Hospitalization for COVID-19 infection carries higher long-term risks of mortality, adverse health outcomes, and significant cumulative excess disability-adjusted life-years (DALYs) than hospitalization for seasonal influenza, according to study results published in Lancet Infectious Diseases.
Researchers conducted a cohort study to compare both acute and long-term risks and burdens associated with hospitalization for COVID-19 infection vs seasonal influenza. The total study population included 92,265 hospitalized patients (mean [SD] age, 70.73 [12.74] years; 74.2% White; 95.0% men). Data were sourced from inpatients (n=81,280) with COVID-19 infection between March 2020 and June 2022 and from inpatients (n=10,985) with seasonal influenza between October 2015 and February 2019. The researchers evaluated a prespecified set of 94 adverse outcomes in both cohorts for up to 18 months following hospital admission. Inverse probability weighting was used to balance baseline characteristics between the cohorts.
During the follow-up period (median, 1.46 years for both cohorts), the mortality rate was consistently higher among patients in the COVID-19 cohort. At 540 days, the cumulative mortality rate per 100 persons was 28.46 (95% CI, 28.14-28.78) for patients in the COVID-19 cohort and 19.84 (95% CI, 19.07-20.59) for those in the influenza cohort.
Although the risk of mortality was higher among patients in the COVID-19 cohort for the duration of the study, it was most apparent in the acute phase of infection (0-30 days posthospitalization; hazard ratio [HR], 2.51; 95% CI, 2.28-2.78).
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[T]hese findings emphasise the need to reduce the risk for infection and hospital admission due to SARS-CoV-2 and seasonal influenza and the need for post-acute care strategies to reduce the burden of health loss in populations.
Patients hospitalized with COVID-19 infection were more likely to experience 64 (68.1%) of the prespecified outcomes, including cardiovascular, hematologic, gastrointestinal, mental health, metabolic, musculoskeletal, neurologic, and kidney outcomes, among others. However, patients hospitalized for seasonal influenza were more likely to experience 6 (6.4%) of the prespecified outcomes, including angina, tachycardia, type 1 diabetes, cough, hypoxemia, and shortness of breath.
With the exception of the pulmonary system, patients with COVID-19 infection were more likely to experience adverse outcomes in all other organ systems. The cumulative rate of adverse outcomes across all organ systems was 615.18 (95% CI, 605.17-624.88) per 100 persons for the COVID-19 cohort and 536.90 (95% CI, 627.38-544.90) per 100 persons for the influenza cohort.
The total number of DALYs associated with adverse outcomes across all organ systems was higher among patients in the COVID-19 cohort (287.43 per 100 persons; 95% CI, 281.10-293.59) compared with those in the influenza cohort (242.66 per 100 persons; 95% CI, 236.75-247.67).
Patients in the COVID-19 cohort were also more likely to be readmitted (HR, 1.11; 95% CI, 1.08-1.13) and require intensive care unit admission (HR, 1.27; 95% CI, 1.19-1.36), with excess admissions of 20.50 (95% CI, 16.10-24.86) and 9.23 (95% CI, 6.68-11.82) per 100 persons, respectively.
Study limitations include the predominance of older White men, the lack of patients with mild infections, the enrollment of a historical influenza cohort, and potential selection and misclassification bias.
The researchers concluded, “[T]hese findings emphasise the need to reduce the risk for infection and hospital admission due to SARS-CoV-2 and seasonal influenza and the need for post-acute care strategies to reduce the burden of health loss in populations.”
Disclosures: Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
