Predictors of health care utilization in patients with post-acute sequelae of COVID-19 (PASC)

Abstract

Background Research on Post-acute sequelae of COVID (PASC) has focused on the prevalence of symptoms, leaving gaps in our understanding of predictors of health care seeking. Objective To identify clinical and sociodemographic characteristics associated with PASC care seeking. Methods Retrospective cohort study of adult patients with COVID-19 diagnosis between January 1, 2021 and June 30, 2022 in a community-based comprehensive health care delivery system at 21 hospitals and medical clinics in Northern California. Primary outcome was one or more PASC care seeking encounters at least 28 days after COVID-19 diagnosis in unadjusted and multivariate analyses. Results Of 600,295 surviving COVID patients, 3,797 (0.63%) had PASC care encounters. Female sex (RR 1.29, 95% CI 1.20–1.39), non-Hispanic White race, age 40–49 years (RR 2.35, 95% CI 2.08–2.66), more severe acute COVID illness, including an ED visit (RR 4.41, 95% CI 3.92–4.96), and severe depression (RR 1.69, 95% CI 1.32–2.16) were associated with PASC care. COVID immunization (RR 0.79, 95% CI 0.72–0.85), metformin use among diabetic patients (RR 0.74, 95% CI 0.64–0.84), and diagnosis during Omicron predominance (RR 0.54, 95% CI 0.49–0.60) were associated with lower PASC care. Conclusion Higher illness severity, medical comorbidities, and infection during the Delta and pre-Delta periods were associated with PASC care seeking. COVID immunization and metformin were associated with lower PASC care seeking. These findings could be useful in understanding the patterns and burden of care seeking for a new disease entity.