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1School of Pharmacy, Sungkyunkwan University, Suwon, Korea
2Columbia School of Social Work, Columbia University, New York, NY, USA
3Lemuel Shattuck Hospital, Boston, MA, USA
4Brigham and Women’s Hospital, Boston, MA, USA
5Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
©2021, Korean Society of Epidemiology
This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICT OF INTEREST
JSL reports receipt of research funding from Columbia University, outside the submitted work. HEJ reports receipt of research funding from the National Research Foundation of Korea, outside the submitted work. JYS reports receipt of research funding from the Ministry of Food and Drug Safety, Ministry of Health and Welfare, and National Research Foundation of Korea; and grants from pharmaceutical companies including Amgen, Pfizer, DongA ST, and Yungjin, outside the submitted work. No other disclosures were reported.
FUNDING
None.
AUTHOR CONTRIBUTIONS
Conceptualization: HEJ, JL, HJS, JYS. Data curation: HEJ. Formal analysis: HEJ. Funding acquisition: None. Methodology: HEJ, JL, HJS, JYS. Project administration: HEJ, JL, JYS. Visualization: HEJ. Writing – original draft: HEJ, JL. Writing – review & editing: HEJ, JL, HJS, JYS.
Characteristics |
Recipients of COVID-19 diagnostic tests (n=232,390) |
Confirmed cases of COVID-19 (n=8,515) |
||||
---|---|---|---|---|---|---|
NHI (n=218,070) | Medicaid (n=14,320) | NHI (n=7,777) | Medicaid (n=738) | p-value1 | ||
Age (yr)2 | ||||||
Mean±SD | 50.2±20.0 | 63.8±17.7 | <0.001 | 47.8±19.1 | 57.5±16.8 | <0.001 |
19-29 | 41,802 (19.2) | 840 (5.9) | <0.001 | 2,039 (26.2) | 79 (10.7) | <0.001 |
30-39 | 39,995 (18.3) | 541 (3.8) | 903 (11.6) | 17 (2.3) | ||
40-49 | 33,040 (15.2) | 1,355 (9.5) | 1,047 (13.5) | 87 (11.8) | ||
50-59 | 30,600 (14.0) | 2,638 (18.4) | 1,536 (19.8) | 195 (26.4) | ||
60-69 | 26,631 (12.2) | 3,156 (22.0) | 1,139 (14.6) | 195 (26.4) | ||
70-79 | 22,949 (10.5) | 2,721 (19.0) | 650 (8.4) | 104 (14.1) | ||
80-89 | 19,257 (8.8) | 2,389 (16.7) | 391 (5.0) | 48 (6.5) | ||
>89 | 3,796 (1.7) | 680 (4.7) | 72 (0.9) | 13 (1.8) | ||
Sex2 | <0.001 | <0.001 | ||||
Male | 102,964 (47.2) | 7,379 (51.5) | 3,127 (40.2) | 348 (47.2) | ||
Female | 115,106 (52.8) | 6,941 (48.5) | 4,650 (59.8) | 390 (52.8) | ||
Charlson comorbidity index score3 | ||||||
Mean±SD | 2.2±1.7 | 2.4±1.6 | <0.001 | 1.7±1.0 | 2.0±1.1 | <0.001 |
1 | 37,850 (17.4) | 3,227 (22.5) | <0.001 | 1,229 (15.8) | 91 (12.3) | <0.001 |
2 | 29,667 (13.6) | 3,305 (23.1) | 862 (11.1) | 165 (22.4) | ||
≥3 | 24,905 (11.4) | 3,802 (26.6) | 387 (5.0) | 65 (8.8) | ||
Comorbidities3 | ||||||
Hypertension | 48,930 (22.4) | 5,999 (41.9) | <0.001 | 1,372 (17.6) | 208 (28.2) | <0.001 |
Hyperlipidemia | 38,384 (17.6) | 3,852 (26.9) | <0.001 | 1,224 (15.7) | 183 (24.8) | <0.001 |
Diabetes mellitus | 29,495 (13.5) | 4,470 (31.2) | <0.001 | 777 (10.0) | 145 (19.6) | <0.001 |
