Risk of Potentially Preventable Hospitalizations After SARS-CoV-2 Infection

2024  Journal Article

Risk of Potentially Preventable Hospitalizations After SARS-CoV-2 Infection


While more research is needed to unravel the complex downstream impacts of SARS-CoV-2 on health and healthcare, this study provides an important piece of the puzzle. It suggests that long after the acute stage of infection, individuals with a history of SARS-CoV-2 infection may need extra support and seamless access to outpatient care to prevent unnecessary hospitalizations. Understanding and addressing these needs will be key to optimizing both patient outcomes and health system efficiency in the aftermath of the COVID-19 pandemic.


College of Health researcher(s)


Key Points


Is infection with SARS-CoV-2 associated with an increased risk of potentially preventable hospitalization, and if so, how long does this association persist after infection?


In this cohort study of 1 132 220 US veterans enrolled in the Veterans Health Administration, veterans with SARS-CoV-2 had 3 times greater risk of potentially preventable hospitalization than matched comparators without SARS-CoV-2 within 30 days after infection and more than 40% greater risk at 1 year.


These findings suggest that the persistently higher risk of potentially preventable hospitalization among veterans with SARS-CoV-2 infection may reflect difficulty meeting postinfection ambulatory health care needs in the broader context of the pandemic.



Research demonstrates that SARS-CoV-2 infection is associated with increased risk of all-cause hospitalization. However, no prior studies have assessed the association between SARS-CoV-2 and potentially preventable hospitalizations—that is, hospitalizations for conditions that can usually be effectively managed in ambulatory care settings.


To examine whether SARS-CoV-2 is associated with potentially preventable hospitalization in a nationwide cohort of US veterans.

Design, Setting, and Participants

This cohort study used an emulated target randomized trial design with monthly sequential trials to compare risk of a potentially preventable hospitalization among veterans with SARS-CoV-2 and matched comparators without SARS-CoV-2. A total of 189 136 US veterans enrolled in the Veterans Health Administration (VHA) who were diagnosed with SARS-CoV-2 between March 1, 2020, and April 30, 2021, and 943 084 matched comparators were included in the analysis. Data were analyzed from May 10, 2023, to January 26, 2024.


SARS-CoV-2 infection.

Main Outcomes and Measures

The primary outcome was a first potentially preventable hospitalization in VHA facilities, VHA-purchased community care, or Medicare fee-for-service care. Extended Cox models were used to examine adjusted hazard ratios (AHRs) of potentially preventable hospitalization among veterans with SARS-CoV-2 and comparators during follow-up periods of 0 to 30, 0 to 90, 0 to 180, and 0 to 365 days. The start of follow-up was defined as the date of each veteran’s first positive SARS-CoV-2 diagnosis, with the same index date applied to their matched comparators.


The 1,132,220 participants were predominantly men (89.06%), with a mean (SD) age of 60.3 (16.4) years. Most veterans were of Black (23.44%) or White (69.37%) race. Veterans with SARS-CoV-2 and comparators were well-balanced (standardized mean differences, all <0.100) on observable baseline clinical and sociodemographic characteristics. Overall, 3.10% of veterans (3.81% of those with SARS-CoV-2 and 2.96% of comparators) had a potentially preventable hospitalization during 1-year follow-up. Risk of a potentially preventable hospitalization was greater among veterans with SARS-CoV-2 than comparators in 4 follow-up periods: 0- to 30-day AHR of 3.26 (95% CI, 3.06-3.46); 0- to 90-day AHR of 2.12 (95% CI, 2.03-2.21); 0- to 180-day AHR of 1.69 (95% CI, 1.63-1.75); and 0- to 365-day AHR of 1.44 (95% CI, 1.40-1.48).

Conclusions and Relevance

In this cohort study, an increased risk of preventable hospitalization in veterans with SARS-CoV-2, which persisted for at least 1 year after initial infection, highlights the need for research on ways in which SARS-CoV-2 shapes postinfection care needs and engagement with the health system. Solutions are needed to mitigate preventable hospitalization after SARS-CoV-2.

Govier, D.J., Niederhausen, M., Takata, Y., Hickok, A., Rowneki, M., McCready, H., Smith, V.A., Osborne, T.F., Boyko, E.J., Ioannou, G.N., Maciejewski, M.L., Viglianti, E.M., Bohnert, A.S., O’Hare, A., Iwashyna, T.J., Hynes, D.M.(2024)Risk of Potentially Preventable Hospitalizations After SARS-CoV-2 InfectionJAMA Network Open7