Abstract

Context: Persons with disabilities were more likely to experience serious illness, death, and adverse consequences by the COVID-19 pandemic. Objective: Compare the incidence of post-COVID conditions (PCC) by pre-pandemic diagnosed by the type of disability. Study Design and Analysis: This is a retrospective observational study of primary care visits during the 2019-2022 study period. Time to post-COVID conditions (PCCs) and unadjusted and adjusted time ratios were estimated using multivariable parametric Accelerated Failure Time (AFT) models. Setting or Dataset: American Family Cohort, a data asset including electronic health records of 8 million patients from family practices across 50 US states. Population Studied: Patients with ≥1 visit between January 2018 and December 2019 and who remained in the cohort until at least May 2020. We compared four groups: patients with and without COVID-19, stratified by pre-pandemic disability status. Measurements. Intervention/Instrument: Disability status was identified from documented diagnostic codes from January 2018 to December 2019, and COVID-19 diagnosis was captured between April 2020 and December 2022. Outcome Measures: The outcomes were incident circulatory, endocrine, neurological, and respiratory diagnoses as measured in primary care using diagnosis codes. Results: Patients with disabilities and COVID-19 had greater and earlier onset of diagnosis of new circulatory (Time Ratio (TR) 0.8, 95% CI 0.74, 0.87), endocrine (TR 0.92, 95% CI 0.86, 0.99), or neurological conditions (TR 0.6, 95% CI 0.51, 0.7) but not respiratory conditions (TR 0.99, 95% CI 0.92, 1.06) during the post-COVID period as compared to patients with COVID-19 without disability. Conclusions: Patients with pre-existing disability experienced a higher incidence of PCC and more rapid onset of adverse long-term outcomes than patients without disability. These findings inform our understanding of PCC burden and may have clinical utility for directing care where most needed.