Risk of Potentially Preventable Hospitalizations After SARS-CoV-2 Infection
Authors: Govier Diana J. , Niederhausen Meike , Takata Yumie , Hickok Alex , Rowneki Mazhgan , McCready Holly , Smith Valerie A. , Osborne Thomas F. , Boyko Edward J. , Ioannou George N. , Maciejewski Matthew L. , Viglianti Elizabeth M. , Bohnert Amy S. B. , O’Hare Ann M. , Iwashyna Theodore J. , Hynes Denise M. ,   US Department of Veterans Affairs Health Services Research and Development COVID-19 Observational Research Collaboratory, Berkowitz Theodore , Doll Jacob , Floyd Breana , Hastings Susan Nicole , Hawkins Eric , Jones Makoto , Kamphius Lee , Moss Abby , Ong Michael , Seelye Sarah , Shah Javeed , Shahoumian Troy , Shaukat Aasma , Shepherd-Banigan Megan , Slatore Christopher , Smith Battista , Suri Pradeep , Teo Alan , Vranas Kelly , Winchell Kara , Wong Edwin , Wyatt Kristin 
Published: April 2024

Importance

Research demonstrates that SARS-CoV-2 infection is associated with increased risk of all-cause hospitalization. However, no prior studies have assessed the association between SARS-CoV-2 and potentially preventable hospitalizations—that is, hospitalizations for conditions that can usually be effectively managed in ambulatory care settings.

Objective

To examine whether SARS-CoV-2 is associated with potentially preventable hospitalization in a nationwide cohort of US veterans.

Design, Setting, and Participants

This cohort study used an emulated target randomized trial design with monthly sequential trials to compare risk of a potentially preventable hospitalization among veterans with SARS-CoV-2 and matched comparators without SARS-CoV-2. A total of 189 136 US veterans enrolled in the Veterans Health Administration (VHA) who were diagnosed with SARS-CoV-2 between March 1, 2020, and April 30, 2021, and 943 084 matched comparators were included in the analysis. Data were analyzed from May 10, 2023, to January 26, 2024.

Exposure

SARS-CoV-2 infection.

Main Outcomes and Measures

The primary outcome was a first potentially preventable hospitalization in VHA facilities, VHA-purchased community care, or Medicare fee-for-service care. Extended Cox models were used to examine adjusted hazard ratios (AHRs) of potentially preventable hospitalization among veterans with SARS-CoV-2 and comparators during follow-up periods of 0 to 30, 0 to 90, 0 to 180, and 0 to 365 days. The start of follow-up was defined as the date of each veteran’s first positive SARS-CoV-2 diagnosis, with the same index date applied to their matched comparators.

Results

The 1 132 220 participants were predominantly men (89.06%), with a mean (SD) age of 60.3 (16.4) years. Most veterans were of Black (23.44%) or White (69.37%) race. Veterans with SARS-CoV-2 and comparators were well-balanced (standardized mean differences, all &amp;lt;0.100) on observable baseline clinical and sociodemographic characteristics. Overall, 3.10% of veterans (3.81% of those with SARS-CoV-2 and 2.96% of comparators) had a potentially preventable hospitalization during 1-year follow-up. Risk of a potentially preventable hospitalization was greater among veterans with SARS-CoV-2 than comparators in 4 follow-up periods: 0- to 30-day AHR of 3.26 (95% CI, 3.06-3.46); 0- to 90-day AHR of 2.12 (95% CI, 2.03-2.21); 0- to 180-day AHR of 1.69 (95% CI, 1.63-1.75); and 0- to 365-day AHR of 1.44 (95% CI, 1.40-1.48).

Conclusions and Relevance

In this cohort study, an increased risk of preventable hospitalization in veterans with SARS-CoV-2, which persisted for at least 1 year after initial infection, highlights the need for research on ways in which SARS-CoV-2 shapes postinfection care needs and engagement with the health system. Solutions are needed to mitigate preventable hospitalization after SARS-CoV-2.