagnoses of all-cause respiratory disease, driven primarily by increases in respiratory tract infections (1.8% [95% confidence interval, 0.6-3.0%]) and chronic respiratory diseases and/or respiratory failure (1.2% [95% confidence interval, 0.0-2.4%]). Stronger associations were observed when exposure was defined using the heat index instead of mean temperature. Across the 120 cities, we observed considerable geographic variation in the relative risk of heat-related respiratory hospitalizations, and we observed disproportionate burdens of heat-related respiratory hospitalizations among the oldest beneficiaries (≥85 yr of age) and among Black beneficiaries living in South Atlantic cities. During the 18-year study period, there were an estimated 11,710 excess respiratory hospitalizations due to heat exposure. Conclusions: Results suggest that high temperature and humidity contribute to exacerbation of respiratory tract infections and chronic lung diseases among older adults. Geographic variation in heat-related hospitalization rates suggests that contextual factors largely account for disproportionate burdens, and area-level influences should be further investigated in multicity studies.

Project description:Pharmacogenetic testing provides patient genotype information which could influence medication selection and dosing for optimal patient care. Insurance coverage for pharmacogenetic testing varies widely. A better understanding of the commonly used medications with clinically important pharmacogenetic recommendations can inform which medications and/or genes should be prioritized for coverage and reimbursement in the context of finite healthcare resources. The aim of this scoping review was to collate previous studies that investigated the utilization rate of medications that could be guided by pharmacogenetic testing. Included studies utilized electronic medical records or claims data to assess pharmacogenetic medication prescription rates for older adults (≥ 65 years old). Identified pharmacogenetic medications were classified according to therapeutic class and assessed for actionability based on the Clinical Pharmacogenetics Implementation Consortium guidelines. Across the 31 included studies, analgesic (n = 29), psychotropic (n = 29), and cardiovascular (n = 27) therapeutic classes were most commonly investigated. Study populations were primarily generalized (48%); however, some studies focused on specific populations, such as, cancer (n = 6), mental health (n = 1), and nursing home (n = 2) cohorts. A total of 215 unique pharmacogenetic medications were reported, of which, 82 were associated with actionable pharmacogenetic recommendations. The most frequent genes implicated in potential drug-gene interactions with these actionable pharmacogenetic drugs were CYP2D6 (25.6%), CYP2C19 (18.3%), and CYP2C9 (11%). Medications most frequently prescribed included pantoprazole (range 0%-49.6%), simvastatin (range 0%-54.9%), and ondansetron (range 0.1%-62.6%). Overall, the frequently prescribed medications and associated genes identified in this review could guide pharmacogenetic testing implementation into clinical practice, including insurer subsidization.

Dataset Information

A real world analysis of COVID-19 impact on hospitalizations in older adults with chronic conditions from an Italian region.

Publications

A real world analysis of COVID-19 impact on hospitalizations in older adults with chronic conditions from an Italian region.

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