Asthma | 15,375 (7.1) | 1,761 (12.3) | <0.001 | 383 (4.9) | 33 (4.5) | 0.585 |
COPD | 37,010 (17.0) | 3,694 (25.8) | <0.001 | 1,021 (13.1) | 84 (11.4) | 0.177 |
Atherosclerosis | 2,161 (1.0) | 331 (2.3) | <0.001 | 31 (0.4) | 11 (1.5) | <0.001 |
Heart failure | 5,282 (2.4) | 942 (6.6) | <0.001 | 84 (1.1) | 17 (2.3) | 0.003 |
Stroke | 9,384 (4.3) | 1,741 (12.2) | <0.001 | 198 (2.5) | 61 (8.3) | <0.001 |
Myocardial infarction | 1,565 (0.7) | 262 (1.8) | <0.001 | 32 (0.4) | 6 (0.8) | 0.118 |
Renal failure | 8,091 (3.7) | 1,792 (12.5) | <0.001 | 56 (0.7) | 17 (2.3) | <0.001 |
Chronic liver disease | 16,894 (7.7) | 2,175 (15.2) | <0.001 | 457 (5.9) | 83 (11.2) | <0.001 |
Fracture | 14,394 (6.6) | 2,080 (14.5) | <0.001 | 344 (4.4) | 62 (8.4) | <0.001 |
Osteoarthritis | 33,865 (15.5) | 4,131 (28.8) | <0.001 | 1,063 (13.7) | 159 (21.5) | <0.001 |
Rheumatoid arthritis | 3,152 (1.4) | 315 (2.2) | <0.001 | 105 (1.4) | 9 (1.2) | 0.768 |
Psychiatric disorders | 33,143 (15.2) | 6,133 (42.8) | <0.001 | 857 (11.0) | 386 (52.3) | <0.001 |
Thyroid disorders | 11,993 (5.5) | 1,067 (7.5) | <0.001 | 389 (5.0) | 52 (7.0) | 0.017 |
Osteoporosis | 11,052 (5.1) | 1,533 (10.7) | <0.001 | 413 (5.3) | 54 (7.3) | 0.022 |
Dementia | 11,885 (5.5) | 2,253 (15.7) | <0.001 | 315 (4.1) | 77 (10.4) | <0.001 |
Cancer | 21,039 (9.6) | 1,834 (12.8) | <0.001 | 253 (3.3) | 31 (4.2) | 0.171 |
Severe incurable disease4 | 37,628 (17.3) | 4,429 (30.9) | <0.001 | 495 (6.4) | 60 (8.1) | 0.063 |
Concomitant medications3 | ||||||
ACE inhibitors | 2,427 (1.1) | 396 (2.8) | <0.001 | 68 (0.9) | 12 (1.6) | 0.043 |
ARBs | 40,853 (18.7) | 5,341 (37.3) | <0.001 | 1,096 (14.1) | 172 (23.3) | <0.001 |
β-blockers | 28,367 (13.0) | 4,272 (29.8) | <0.001 | 667 (8.6) | 171 (23.2) | <0.001 |
Calcium channel blockers | 40,060 (18.4) | 5,652 (39.5) | <0.001 | 943 (12.1) | 173 (23.4) | <0.001 |
Diuretics | 14,107 (6.5) | 1,734 (12.1) | <0.001 | 429 (5.5) | 49 (6.6) | 0.205 |
Nitrates | 8,932 (4.1) | 1,469 (10.3) | <0.001 | 103 (1.3) | 20 (2.7) | 0.003 |
Antidiabetic drugs | 28,926 (13.3) | 4,401 (30.7) | <0.001 | 729 (9.4) | 149 (20.2) | <0.001 |
Anxiolytics | 127,676 (58.5) | 12,052 (84.2) | <0.001 | 3,186 (41.0) | 544 (73.7) | <0.001 |
Antipsychotics | 16,336 (7.5) | 4,494 (31.4) | <0.001 | 316 (4.1) | 292 (39.6) | <0.001 |
Antidepressants | 30,304 (13.9) | 5,289 (36.9) | <0.001 | 721 (9.3) | 231 (31.3) | <0.001 |
NSAIDs | 177,366 (81.3) | 11,814 (82.5) | <0.001 | 6,101 (78.4) | 527 (71.4) | <0.001 |
Anticoagulants | 53,794 (24.7) | 7,739 (54.0) | <0.001 | 1,149 (14.8) | 231 (31.3) | <0.001 |
Values are presented as number (%).
COVID-19, coronavirus disease 2019; NHI, National Health Insurance; SD, standard deviation; COPD, chronic obstructive pulmonary disease; ACE, angiotensin converting enzyme; ARB, angiotensin-receptor II blocker; NSAID, non-steroidal anti-inflammatory drug.
