COVID-19 clinical outcomes by patient disability status: A retrospective cohort study.
Jennifer A Deal, Kening Jiang, Joshua F Betz and 5 others
PMID 36764842WHAT IT FOUND
Adults under 65 with disabilities requiring assistance had a 35% increased hazard of developing severe COVID-19 during hospitalization.
This risk did not persist after adjusting for body mass index and comorbidities. No increased risk of severe disease was found in patients 65 or older.
Key findings
01Patients under 65 with disabilities requiring assistance had a 35% increased hazard of developing severe COVID-19 during hospitalization compared to those without assistive needs.
02The association between disability status and severe COVID-19 in patients under 65 was attenuated and no longer statistically significant after adjusting for body mass index and comorbidities.
03There was no significant association between having disabilities requiring assistance and developing severe COVID-19 for patients aged 65 and older.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Disability status was defined by self-report or proxy report of assistive needs, which may misclassify individuals with disabilities who do not require assistance as being in the reference group. The study was conducted in a single, well-resourced academic hospital system, which may limit generalizability to other healthcare settings. The finding of lower mortality in younger patients with disabilities was based on only 7 deaths and was not robust to sensitivity analyses or different age cut-offs. The association with severe disease in younger adults was not significant after adjusting for BMI and comorbidities, making it difficult to determine if disability itself or associated health conditions drive the risk.
Declared interests
Funding was provided by NIH/NIA grants and the Johns Hopkins Precision Medicine Program. Authors reported various conflicts including equity in miDiagnostics, advisory board memberships for Neosensory and Innovation and Value Initiative, and consulting fees from Janssen, Gilead, and Atea Pharmaceuticals.
The easy way to misread this
Do not assume that disability status independently causes severe COVID-19 outcomes in younger adults. The initial 35% increased risk became statistically non-significant after adjusting for body mass index and comorbidities, suggesting these factors play a major role. Additionally, the apparent protective effect against mortality in younger patients with disabilities is unreliable due to the extremely small number of deaths observed.