PLoS Medicine (Jan 2022)

Overall and cause-specific hospitalisation and death after COVID-19 hospitalisation in England: A cohort study using linked primary care, secondary care, and death registration data in the OpenSAFELY platform.

  • Krishnan Bhaskaran,
  • Christopher T Rentsch,
  • George Hickman,
  • William J Hulme,
  • Anna Schultze,
  • Helen J Curtis,
  • Kevin Wing,
  • Charlotte Warren-Gash,
  • Laurie Tomlinson,
  • Chris J Bates,
  • Rohini Mathur,
  • Brian MacKenna,
  • Viyaasan Mahalingasivam,
  • Angel Wong,
  • Alex J Walker,
  • Caroline E Morton,
  • Daniel Grint,
  • Amir Mehrkar,
  • Rosalind M Eggo,
  • Peter Inglesby,
  • Ian J Douglas,
  • Helen I McDonald,
  • Jonathan Cockburn,
  • Elizabeth J Williamson,
  • David Evans,
  • John Parry,
  • Frank Hester,
  • Sam Harper,
  • Stephen Jw Evans,
  • Sebastian Bacon,
  • Liam Smeeth,
  • Ben Goldacre

DOI
https://doi.org/10.1371/journal.pmed.1003871
Journal volume & issue
Vol. 19, no. 1
p. e1003871

Abstract

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BackgroundThere is concern about medium to long-term adverse outcomes following acute Coronavirus Disease 2019 (COVID-19), but little relevant evidence exists. We aimed to investigate whether risks of hospital admission and death, overall and by specific cause, are raised following discharge from a COVID-19 hospitalisation.Methods and findingsWith the approval of NHS-England, we conducted a cohort study, using linked primary care and hospital data in OpenSAFELY to compare risks of hospital admission and death, overall and by specific cause, between people discharged from COVID-19 hospitalisation (February to December 2020) and surviving at least 1 week, and (i) demographically matched controls from the 2019 general population; and (ii) people discharged from influenza hospitalisation in 2017 to 2019. We used Cox regression adjusted for age, sex, ethnicity, obesity, smoking status, deprivation, and comorbidities considered potential risk factors for severe COVID-19 outcomes. We included 24,673 postdischarge COVID-19 patients, 123,362 general population controls, and 16,058 influenza controls, followed for ≤315 days. COVID-19 patients had median age of 66 years, 13,733 (56%) were male, and 19,061 (77%) were of white ethnicity. Overall risk of hospitalisation or death (30,968 events) was higher in the COVID-19 group than general population controls (fully adjusted hazard ratio [aHR] 2.22, 2.14 to 2.30, p ConclusionsIn this study, we observed that people discharged from a COVID-19 hospital admission had markedly higher risks for rehospitalisation and death than the general population, suggesting a substantial extra burden on healthcare. Most risks were similar to those observed after influenza hospitalisations, but COVID-19 patients had higher risks of all-cause mortality, readmission or death due to the initial infection, and dementia death, highlighting the importance of postdischarge monitoring.