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Design and analysis of outcomes following SARS-CoV-2 infection in veterans.

Publication ,  Journal Article
Smith, VA; Berkowitz, TSZ; Hebert, P; Wong, ES; Niederhausen, M; Pura, JA; Berry, K; Green, P; Korpak, A; Fox, A; Baraff, A; Hickok, A ...
Published in: BMC Med Res Methodol
April 4, 2023

BACKGROUND: Understanding how SARS-CoV-2 infection impacts long-term patient outcomes requires identification of comparable persons with and without infection. We report the design and implementation of a matching strategy employed by the Department of Veterans Affairs' (VA) COVID-19 Observational Research Collaboratory (CORC) to develop comparable cohorts of SARS-CoV-2 infected and uninfected persons for the purpose of inferring potential causative long-term adverse effects of SARS-CoV-2 infection in the Veteran population. METHODS: In a retrospective cohort study, we identified VA health care system patients who were and were not infected with SARS-CoV-2 on a rolling monthly basis. We generated matched cohorts within each month utilizing a combination of exact and time-varying propensity score matching based on electronic health record (EHR)-derived covariates that can be confounders or risk factors across a range of outcomes. RESULTS: From an initial pool of 126,689,864 person-months of observation, we generated final matched cohorts of 208,536 Veterans infected between March 2020-April 2021 and 3,014,091 uninfected Veterans. Matched cohorts were well-balanced on all 39 covariates used in matching after excluding patients for: no VA health care utilization; implausible age, weight, or height; living outside of the 50 states or Washington, D.C.; prior SARS-CoV-2 diagnosis per Medicare claims; or lack of a suitable match. Most Veterans in the matched cohort were male (88.3%), non-Hispanic (87.1%), white (67.2%), and living in urban areas (71.5%), with a mean age of 60.6, BMI of 31.3, Gagne comorbidity score of 1.4 and a mean of 2.3 CDC high-risk conditions. The most common diagnoses were hypertension (61.4%), diabetes (34.3%), major depression (32.2%), coronary heart disease (28.5%), PTSD (25.5%), anxiety (22.5%), and chronic kidney disease (22.5%). CONCLUSION: This successful creation of matched SARS-CoV-2 infected and uninfected patient cohorts from the largest integrated health system in the United States will support cohort studies of outcomes derived from EHRs and sample selection for qualitative interviews and patient surveys. These studies will increase our understanding of the long-term outcomes of Veterans who were infected with SARS-CoV-2.

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Published In

BMC Med Res Methodol

DOI

EISSN

1471-2288

Publication Date

April 4, 2023

Volume

23

Issue

1

Start / End Page

81

Location

England

Related Subject Headings

  • Veterans
  • United States
  • SARS-CoV-2
  • Retrospective Studies
  • Middle Aged
  • Medicare
  • Male
  • Humans
  • General & Internal Medicine
  • Female
 

Citation

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Chicago
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Smith, V. A., Berkowitz, T. S. Z., Hebert, P., Wong, E. S., Niederhausen, M., Pura, J. A., … Maciejewski, M. L. (2023). Design and analysis of outcomes following SARS-CoV-2 infection in veterans. BMC Med Res Methodol, 23(1), 81. https://doi.org/10.1186/s12874-023-01882-z
Smith, Valerie A., Theodore S. Z. Berkowitz, Paul Hebert, Edwin S. Wong, Meike Niederhausen, John A. Pura, Kristin Berry, et al. “Design and analysis of outcomes following SARS-CoV-2 infection in veterans.BMC Med Res Methodol 23, no. 1 (April 4, 2023): 81. https://doi.org/10.1186/s12874-023-01882-z.
Smith VA, Berkowitz TSZ, Hebert P, Wong ES, Niederhausen M, Pura JA, et al. Design and analysis of outcomes following SARS-CoV-2 infection in veterans. BMC Med Res Methodol. 2023 Apr 4;23(1):81.
Smith, Valerie A., et al. “Design and analysis of outcomes following SARS-CoV-2 infection in veterans.BMC Med Res Methodol, vol. 23, no. 1, Apr. 2023, p. 81. Pubmed, doi:10.1186/s12874-023-01882-z.
Smith VA, Berkowitz TSZ, Hebert P, Wong ES, Niederhausen M, Pura JA, Berry K, Green P, Korpak A, Fox A, Baraff A, Hickok A, Shahoumian TA, Bohnert ASB, Hynes DM, Boyko EJ, Ioannou GN, Iwashyna TJ, Bowling CB, O’Hare AM, Maciejewski ML. Design and analysis of outcomes following SARS-CoV-2 infection in veterans. BMC Med Res Methodol. 2023 Apr 4;23(1):81.
Journal cover image

Published In

BMC Med Res Methodol

DOI

EISSN

1471-2288

Publication Date

April 4, 2023

Volume

23

Issue

1

Start / End Page

81

Location

England

Related Subject Headings

  • Veterans
  • United States
  • SARS-CoV-2
  • Retrospective Studies
  • Middle Aged
  • Medicare
  • Male
  • Humans
  • General & Internal Medicine
  • Female