Harindra C Wijeysundera1,2,3,4, Husam Abdel-Qadir5,6,7,8, Feng Qiu6, Ragavie Manoragavan9, Peter C Austin5,6, Moira K Kapral5,6,7,10, Jeffrey C Kwong6,7, Louise Y Sun6,11, Heather J Ross7,12, Jacob A Udell5,6,7,8,12, Idan Roifman5,6,9,7, Amy Y X Yu5,6,7,13, Anna Chu6, Finlay A McAlister14,15, Douglas S Lee5,6,7,12. 1. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. harindra.wijeysundera@sunnybrook.ca. 2. ICES, Toronto, Canada. harindra.wijeysundera@sunnybrook.ca. 3. Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave., Room A202, Toronto, ON, M4N 3M5, Canada. harindra.wijeysundera@sunnybrook.ca. 4. Temerty Faculty of Medicine, University of Toronto, Toronto, Canada. harindra.wijeysundera@sunnybrook.ca. 5. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. 6. ICES, Toronto, Canada. 7. Temerty Faculty of Medicine, University of Toronto, Toronto, Canada. 8. Cardiovascular Division, Department of Medicine, Women's College Hospital, Toronto, Canada. 9. Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave., Room A202, Toronto, ON, M4N 3M5, Canada. 10. Division of General Internal Medicine and Women's Health Program, University Health Network, Toronto, Canada. 11. Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Canada. 12. Peter Munk Cardiac Centre, University Health Network, Toronto, Canada. 13. Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 14. Division of General Internal Medicine, University of Alberta, Edmonton, Canada. 15. Canadian VIGOUR Centre, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada.
Abstract
BACKGROUND: There is a paucity of the literature on the relationship between frailty and excess mortality due to the COVID-19 pandemic. METHODS: The entire community-dwelling adult population of Ontario, Canada, as of January 1st, 2018, was identified using the Cardiovascular Health in Ambulatory Care Research Team (CANHEART) cohort. Residents of long-term care facilities were excluded. Frailty was categorized through the Johns Hopkins Adjusted Clinical Groups (ACG® System) frailty indicator. Follow-up was until December 31st, 2020, with March 11th, 2020, indicating the beginning of the COVID-19 pandemic. Using multivariable Cox models with patient age as the timescale, we determined the relationship between frailty status and pandemic period on all-cause mortality. We evaluated the modifier effect of frailty using both stratified models as well as incorporating an interaction between frailty and the pandemic period. RESULTS: We identified 11,481,391 persons in our cohort, of whom 3.2% were frail based on the ACG indicator. Crude mortality increased from 0.75 to 0.87% per 100 person years from the pre- to post-pandemic period, translating to ~ 13,800 excess deaths among the community-dwelling adult population of Ontario (HR 1.11 95% CI 1.09-1.11). Frailty was associated with a statistically significant increase in all-cause mortality (HR 3.02, 95% CI 2.99-3.06). However, all-cause mortality increased similarly during the pandemic in frail (aHR 1.13, 95% CI 1.09-1.16) and non-frail (aHR 1.15, 95% CI 1.13-1.17) persons. CONCLUSION: Although frailty was associated with greater mortality, frailty did not modify the excess mortality associated with the pandemic.
BACKGROUND: There is a paucity of the literature on the relationship between frailty and excess mortality due to the COVID-19 pandemic. METHODS: The entire community-dwelling adult population of Ontario, Canada, as of January 1st, 2018, was identified using the Cardiovascular Health in Ambulatory Care Research Team (CANHEART) cohort. Residents of long-term care facilities were excluded. Frailty was categorized through the Johns Hopkins Adjusted Clinical Groups (ACG® System) frailty indicator. Follow-up was until December 31st, 2020, with March 11th, 2020, indicating the beginning of the COVID-19 pandemic. Using multivariable Cox models with patient age as the timescale, we determined the relationship between frailty status and pandemic period on all-cause mortality. We evaluated the modifier effect of frailty using both stratified models as well as incorporating an interaction between frailty and the pandemic period. RESULTS: We identified 11,481,391 persons in our cohort, of whom 3.2% were frail based on the ACG indicator. Crude mortality increased from 0.75 to 0.87% per 100 person years from the pre- to post-pandemic period, translating to ~ 13,800 excess deaths among the community-dwelling adult population of Ontario (HR 1.11 95% CI 1.09-1.11). Frailty was associated with a statistically significant increase in all-cause mortality (HR 3.02, 95% CI 2.99-3.06). However, all-cause mortality increased similarly during the pandemic in frail (aHR 1.13, 95% CI 1.09-1.16) and non-frail (aHR 1.15, 95% CI 1.13-1.17) persons. CONCLUSION: Although frailty was associated with greater mortality, frailty did not modify the excess mortality associated with the pandemic.
Authors: Shelley A Sternberg; Netta Bentur; Chad Abrams; Tal Spalter; Tomas Karpati; John Lemberger; Anthony D Heymann Journal: Am J Manag Care Date: 2012-10-01 Impact factor: 2.229
Authors: Douglas S Lee; Chloe X Wang; Finlay A McAlister; Shihao Ma; Anna Chu; Paula A Rochon; Padma Kaul; Peter C Austin; Xuesong Wang; Sunil V Kalmady; Jacob A Udell; Michael J Schull; Barry B Rubin; Bo Wang Journal: Lancet Reg Health Am Date: 2022-01-17