Post-COVID-19 condition risk in patients with intellectual and developmental disabilities: a retrospective cohort study … – BMC Medicine

Data source

This study used data from the TriNetX Research Network, a collaborative health research platform that aggregates de-identified patient-level data from electronic health records, including demographic data, diagnoses, procedures, medications, laboratory data, genomic data, and types of healthcare organization (HCO) visits. TriNetX contains data from over 120 HCOs globally, typically academic health centers that collect data from their affiliated facilities, including main and satellite hospitals and outpatient clinics. For the present analysis, we used the Research Network, which contains the data of over 107 million patients from 76 HCOs. The TriNetX platform includes built-in tools for analyzing patient-level data, and the results are provided to researchers in an aggregate form. Detailed information on the database can be found online [11]. Written informed consent was not required because TriNetX contains anonymized data. The Institutional Review Board of the Chi Mei Medical Center approved the study protocol (no. 11202-002).

We compared the risk of post-COVID-19 conditions between patients with and without an IDD. The IDD group comprised patients aged18 years with a diagnosis of IDD before testing positive for SARS-CoV-2 or receiving a COVID-19 diagnosis (Table S1). We created exclusive categories for patients with commonly reported IDDs using International Classification of Diseases (ICD-10) codes: intellectual disability, ICD-10 F70-79; Down syndrome, ICD-10 Q90.9; and cerebral palsy, ICD-10 G80, as previous described [1, 12,13,14,15].

The non-IDD group was identified using identical criteria but without any IDD diagnosis (Table S2). To ensure a 180-day follow-up for each patient, at least two medical encounters with HCOs were required between March 1, 2020, and October 1, 2022. Patients diagnosed with post-COVID-19 conditions within 1 year before the index date or those requiring initial hospitalization were excluded Index date was defined as the date of diagnosing COVID-19 and only first episode of SARS-CoV-2 infection was included (Table S3).

The primary outcome of this study was a composite outcome consisting of 12 clinical features of post-COVID-19 conditions observed 90180 days after the index event. The follow up period was used based on the definition of post-COVID-19 conditions by World Health Organization the symptoms persist for 3 months after the initial infection. These features include chest/throat pain, abnormal breathing, abdominal symptoms, fatigue/malaise, anxiety/depression, headache, cognitive dysfunction, myalgia, loss of taste or smell, sleep disturbance, cough, and palpitations [16,17,18] and were identified using ICD-10 code (Table S4). In addition to these clinical features, survival and time-to-event outcomes following the index event were also evaluated using Kaplan-Meier and log rank testing to provide further insights into the potential progression and duration of these post-COVID-19 conditions in individuals with IDD versus the general population.

The secondary outcomes encompassed the components of the primary outcome, specifically post-acute COVID-19 conditions, such as chest/throat pain, abnormal breathing, abdominal symptoms, fatigue/malaise, anxiety/depression, headache, cognitive dysfunction, myalgia, loss of taste or smell, sleep disturbance, cough, and palpitations between 90 and 180days after the index date.

We considered 39 variables to adjust for imbalances in baseline characteristics between the IDD and non-IDD groups. We utilized a list of both confirmed and suspected risk factors for COVID-19 and more severe cases of the illness, which included demographics (such as age, sex, and ethnicity), adverse socioeconomic determinants of health (including problems related to education and literacy, problems related to employment and unemployment, and problems related to housing and economic circumstances, as defined by ICD-10), and comorbidities (such as obesity, hypertension, diabetes mellitus, chronic kidney disease [CKD], asthma, chronic lower respiratory diseases, ischemic heart disease, neoplasm, chronic liver diseases, stroke, dementia, rheumatoid arthritis, lupus, psoriasis, human immunodeficiency virus [HIV] infection, mood disorders, and psychotic disorders) [19,20,21]. We compiled all baseline characteristics and underlying conditions using the most recent data within the three years before the index date. If multiple data points were available within this period, we chose the one closest to the index date.

We used the built-in propensity score-matching function of the TriNetX platform to ensure a 1:1 match between the participants in the IDD and non-IDD groups. This was enabled by employing a nearest-neighbor greedy matching algorithm with a caliper width of 0.1 pooled standard deviation. The propensity score was assigned as the probability of exposure to IDD or non-IDD patients with the covariates included in the regression model and then used to balance the differences between groups. Standardized differences were computed to assess the inequality and the confounding effect between groups. Any differences in absolute values<0.1 indicated a good match between groups [22]. To evaluate the survival and the time-to-event data, we employed the Kaplan-Meier survival analysis. The differences between survival curves were analyzed using the log-rank test. We used Cox proportional hazard models to calculate the hazard ratios, which involved adjusting for potential confounding variables. The hazard ratios, with corresponding confidence intervals, were derived to examine the relative risk of post-COVID-19 conditions in the IDD population compared to the control group. All tests were two-sided, and p-values less than 0.05 were considered statistically significant.

For the subgroup analysis, we compared the risks of post-COVID-19 conditions between IDD and non-IDD groups. This comparison was stratified by age (1864 and65 years), sex, vaccine status (unvaccinated or vaccinated with at least one dose 14 days before the SARS-CoV-2 infection), and race (white and non-white).

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Post-COVID-19 condition risk in patients with intellectual and developmental disabilities: a retrospective cohort study ... - BMC Medicine