Abstract
BACKGROUND: Individuals with COPD are at elevated risk of severe outcomes following COVID-19 infection. RESEARCH QUESTION: Does COVID-19 have a long-term impact on health care utilization (HCU) for individuals with COPD? STUDY DESIGN AND METHODS: This retrospective matched cohort study was conducted by using health administrative data from Ontario, Canada, between April 2020 and June 2022. Individuals with physician-diagnosed COPD who underwent COVID-19 polymerase chain reaction (PCR) testing were included. Patients positive and negative for COVID-19 were matched on age, sex, vaccination status, PCR test date, and a propensity score. Patients were followed up from the end of the acute infection period (12 weeks after PCR) until the study end date. Per-person per-year HCU rates were captured and compared. Analyses were stratified according to COVID-19 variant eras (wild-type/Alpha/Beta, Delta, and Omicron) and vaccination status (0, 1, 2, and ≥ 3). RESULTS: A total of 31,540 matched pairs were identified. Mean age was 66.4 years, and 49.9% were male. Individuals with positive COVID-19 test results had 9% higher HCU rates than those who tested negative (rate ratio [RR], 1.09; 95% CI, 1.067-1.127). Stratifying according to variant, wild-type/Alpha/Beta and Omicron variants had 16% (RR, 1.16; 95% CI, 1.119-1.22) and 5% (RR, 1.051; 95% CI, 1.01-1.092) higher HCU rates, respectively. Individuals with ≥ 3 vaccinations did not have elevated rates of HCU (RR, 1.03; 95% CI, 0.981-1.081) compared with those who tested negative. INTERPRETATION: In this study, patients with COPD who were positive for COVID-19 had significantly greater long-term HCU usage. Although Omicron has been considered milder than previous variants, it was still associated with significantly elevated long-term HCU. Individuals with ≥ 3 vaccinations who tested positive for COVID-19 had HCU rates similar to those who tested negative, suggesting that vaccinations can reduce long-term HCU.