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Early Adoption of Anti–SARS-CoV-2 Pharmacotherapies Among US Veterans With Mild to Moderate COVID-19, January and February 2022
IMPORTANCE: Older adults and individuals with medical comorbidities are at increased risk for severe COVID-19. Several pharmacotherapies demonstrated to reduce the risk of COVID-19–related hospitalization and death have been authorized for use. OBJECTIVE: To describe factors associated with receipt...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Medical Association
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9652752/ https://www.ncbi.nlm.nih.gov/pubmed/36367727 http://dx.doi.org/10.1001/jamanetworkopen.2022.41434 |
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author | Bajema, Kristina L. Wang, Xiao Qing Hynes, Denise M. Rowneki, Mazhgan Hickok, Alex Cunningham, Francesca Bohnert, Amy Boyko, Edward J. Iwashyna, Theodore J. Maciejewski, Matthew L. Viglianti, Elizabeth M. Streja, Elani Yan, Lei Aslan, Mihaela Huang, Grant D. Ioannou, George N. |
author_facet | Bajema, Kristina L. Wang, Xiao Qing Hynes, Denise M. Rowneki, Mazhgan Hickok, Alex Cunningham, Francesca Bohnert, Amy Boyko, Edward J. Iwashyna, Theodore J. Maciejewski, Matthew L. Viglianti, Elizabeth M. Streja, Elani Yan, Lei Aslan, Mihaela Huang, Grant D. Ioannou, George N. |
author_sort | Bajema, Kristina L. |
collection | PubMed |
description | IMPORTANCE: Older adults and individuals with medical comorbidities are at increased risk for severe COVID-19. Several pharmacotherapies demonstrated to reduce the risk of COVID-19–related hospitalization and death have been authorized for use. OBJECTIVE: To describe factors associated with receipt of outpatient COVID-19 pharmacotherapies in the Veterans Affairs (VA) health care system. DESIGN, SETTINGS, AND PARTICIPANTS: This cohort study assessed outpatient veterans with risk factors for severe COVID-19 who tested positive for SARS-CoV-2 during January and February 2022. The setting was the VA health care system, the largest integrated health care system in the US. EXPOSURES: Demographic characteristics, place of residence, underlying medical conditions, and COVID-19 vaccination. MAIN OUTCOMES AND MEASURES: The odds of receipt of any COVID-19 pharmacotherapy, including sotrovimab, nirmatrelvir boosted with ritonavir, molnupiravir, or remdesivir were estimated using multivariable logistic regression. RESULTS: Among 111 717 veterans included in this study (median [IQR] age, 60 [46-72] years; 96 482 [86.4%] male, 23 362 [20.9%] Black, 10 740 [9.6%] Hispanic, 75 973 [68.0%] White) who tested positive for SARS-CoV-2 during January to February 2022, 4233 (3.8%) received any COVID-19 pharmacotherapy, including 2870 of 92 396 (3.1%) in January and 1363 of 19 321 (7.1%) in February. Among a subset of 56 285 veterans with documented COVID-19–related symptoms in the 30 days preceding a positive SARS-CoV-2 test, 3079 (5.5%) received any COVID-19 pharmacotherapy. Untreated veterans had a median (IQR) age of 60 (46-71) years and a median (IQR) of 3 (2-5) underlying medical conditions. Veterans receiving any treatment were more likely to be older (aged 65 to 74 years vs 50 to 64 years: adjusted odds ratio [aOR], 1.66 [95% CI, 1.52-1.80]; aged at least 75 years vs 50 to 64 years: aOR, 1.67 [95% CI, 1.53-1.84]) and have a higher number of underlying conditions (at least 5 conditions vs 1 to 2 conditions: aOR, 2.17 [95% CI, 1.98-2.39]). Compared with White veterans, Black veterans (aOR, 0.65 [95% CI, 0.60-0.72]) were less likely to receive treatment; and compared with non-Hispanic veterans, Hispanic veterans (aOR, 0.88 [95% CI, 0.77-0.99]) were less likely to receive treatment. There were 16 546 courses of sotrovimab, nirmatrelvir, and molnupiravir allocated across the VA during this period. CONCLUSIONS AND RELEVANCE: In this cohort study of veterans who tested positive for SARS-CoV-2 during January and February when supply of outpatient COVID-19 pharmacotherapies was limited, prescription of these pharmacotherapies was underused, and many veterans with risk factors for severe COVID-19 did not receive treatment. Veterans from minority racial and ethnic groups were less likely to receive any pharmacotherapy. |
format | Online Article Text |
id | pubmed-9652752 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | American Medical Association |
record_format | MEDLINE/PubMed |
