Adults with disabilities in hospital for COVID-19 have worse outcomes

Adults with disabilities have worse outcomes when hospitalized with COVID-19 than patients without disabilities, including longer hospital stays and increased risk of readmission, found new research in CMAJ (Canadian Medical Association Journal).

The differences were especially pronounced in people younger than 65 years.

"[C]onsideration of disability-related needs has largely been absent from the COVID-19 response, with vaccine eligibility driven primarily by age and medical comorbidity, limited accommodations made for patients with disabilities who are in hospital, and disability data often not being captured in surveillance programs," writes Dr. Hilary Brown, University of Toronto Scarborough, with coauthors.

The study included data on 1279 patients aged 18 years or older hospitalized for COVID-19 at seven teaching hospitals in Toronto and Mississauga, Ontario, between January 1 and November 30, 2020. Researchers found that people with disabilities had 36% longer hospital stays and were 77% more likely to be readmitted to hospital within 30 days of their first hospitalization. These higher rates persisted after the researchers accounted for age and other factors that might explain differences.

Highest risks for poor outcomes were in patients with traumatic brain injury, intellectual or developmental disabilities, and multiple disabilities.

"Our findings suggest disability-related needs must be included in plans for COVID-19 response, in particular to support patients in hospital and immediately after hospitalization, including community supports to ensure safe transitions home and reduce risk of unplanned return to hospital," says Dr. Amol Verma, St. Michael's Hospital, Unity Health Toronto.

The findings are consistent with studies from the United States and the United Kingdom showing worse outcomes from COVID-19 in people with disabilities.

Disability advocates welcome the contribution of new data to highlight the importance of supporting people with disabilities during the pandemic.

"There are two and a half million Ontarians who have disabilities, which is a significant proportion of the population, and includes our family members, our friends, our co-workers, and people in our communities," says disability advocate Sandi Bell, chair of the Accessibility for Ontarians with Disabilities Act (AODA) Health Care Standards Development Committee and member of the Board of Directors of ARCH Disability Law Centre. "Yet throughout COVID-19, people with disabilities have been made to feel invisible. We have become even more vulnerable, as maneuvering [through] the health care system has been difficult, confusing and scary. There is genuine demand for this type of data to help prioritize the needs of people with disabilities, which is what we believe Canadians would want to see."

Steps to address the needs of people with disabilities include accommodations for patients who need support persons, training of clinicians on the needs and rights of people with disabilities, introducing patient-oriented discharge planning to home and inclusion of disability-related data in COVID-19 surveillance.

"Such efforts should be prioritized in the pandemic response to ensure equitable care for patients with disabilities who have COVID-19," the authors urge.