30-day mortality following COVID-19 and influenza hospitalization among US veterans aged 65 and older.
COVID-19
Frailty
Hospitalization
Influenza
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
09 2022
09 2022
Historique:
revised:
29
03
2022
received:
22
10
2021
accepted:
09
04
2022
pubmed:
28
4
2022
medline:
23
9
2022
entrez:
27
4
2022
Statut:
ppublish
Résumé
COVID-19 and influenza are important sources of morbidity and mortality among older adults. Understanding how outcomes differ for older adults hospitalized with either infection is important for improving care. We compared outcomes from infection with COVID-19 and influenza among hospitalized older adults. We conducted a retrospective study of 30-day mortality among veterans aged 65+ hospitalized with COVID-19 from March 1, 2020-December 31, 2020 or with influenza A/B from September 1, 2017 to August 31, 2019 in Veterans Affairs Health Care System (VAHCS). COVID-19 infection was determined by a positive PCR test and influenza by tests used in the VA system. Frailty was defined by the claims-based Veterans Affairs Frailty Index (VA-FI). Logistic regressions of mortality on frailty, age, and infection were adjusted for multiple confounders. A total of 15,474 veterans were admitted with COVID-19 and 7867 with influenza. Mean (SD) ages were 76.1 (7.8) and 75.8 (8.3) years, 97.7% and 97.4% were male, and 66.9% and 76.4% were white in the COVID-19 and influenza cohorts respectively. Crude 30-day mortality (95% CI) was 18.9% (18.3%-19.5%) for COVID-19 and 4.3% (3.8%-4.7%) for influenza. Combining cohorts, the odds ratio for 30-day mortality from COVID-19 (versus influenza) was 6.61 (5.74-7.65). There was a statistically significant interaction between infection with COVID-19 and frailty, but there was no significant interaction between COVID-19 and age. Separating cohorts, greater 30-day mortality was significantly associated with older age (p: COVID-19: <0.001, Influenza: <0.001) and for frail compared with robust individuals (p for trend: COVID-19: <0.001, Influenza: <0.001). Mortality from COVID-19 exceeded that from influenza among hospitalized older adults. However, odds of mortality were higher at every level of frailty among those admitted with influenza compared to COVID-19. Prevention will remain key to reducing mortality from viral illnesses among older adults.
Sections du résumé
BACKGROUND
COVID-19 and influenza are important sources of morbidity and mortality among older adults. Understanding how outcomes differ for older adults hospitalized with either infection is important for improving care. We compared outcomes from infection with COVID-19 and influenza among hospitalized older adults.
METHODS
We conducted a retrospective study of 30-day mortality among veterans aged 65+ hospitalized with COVID-19 from March 1, 2020-December 31, 2020 or with influenza A/B from September 1, 2017 to August 31, 2019 in Veterans Affairs Health Care System (VAHCS). COVID-19 infection was determined by a positive PCR test and influenza by tests used in the VA system. Frailty was defined by the claims-based Veterans Affairs Frailty Index (VA-FI). Logistic regressions of mortality on frailty, age, and infection were adjusted for multiple confounders.
RESULTS
A total of 15,474 veterans were admitted with COVID-19 and 7867 with influenza. Mean (SD) ages were 76.1 (7.8) and 75.8 (8.3) years, 97.7% and 97.4% were male, and 66.9% and 76.4% were white in the COVID-19 and influenza cohorts respectively. Crude 30-day mortality (95% CI) was 18.9% (18.3%-19.5%) for COVID-19 and 4.3% (3.8%-4.7%) for influenza. Combining cohorts, the odds ratio for 30-day mortality from COVID-19 (versus influenza) was 6.61 (5.74-7.65). There was a statistically significant interaction between infection with COVID-19 and frailty, but there was no significant interaction between COVID-19 and age. Separating cohorts, greater 30-day mortality was significantly associated with older age (p: COVID-19: <0.001, Influenza: <0.001) and for frail compared with robust individuals (p for trend: COVID-19: <0.001, Influenza: <0.001).
CONCLUSION
Mortality from COVID-19 exceeded that from influenza among hospitalized older adults. However, odds of mortality were higher at every level of frailty among those admitted with influenza compared to COVID-19. Prevention will remain key to reducing mortality from viral illnesses among older adults.
Identifiants
pubmed: 35474510
doi: 10.1111/jgs.17828
pmc: PMC9115089
doi:
Types de publication
Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
2542-2551Subventions
Organisme : CSRD VA
ID : IK2 CX001800
Pays : United States
Organisme : U.S. Department of Veterans Affairs
ID : CDA2 IK2CX001800-01A1
Informations de copyright
Published 2022. This article is a U.S. Government work and is in the public domain in the USA.
Références
Emerg Infect Dis. 2004 Jan;10(1):25-31
pubmed: 15078593
Lancet Infect Dis. 2020 Jul;20(7):776-777
pubmed: 32224313
CMAJ. 2005 Aug 30;173(5):489-95
pubmed: 16129869
Arch Gerontol Geriatr. 2021 Mar-Apr;93:104324
pubmed: 33352430
Age Ageing. 2021 May 5;50(3):608-616
pubmed: 33951151
J Infect Dis. 2020 Jul 6;222(3):428-437
pubmed: 32147711
N Engl J Med. 2017 Feb 9;376(6):584-594
pubmed: 28177862
Ageing Res Rev. 2021 Aug;69:101351
pubmed: 33971332
Chest. 1992 Jun;101(6):1644-55
pubmed: 1303622
Age Ageing. 2016 May;45(3):353-60
pubmed: 26944937
J Gerontol A Biol Sci Med Sci. 2019 Jul 12;74(8):1257-1264
pubmed: 30307533
J Am Geriatr Soc. 2022 Sep;70(9):2542-2551
pubmed: 35474510
J Gen Intern Med. 2022 Jan 3;:
pubmed: 34981346
J Gerontol A Biol Sci Med Sci. 2021 Jun 14;76(7):1318-1325
pubmed: 33693638
Lancet Respir Med. 2021 Mar;9(3):251-259
pubmed: 33341155
J Gerontol A Biol Sci Med Sci. 2021 Feb 25;76(3):e38-e45
pubmed: 33216846
Lancet. 2013 Mar 2;381(9868):752-62
pubmed: 23395245
Lancet Public Health. 2020 Aug;5(8):e444-e451
pubmed: 32619408
Nurs Adm Q. 2015 Oct-Dec;39(4):311-8
pubmed: 26340242
BMJ. 2020 Dec 15;371:m4677
pubmed: 33323357
J Am Geriatr Soc. 2021 May;69(5):1357-1362
pubmed: 33469933
Eur Geriatr Med. 2020 Oct;11(5):851-855
pubmed: 32683576
JAMA. 2020 May 12;323(18):1775-1776
pubmed: 32203977
BMC Geriatr. 2008 Sep 30;8:24
pubmed: 18826625
Geroscience. 2020 Apr;42(2):505-514
pubmed: 32274617
JAMA. 2021 Apr 13;325(14):1469-1470
pubmed: 33595630
J Am Geriatr Soc. 2021 May;69(5):1116-1127
pubmed: 33818759
JAMA Intern Med. 2020 Aug 1;180(8):1045-1046
pubmed: 32407441
Arch Gerontol Geriatr. 2021 May-Jun;94:104331
pubmed: 33476755