spelling | pubmed-96527522022-11-28 Early Adoption of Anti–SARS-CoV-2 Pharmacotherapies Among US Veterans With Mild to Moderate COVID-19, January and February 2022 Bajema, Kristina L. Wang, Xiao Qing Hynes, Denise M. Rowneki, Mazhgan Hickok, Alex Cunningham, Francesca Bohnert, Amy Boyko, Edward J. Iwashyna, Theodore J. Maciejewski, Matthew L. Viglianti, Elizabeth M. Streja, Elani Yan, Lei Aslan, Mihaela Huang, Grant D. Ioannou, George N. JAMA Netw Open Original Investigation IMPORTANCE: Older adults and individuals with medical comorbidities are at increased risk for severe COVID-19. Several pharmacotherapies demonstrated to reduce the risk of COVID-19–related hospitalization and death have been authorized for use. OBJECTIVE: To describe factors associated with receipt of outpatient COVID-19 pharmacotherapies in the Veterans Affairs (VA) health care system. DESIGN, SETTINGS, AND PARTICIPANTS: This cohort study assessed outpatient veterans with risk factors for severe COVID-19 who tested positive for SARS-CoV-2 during January and February 2022. The setting was the VA health care system, the largest integrated health care system in the US. EXPOSURES: Demographic characteristics, place of residence, underlying medical conditions, and COVID-19 vaccination. MAIN OUTCOMES AND MEASURES: The odds of receipt of any COVID-19 pharmacotherapy, including sotrovimab, nirmatrelvir boosted with ritonavir, molnupiravir, or remdesivir were estimated using multivariable logistic regression. RESULTS: Among 111 717 veterans included in this study (median [IQR] age, 60 [46-72] years; 96 482 [86.4%] male, 23 362 [20.9%] Black, 10 740 [9.6%] Hispanic, 75 973 [68.0%] White) who tested positive for SARS-CoV-2 during January to February 2022, 4233 (3.8%) received any COVID-19 pharmacotherapy, including 2870 of 92 396 (3.1%) in January and 1363 of 19 321 (7.1%) in February. Among a subset of 56 285 veterans with documented COVID-19–related symptoms in the 30 days preceding a positive SARS-CoV-2 test, 3079 (5.5%) received any COVID-19 pharmacotherapy. Untreated veterans had a median (IQR) age of 60 (46-71) years and a median (IQR) of 3 (2-5) underlying medical conditions. Veterans receiving any treatment were more likely to be older (aged 65 to 74 years vs 50 to 64 years: adjusted odds ratio [aOR], 1.66 [95% CI, 1.52-1.80]; aged at least 75 years vs 50 to 64 years: aOR, 1.67 [95% CI, 1.53-1.84]) and have a higher number of underlying conditions (at least 5 conditions vs 1 to 2 conditions: aOR, 2.17 [95% CI, 1.98-2.39]). Compared with White veterans, Black veterans (aOR, 0.65 [95% CI, 0.60-0.72]) were less likely to receive treatment; and compared with non-Hispanic veterans, Hispanic veterans (aOR, 0.88 [95% CI, 0.77-0.99]) were less likely to receive treatment. There were 16 546 courses of sotrovimab, nirmatrelvir, and molnupiravir allocated across the VA during this period. CONCLUSIONS AND RELEVANCE: In this cohort study of veterans who tested positive for SARS-CoV-2 during January and February when supply of outpatient COVID-19 pharmacotherapies was limited, prescription of these pharmacotherapies was underused, and many veterans with risk factors for severe COVID-19 did not receive treatment. Veterans from minority racial and ethnic groups were less likely to receive any pharmacotherapy. American Medical Association 2022-11-11 /pmc/articles/PMC9652752/ /pubmed/36367727 http://dx.doi.org/10.1001/jamanetworkopen.2022.41434 Text en Copyright 2022 Bajema KL et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License. |
spellingShingle | Original Investigation Bajema, Kristina L. Wang, Xiao Qing Hynes, Denise M. Rowneki, Mazhgan Hickok, Alex Cunningham, Francesca Bohnert, Amy Boyko, Edward J. Iwashyna, Theodore J. Maciejewski, Matthew L. Viglianti, Elizabeth M. Streja, Elani Yan, Lei Aslan, Mihaela Huang, Grant D. Ioannou, George N. Early Adoption of Anti–SARS-CoV-2 Pharmacotherapies Among US Veterans With Mild to Moderate COVID-19, January and February 2022 |
title | Early Adoption of Anti–SARS-CoV-2 Pharmacotherapies Among US Veterans With Mild to Moderate COVID-19, January and February 2022 |
title_full | Early Adoption of Anti–SARS-CoV-2 Pharmacotherapies Among US Veterans With Mild to Moderate COVID-19, January and February 2022 |
title_fullStr | Early Adoption of Anti–SARS-CoV-2 Pharmacotherapies Among US Veterans With Mild to Moderate COVID-19, January and February 2022 |
title_full_unstemmed | Early Adoption of Anti–SARS-CoV-2 Pharmacotherapies Among US Veterans With Mild to Moderate COVID-19, January and February 2022 |
title_short | Early Adoption of Anti–SARS-CoV-2 Pharmacotherapies Among US Veterans With Mild to Moderate COVID-19, January and February 2022 |
title_sort | early adoption of anti–sars-cov-2 pharmacotherapies among us veterans with mild to moderate covid-19, january and february 2022 |
topic | Original Investigation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9652752/ https://www.ncbi.nlm.nih.gov/pubmed/36367727 http://dx.doi.org/10.1001/jamanetworkopen.2022.41434 |
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