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Dysphagia Is an Underrecognized Risk Factor for Viral Pneumonia Severity

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Abstract

The aim of this study was to examine the role of pre-existing dysphagia as a risk factor for COVID-19 severity among adults ≥50 years of age presenting to the emergency department (ED). This was a retrospective cohort study that used electronic health record data from two Midwestern EDs in the same health care system. The sample included patients ≥50 years of age who tested positive for SARS-COV-2 during an ED visit between March 15, 2020 and November 19, 2020. Patients were dichotomized based on documented history of dysphagia. The primary outcome was the highest World Health Organization COVID-19 clinical severity score within 30-days of ED arrival. Patients with a score of <4 were classified as non-severe whereas a score ≥4 was considered severe. Chi-square tests were used to assess differences in clinical severity scores between patients with and without dysphagia. A logistic regression model was created to estimate the odds of a severe COVID-19 clinical score. The sample included 126 patients without dysphagia and 40 patients with dysphagia. Patients with a history of dysphagia were more likely to develop severe COVID-19 disease compared to patients without (65.0% vs. 41.3%, p = 0.015). In multivariable analysis, patients with preexisting dysphagia (OR 2.38, 95% CI: 1.05–5.42; p = 0.038) and diabetes (OR 2.42 95% CI: 1.15–5.30; p = 0.021) had significantly increased odds of developing severe COVID-19. This study showed that a pre-existing diagnosis of dysphagia was independently associated with COVID-19 severity in adults ≥50 years of age.

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Data Availability

Because this is healthcare data; the analytical dataset will be made available upon reasonable request to the First Author and after full execution of a data use agreement with our institution.

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Funding

The content and views expressed in this article are those of the authors and do not necessarily reflect the position or official policies of the United States Government or the US Department of Veterans Affairs. This work was also partially supported by the William S. Middleton Veteran Affairs Hospital, Madison, WI (Dr. Rogus-Pulia, GRECC Manuscript 2023-06- 2024); and the National Institute on Aging (1K76AG068590 to Dr. Rogus-Pulia and K00AG076123 to Dr. Robison).

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Authors and Affiliations

  1. BerbeeWalsh Department of Emergency Medicine, University of Wisconsin Madison School of Medicine and Public Health, 800 University Bay Drive Suite 310, Madison, WI, 53705, USA

    Michael S. Pulia, Charles Broghammer & Rebecca J. Schwei

  2. Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin Madison, 1513 University Ave., Madison, WI, USA

    Michael S. Pulia

  3. University of Wisconsin Madison School of Medicine and Public Health, 750 Highland Ave., Madison, WI, USA

    Rachelle Herrin & Rosemary Grant

  4. Department of Medicine, University of Wisconsin Madison School of Medicine and Public Health, 750 Highland Ave.,, Madison, WI, USA

    Raele Donetha Robison, Sara Gustafson & Nicole Rogus-Pulia

  5. Geriatric Research Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI, USA

    Nicole Rogus-Pulia

  6. Center for Health Disparities Research , University of Wisconsin Madison, 600 Highland Ave, MSC 3690, K$, Madison, WI, 53792, USA

    Raele Donetha Robison

Authors
  1. Michael S. Pulia
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  2. Rachelle Herrin
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  4. Sara Gustafson
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  7. Rebecca J. Schwei
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  8. Nicole Rogus-Pulia
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Contributions

MSP and NRP conceived of the study idea. MSP, RDR, SG, RJS and NRP designed the chart review process and trained the reviewers. RH, CB, RG completed the chart reviews. RH and RG wrote an initial draft of the manuscript. All authors revised the article significantly for intellectual content and approved the final version of the manuscript.

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Correspondence to Michael S. Pulia.

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Pulia, M.S., Herrin, R., Robison, R.D. et al. Dysphagia Is an Underrecognized Risk Factor for Viral Pneumonia Severity. Dysphagia (2024). https://doi.org/10.1007/s00455-024-10697-z

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