Impact of dementia, living in a long-term care facility, and physical activity status on COVID-19 severity in older adults
Shinya Tsuzuki, Takayuki Akiyama, Nobuaki Matsunaga, Norio Ohmagari
doi:10.1101/2022.07.01.22277144
Background: Japan is fast becoming an extremely aged society and older adults are known to be at risk of severe COVID-19. However, the impact of risk factors specific to this population for severe COVID-19 caused by the Omicron variant of concern (VOC) are not yet clear.
Methods: We performed an exploratory analysis using logistic regression to identify risk factors for severe COVID-19 illness among 4,868 older adults with a positive SARS-CoV-2 test result who were admitted to a healthcare facility between 1 January 2022 and 16 May 2022. We then conducted one-to-one propensity score (PS) matching for three factors-dementia, admission from a long-term care facility, and poor physical activity status-and used Fisher's exact test to compare the proportion of severe COVID-19 cases in the matched data. We also estimated the average treatment effect on treated (ATT) in each PS matching analysis. Results: Of the 4,868 cases analyzed, 1,380 were severe. Logistic regression analysis showed that age, male sex, cardiovascular disease, cerebrovascular disease, chronic lung disease, renal failure and/or dialysis, physician-diagnosed obesity, admission from a long-term care facility, and poor physical activity status were risk factors for severe disease. Vaccination and dementia were identified as factors associated with non-severe illness. The ATT for dementia, admission from a long-term care facility, and poor . physical activity status was −0.04 (95% confidence interval −0.07, −0.01), 0.09 (0.06, 0.12), and 0.17 (0.14, 0.19), respectively.
Conclusions: Our results suggest that poor physical activity status and living in a long-term care facility have a substantial impact on the risk of severe COVID-19 caused by the Omicron VOC, while dementia might be associated with non-severe illness. .
Ethics approval . Our study data were provided by Research Electronic Data Capture, a secure, Web-based data capture application hosted at the JCRAC Data Center of the National Center for Global Health and Medicine. The opt-out recruitment method was applied, and informed consents for individuals were waived, as approved by the National Center for Global Health and Medicine Ethics Review Board. Information about the entire research is available through the COVID-19 Registry Japan website (https://covid-registry.ncgm.go.jp/). This study was approved by the National Center for Global Health and Medicine Ethics Review Board (approval number: NCGM-G-003494-0).
Conflict of interest statement All authors have no conflicts of interest to be disclosed.
Authors' contributions ST and NO conceived the study. TA curated the data. ST and TA analyzed and interpreted the data. ST wrote the first draft of the manuscript. All authors critically reviewed the manuscript and approved the final version. .
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'abstract': '<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Japan '
'is fast becoming an extremely aged society and older adults are known to be at risk of severe '
'COVID-19. However, the impact of risk factors specific to this population for severe COVID-19 '
'caused by the Omicron variant of concern (VOC) are not yet '
'clear.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We performed an '
'exploratory analysis using logistic regression to identify risk factors for severe COVID-19 '
'illness among 4,868 older adults with a positive SARS-CoV-2 test result who were admitted to '
'a healthcare facility between 1 January 2022 and 16 May 2022. We then conducted one-to-one '
'propensity score (PS) matching for three factors—dementia, admission from a long-term care '
'facility, and poor physical activity status—and used Fisher’s exact test to compare the '
'proportion of severe COVID-19 cases in the matched data. We also estimated the average '
'treatment effect on treated (ATT) in each PS matching '
'analysis.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of the 4,868 '
'cases analyzed, 1,380 were severe. Logistic regression analysis showed that age, male sex, '
'cardiovascular disease, cerebrovascular disease, chronic lung disease, renal failure and/or '
'dialysis, physician-diagnosed obesity, admission from a long-term care facility, and poor '
'physical activity status were risk factors for severe disease. Vaccination and dementia were '
'identified as factors associated with non-severe illness. The ATT for dementia, admission '
'from a long-term care facility, and poor physical activity status was −0.04 (95% confidence '
'interval −0.07, −0.01), 0.09 (0.06, 0.12), and 0.17 (0.14, 0.19), '
'respectively.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Our '
'results suggest that poor physical activity status and living in a long-term care facility '
'have a substantial impact on the risk of severe COVID-19 caused by the Omicron VOC, while '
'dementia might be associated with non-severe illness.</jats:p></jats:sec>',
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