One-year healthcare trajectories after COVID-19 hospitalisation in patients with chronic respiratory diseases: a nationwide study.

RATIONALE: COVID-19 pandemic had a significant impact on patients with chronic respiratory diseases (CRD) and was associated with an increased risk of severe outcomes. However, long-term burden of COVID-19 and the dynamics on healthcare utilisation of patients with CRD remain largely unknown. OBJECTIVE: The objective was to evaluate outcomes and healthcare utilisation trajectories 1 year after hospitalisation for COVID-19 in patients with CRD. METHODS: Data were extracted from the French National Health Database (SNDS). All adults with CRD who had a first hospitalisation for symptomatic COVID-19 and discharged alive between March 2020 and January 2021 were included. Postdischarge care trajectories, including any hospitalisations and ambulatory care recorded in the SNDS, over a 1-year period, were analysed using state sequence analysis. Healthcare utilisation patterns between the year prior to and the year following hospitalisation were then compared, and a multinomial logistic regression analysis was performed to identify baseline CRD category associated with trajectory clusters. RESULTS: Among the 40 066 patients with CRD discharged alive, chronic obstructive pulmonary disease was the main CRD followed by asthma, sleep apnoea and interstitial lung disease. Overall, 6913 (17.3%) died at 1 year. Proportion of days alive spent at home without any care decreased from 91.1% to 64.4%. Five distinct clusters of healthcare trajectories were identified: 'home' (52%) with a slight increase in healthcare utilisation, 'home with care' (22%) with a high healthcare utilisation, 'extended hospitalisation' (9.4%) in long-term care or acute care, 'early death' (11%) and 'late death' (5.1%). Asthma was more often associated with the 'home' trajectory, while other CRD categories were more often associated with other clusters. CONCLUSION: Patients with CRD hospitalised for COVID-19 had heterogeneous 1-year trajectories, characterised by increased healthcare utilisation and risk of death. Asthma was the only CRD category not associated with excess mortality or high healthcare consumption.