Healthcare utilization patterns before and after a long COVID diagnosis: a case-control study, 2025, DeVoss+

Abstract:
Background
Documenting Long COVID cases has been challenging partly due to the lack of population-level data and uncertain diagnostic criteria, hindering the ability to ascertain healthcare utilization patterns over time. The objective of this study is to examine the characteristics and healthcare utilization patterns of Long COVID patients in Colorado pre- and post-diagnosis compared to controls.

Methods
Retrospective, longitudinal case-control study using a 100% sample of Colorado’s All-Payer Claims Database. The sample includes individuals 18 or older diagnosed with Long COVID between October 1, 2021, and August 1, 2022, with patients followed until August 2023. Long COVID was identified using the International Classification of Diseases, 10th Revision, U09.9 code in medical insurance claims. Analysis of healthcare utilization required one year of continuous enrollment before and after diagnosis. Controls were matched 2:1 on age group, sex, payer, and index month to account for contemporaneous trends in utilization.

Results
26,358 individuals were ever diagnosed with Long COVID, resulting in a claims-based prevalence of 674 per 100,000 during the study period (population 3,906,402 individuals). Of these, 12,698 individuals had continuous enrollment and a Long COVID diagnosis: mean (SD) age, 59.0 (17.1); 65.3% female; 60.1% white; 83.0% residing in urban areas. The Long COVID sample was matched with 25,376 controls. Before diagnosis, 17% of Long COVID patients were hospitalized at least once, and 40% visited an emergency department on at least one occasion. Within the year following diagnosis, utilization of acute healthcare services significantly decreased relative to controls: hospitalizations, -6.1percentage points (p.p.), emergency department visits, -7.7 p.p., whereas outpatient services and medications increased: office visits, 3.6 p.p.; specialist office visits, 4.7 p.p.; and 5.2 new medications, (controls: 2.8). Changes in diagnoses of some conditions (e.g., metastatic carcinomas and lung cancer) were similar between groups.

Conclusions and relevance
Long COVID patients increased outpatient healthcare utilization following a diagnosis, switching from acute care settings. The change in service settings among this population suggests that diagnosis could lead to better patient management. Healthcare utilization among these patients is high, underscoring the need to understand the Long COVID burden on healthcare systems with population-level data.

Link | PDF (BMC Public Health, February 2025, open access)

 

I’m not from the US. Can someone explain what this DB is?

 

https://www.eurekalert.org/news-releases/1073120

News Release 10-Feb-2025
New study highlights healthcare utilization shifts among Long COVID patients in Colorado after diagnosis

Patients were more likely to utilize outpatient healthcare, versus hospitals, following diagnosis, a trend that may lead to improved patient outcomes and targeted treatment plans

Peer-Reviewed Publication
University of Colorado Anschutz Medical Campus


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AURORA, Colo. (Feb 10, 2025) – A new study analyzing Long COVID healthcare utilization in Colorado reveals a significant shift from acute care to outpatient services following diagnosis, shedding light on evolving treatment patterns and the broader healthcare burden posed by the condition.

The study, published today in BMC Public Health, was conducted using Colorado’s comprehensive All-Payer Claims Database and provides one of the most detailed population-level insights into Long COVID patients to date. Researchers examined utilization patterns of individuals diagnosed with Long COVID between October 2021 and August 2022, tracking them for one-year post-diagnosis.

“The study highlights the substantial burden Long COVID places on healthcare systems, emphasizing the need for robust data and comprehensive care models,” says Rick Devoss, MPH, doctoral student at the Colorado School of Public Health at the University of Colorado Anschutz Medical Campus and study co-author. “Understanding these utilization patterns can help policymakers and healthcare providers allocate resources effectively and design interventions that address the unique needs of Long COVID patients.”

Out of a population of approximately 3.9 million, 26,358 (0.67%) individuals were diagnosed with Long COVID, equating to 674 cases per 100,000 people.

"This collaboration between the State and the University of Colorado Anschutz Medical Campus represents a critical step in understanding the long-term impact of COVID-19 on our communities,” says Rachel Herlihy, MD, MPH, Colorado State Epidemiologist. “By leveraging insurance data, we can uncover vital insights into healthcare utilization, costs, and patient outcomes, ultimately guiding policy and improving care for those affected by Long COVID. This research is a testament to the power of state and academic partnerships in addressing pressing public health challenges."

