Demographics, Characteristics, Health Outcomes of People Diagnosed With COVID-19 in the Outpatient Setting

Rikisha Gupta, MPH

In this video, Rikisha Gupta, MPH, discusses the results of a study on people diagnosed with COVID-19 in an outpatient setting in the United States, including the demographics, characteristics, health outcomes, and risk factors. She presented these findings at IDWeek 2023 in Boston, MA.

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Rikisha Gupta, MPH: My name is Rikisha Gupta. I'm an epidemiologist by training and I'm based on the Real-World Evidence team at Gilead Sciences, mainly focusing in emerging viruses. So I have been working with the COVID-19 since the start of the pandemic.

Consultant360: Please provide an overview of your presentation at IDWeek 2023 titled “Demographics, Characteristics, and Health Outcomes of US Individuals Diagnosed With COVID-19 in the Outpatient Setting.”

Rikisha Gupta, MPH: So to summarize, the objective of this study was to look at the demographic clinical characteristics and health outcomes in the patients who were diagnosed with COVID-19 in the outpatient setting. And the rationale for doing that is since the start of the pandemic the COVID-19 has evolved a lot. And the current strains, what we're seeing, the variants what we're seeing are less severe. There's less hospitalization, less mortality. But at the same time, we've seen increased testing in community setting, and we've seen increased number of patients who've been tested in the outpatient setting. So the idea was to understand these patients who are no longer now going to the hospital, but now are being treated or being looked at into the outpatient setting.

In order to do so, we used secondary data source, and this is a US-based data source which includes the medical and pharmacy claims within US. And we looked at patients who were diagnosed in outpatient setting from March 2020 until end of November 2022. And among these patients, we tried to look at their age, their demographic, what kind of risk factors they had, how many of these patients were immunocompromised. So just getting a sense of the clinical profile of these patients. Who are we dealing with now? As the pandemic has changed, what are the change in the clinical profile of these patients what we're seeing? We followed the patients from the COVID-19 diagnosis up to three months, and we tried to see that during this three months of follow-up, how many of them turned up in the hospital and what kind of outcomes are we seeing in the patient?

C360: What were the results of the study?

Rikisha Gupta, MPH: So in total, to start with, we had about 15 million, 15.5 million, patients approximately who were eligible for the study. The median age was 50 years and majority of these patients were female. So 60% of the population was female. The immunocompromised, so I looked at the CDC definition of immunocompromised, so from mild to moderate immunocompromised, so about 23% of this 15.5 million were immunocompromised. In addition to that, I took the high risk factors, which high risk factors for COVID-19, which is again based on the CDC list, and tried to look at the proportion of these patients. So basically of the 15.5 million patients, how many of them meet a high risk criteria? And I categorized them based on presence of one high risk factor or two or three high risk factor. And what we saw was 60%. So majority of the cohort had at least one high risk factor at their COVID-19 diagnosis.

And in addition to that, I evaluated two outcomes. So that's going to be hospitalization for any cause within the 28 days after the COVID-19 diagnosis and hospitalization for specific COVID-19, again during 28 days after COVID-19 hospitalization. And what we saw with no surprise that if someone has more risk factors, you are going to be at an elevated risk associated of hospitalization.

C360: Why are these data points important to study?

Rikisha Gupta, MPH: Again, it goes back. We've seen so much evolve. The COVID-19 variants have changed so much over time. If we go back to the start of the pandemic, to Delta, to Omicron, the kind of people who are now being infected is so different to what we've seen before. So in order to understand how we can manage these patients and how we can help them, I think the first step is to understand what are these patients? Who are these patients? What kind of patients are we dealing with? What kind of conditions are we dealing with? So I think it goes back like these data points are important because it gives us a holistic picture, or at least a part of the holistic picture, in terms of who are the patients and what are the patients which are showing up now with COVID-19?

C360: How does this research contribute to existing literature on these topics?

Rikisha Gupta, MPH: No, that's a good question. I think the so what, or the added value for this research, I would say is giving us a real world preview of what's happening. So we're trying to use the most updated data and trying to get a reflection who are these people are showing up now? So this is one of the top benefits of using the real world data. We have a sample size of 15.5 million, and we're able to look at that and see in the real world setting of what's exactly going on with these patients and what kind of patients are showing up.

C360: What’s next for research on these topics?

Rikisha Gupta, MPH: I think with COVID-19 it's so tough. We don't know what's in store. So I think as we are moving forward, as now we're dealing with different variant, I think it continues to build on the value story and trying to understand more that how this virus is evolving? What are the different outcomes? What are the different features of the virus? Is there a specific population we need to be more attentive to? So I think more research is just understanding how it's evolving and looking more into the outcomes, long COVID, looking at different profile of patients who continue to be impacted by COVID-19.

C360: What were the key take-home messages from this study?

Rikisha Gupta, MPH: I would say the virus is less severe, but at the same time, it's still infecting a lot of patients and it's still infecting a lot of people. So I do think it's very important for us to understand how do we still manage it? And of course, it has changed how we managing the patients. So how do we continue to manage and understand the clinical profile of these patients? Because a lot of them, as you can see 60% of them, still have a high risk factor.

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