Frailty as a risk factor for post‐acute sequelae of COVID‐19 among US veterans during the Delta and Omicron waves

Abstract

AbstractBackgroundOlder populations have suffered the highest rates of SARS‐CoV‐2 infection and associated complications, including Post‐Acute Sequelae of SARS‐CoV‐2 infection (PASC). Frailty is a geriatric syndrome that often coexists with COVID‐19 infection. The vulnerability to stressors caused by multisystemic dysfunction that characterizes frailty may predispose older adults to develop PASC.MethodsRetrospective cohort study using the VA COVID‐19 Shared Data Resource to identify US veterans testing positive for SARS‐CoV‐2 between July 2021 and February 2022, without prior positive tests and who were alive 30 days after infection. Frailty was calculated using a 31‐item VA Frailty Index generated from electronic health records. We categorized Veterans into robust (FI ≤ 0.10), prefrail (FI: >0.10‐ < 0.21), and frail (FI ≥ 0.21). We assessed the association between frailty and PASC and vaccination and PASC using Cox survival model, adjusting for covariates.ResultsWe identified 245,857 COVID‐19‐positive veterans surviving 30 days after infection. The mean age was 57.5 ± 16.5 years; 87.2% were males, 68.1% were white, and 9.0% were Hispanic. Almost half of the sample (48.9%) were classified as robust, while 28.3% were pre‐frail and 22.7% were frail; 99,886 (40.6%) were fully vaccinated, and 33,516 (13.6%) received booster doses. Over a median follow‐up of 143 days (IQR = 101), 23,890 (9.7%) patients developed PASC. Within 6 months after infection, frailty and pre‐frailty were associated with a 41% (adjusted HR [aHR]:1.40 (95% CI: 1.35–1.47) and 15% (aHR: 1.17 (95% CI: 1.11–1.19) increase in the risk of PASC compared with the robust, respectively. Vaccination and booster doses before infection were associated with a 27% (aHR: 0.73 (95% CI: 0.71–0.75) and 33% (aHR: 0.66 (95% CI: 0.63–0.69) reduction in the risk of developing PASC, respectively.ConclusionsFrailty was associated with an increased risk of developing PASC. Vaccination was associated with a decreased risk of PASC, further reduced by booster doses. Early recognition of frailty in patients with COVID‐19 may assist in the early identification and management of PASC.