Researchers observed a significant shift in healthcare utilization with these data. Prior to diagnosis, 17% of patients experienced at least one hospitalization, and 40% had visited an emergency department. Post-diagnosis, hospitalizations decreased by 6.1 percentage points (p.p.), and emergency department visits dropped by 7.7 (p.p.) compared to matched controls. In contrast, outpatient office visits increased by 3.6 (p.p.), specialist visits rose by 4.7(p.p.), and prescription of new medications surged.

“These results suggest that receipt of a Long COVID diagnosis, which often comes in conjunction with engagement with a multidisciplinary Long COVID clinic, may lead to better management and a shift away from costly acute care settings toward more sustainable outpatient care. Engagement in care with Long COVID aware providers may allow for more treatment options and greater validation of lived experience for patients with Long COVID,” says Sarah Jolley, MD, co-author of the study and director of the UCHealth Post-COVID/ICU Recovery Clinic. “This trend underscores the importance of timely diagnosis and coordinated care strategies for improving patient outcomes,” she continued.

“This marks a critical step toward understanding the long-term healthcare needs of this patient population, and similar groups affected by post-viral conditions that are hard to diagnose and treat because of the constellation of symptoms and organs involved” says Marcelo Perraillon, PhD, associate professor at the Colorado School of Public Health and study co-author. “Moreover, utilizing the All-Payer Claims Database, which includes data from about 75% of the state population, allows us to capture a more robust representation of the entire population rather than pulling from anonymized electronic health records from some select health systems.”

This research leveraged the International Classification of Diseases (ICD-10) U09.9 code to identify Long COVID cases, offering a new lens through which to view healthcare demands associated with the condition. Patients diagnosed with Long COVID were compared to similar patients without the condition to account for changes in healthcare utilization during the pandemic years. The study also found that some diagnosed conditions like advanced cancer changed similarly among Long COVID patients and controls, suggesting the importance of considering the impact of changes in utilization that affected the entire population during the pandemic period.

“Long COVID is disabling and can be psychologically damaging,” Dr. Perraillon says. “If you are fatigued, in pain, and cannot sleep, it’s very hard to function. Quality of life and productivity suffer, and like similar conditions hard to diagnose, patients go from doctor to doctor or the emergency department to find relief and answers. Some also get the additional diagnosis of chronic fatigue syndrome.”

This research is part of a larger project to investigate utilization patterns, costs, and outcomes of patients diagnosed with Long COVID and those who are likely to have the condition but have not received a diagnosis. The research would not have been possible without funding made available by the Office of Saving People Money on Health Care, the Colorado School of Public Health’s Dean’s Initiative Funding, the Colorado Department of Public Health and Environment, and others. Moreover, it exemplifies the important work that can be accomplished through enhanced collaborations between the state agencies and the university.

“This study exemplifies the power of collaboration between state agencies and our world-class research institutions,” says Dianne Primavera, Lieutenant Governor of Colorado and director of the Office of Saving People Money on Health Care. “By working together with the University of Colorado Anschutz Medical Campus, we are deepening our understanding of Long COVID’s impact on our population and improving our ability to support Coloradans affected by this condition. Partnerships like these are essential to driving forward data-driven policies that enhance public health and ensure that our healthcare system can meet evolving needs.”

About the University of Colorado Anschutz Medical Campus

The University of Colorado Anschutz Medical Campus is a world-class medical destination at the forefront of transformative science, medicine, education and patient care. The campus encompasses the University of Colorado health professional schools, more than 60 centers and institutes and two nationally ranked independent hospitals - UCHealth University of Colorado Hospital and Children's Hospital Colorado – which see more than two million adult and pediatric patient visits yearly. Innovative, interconnected and highly collaborative, the CU Anschutz Medical Campus delivers life-changing treatments, patient care and professional training and conducts world-renowned research fueled by $910 million in annual research funding, including $757 million in sponsored awards and $153 million in philanthropic gifts.

Journal
BMC Public Health

DOI
10.1186/s12889-025-21393-4

Article Publication Date
10-Feb-2025