Outcomes in patients with and without disability admitted to hospital with COVID-19: a retrospective cohort study

Authors:
  • HBHilary K. Brown
    Hilary K. Brown
  • SSSudipta Saha
    Sudipta Saha
  • TCTimothy C.Y. Chan
    Timothy C.Y. Chan
  • ACAngela M. Cheung
    Angela M. Cheung
  • MFMichael Fralick
    Michael Fralick
  • MGMarzyeh Ghassemi
    Marzyeh Ghassemi
  • MHMargaret Herridge
    Margaret Herridge
  • JKJanice Kwan
    Janice Kwan
  • SRShail Rawal
    Shail Rawal
  • LRLaura Rosella
    Laura Rosella
  • TTTerence Tang
    Terence Tang
  • AWAdina Weinerman
    Adina Weinerman
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Abstract
Background: Disability-related considerations have largely been absent from the COVID-19 response, despite evidence that people with disabilities are at elevated risk for acquiring COVID-19. We evaluated clinical outcomes in patients who were admitted to hospital with COVID-19 with a disability compared with patients without a disability. Methods: We conducted a retrospective cohort study that included adults with COVID-19 who were admitted to hospital and discharged between Jan. 1, 2020, and Nov. 30, 2020, at 7 hospitals in Ontario, Canada. We compared in-hospital death, admission to the intensive care unit (ICU), hospital length of stay and unplanned 30-day readmission among patients with and without a physical disability, hearing or vision impairment, traumatic brain injury, or intellectual or developmental disability, overall and stratified by age (≤ 64 and ≥ 65 yr) using multivariable regression, controlling for sex, residence in a long-term care facility and comorbidity. Results: Among 1279 admissions to hospital for COVID-19, 22.3% had a disability. We found that patients with a disability were more likely to die than those without a disability (28.1% v. 17.6%), had longer hospital stays (median 13.9 v. 7.8 d) and more readmissions (17.6% v. 7.9%), but had lower ICU admission rates (22.5% v. 28.3%). After adjustment, there were no statistically significant differences between those with and without disabilities for in-hospital death or admission to ICU. After adjustment, patients with a disability had longer hospital stays (rate ratio 1.36, 95% confidence interval [CI] 1.19–1.56) and greater risk of readmission (relative risk 1.77, 95% CI 1.14–2.75). In age-stratified analyses, we observed longer hospital stays among patients with a disability than in those without, in both younger and older subgroups; readmission risk was driven by younger patients with a disability. Interpretation: Patients with a disability who were admitted to hospital with COVID-19 had longer stays and elevated readmission risk than those without disabilities. Disability-related needs should be addressed to support these patients in hospital and after discharge.

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