1 The chi-square test for categorical variables and the t-test for continuous variables were used to determine statistically significant differences between health insurance types.
2 Assessed on cohort entry (the date when subjects received the test for COVID-19 or the date when subjects tested positive for COVID-19).
3 Assessed in the year prior to cohort entry.
4 Severe incurable diseases are Medicaid eligibility criteria, which include rare or incurable diseases.
Characteristics | No. of subjects | No. of events | No. of events per 100 patients, % (95% CI) | Unadjusted model | Age- and sex-adjusted model | IPT weighted model1,2 | Age-, sex-, CCI- adjusted model |
---|---|---|---|---|---|---|---|
Risk of SARS-CoV-2 infection | |||||||
NHI | 218,070 | 7,777 | 3.57 (3.49, 3.64) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
Medicaid | 14,320 | 738 | 5.15 (4.79, 5.52) | 1.47 (1.36, 1.59) | 1.54 (1.42, 1.67) | 1.17 (1.05, 1.30) | 1.22 (1.09 1.38) |
Primary composite outcome | |||||||
NHI | 7,777 | 403 | 5.18 (4.69, 5.67) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
Medicaid | 738 | 69 | 9.35 (7.25, 11.45) | 1.89 (1.45, 2.47) | 1.26 (0.95, 1.67) | 1.20 (0.90, 1.60) | 1.10 (0.77, 1.57) |
All-cause death | |||||||
NHI | 7,777 | 238 | 3.06 (2.68, 3.44) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
Medicaid | 738 | 51 | 6.91 (5.08, 8.74) | 2.35 (1.72, 3.21) | 1.68 (1.19, 2.36) | 1.31 (0.95, 1.80) | 1.35 (0.90, 2.02) |
Intensive care unit admission | |||||||
NHI | 7,777 | 171 | 2.20 (1.87, 2.52) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
Medicaid | 738 | 18 | 2.44 (1.33, 3.55) | 1.11 (0.68, 1.82) | 0.74 (0.45, 1.21) | 1.35 (0.84, 2.16) | 0.98 (0.53, 1.79) |
Mechanical ventilation use | |||||||
NHI | 7,777 | 166 | 2.13 (1.81, 2.46) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
Medicaid | 738 | 22 | 2.98 (1.75, 4.21) | 1.41 (0.90, 2.21) | 0.86 (0.55, 1.37) | 0.96 (0.58, 1.57) | 0.77 (0.41, 1.42) |
Values are presented as odds ratio (95% confidence interval).
SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; COVID-19, coronavirus disease 2019; IPT, inverse probability of treatment; CCI, Charlson comorbidity index score; NHI, National Health Insurance.
1 IPT-weighted multivariable logistic regression model (considered our sensitivity analysis) for the risk of SARS-CoV-2 infection, in which the propensity score was estimated by including age, sex, CCI, hypertension, hyperlipidemia, diabetes mellitus, asthma, chronic obstructive pulmonary disease, atherosclerosis, heart failure, myocardial infarction, stroke, renal failure, chronic liver disease, fractures, osteoarthritis, psychiatric disorders, thyroid disorders, dementia, malignancy, severe incurable diseases, angiotensin converting enzyme inhibitors, angiotensin-receptor II blockers, β-blockers, calcium channel blockers, diuretics, nitrates, antidiabetic medications including insulin, anxiolytics, antipsychotics, antidepressants, non-steroidal anti-inflammatory drugs, and anticoagulants in the multivariable logistic regression model (c-statistic, 0.719).
2 IPT-weighted multivariable logistic regression model (considered our sensitivity analysis) for the risk of worsened clinical outcomes, in which the propensity score was estimated by including age, CCI, hypertension, hyperlipidemia, diabetes mellitus, asthma, chronic obstructive pulmonary disease, atherosclerosis, heart failure, myocardial infarction, renal failure, chronic liver disease, fractures, osteoarthritis, psychiatric disorders, osteoporosis, dementia, malignancy, severe incurable diseases, and use of angiotensin converting enzyme inhibitors, angiotensin-receptor II blockers, β-blockers, calcium channel blockers, diuretics, nitrates, antidiabetic medications including insulin, anxiolytics, antipsychotics, antidepressants, and anticoagulants in the multivariable logistic regression model (c-statistic, 0.779).
Characteristics | Recipients of COVID-19 diagnostic tests (n=232,390) |
Confirmed cases of COVID-19 (n=8,515) |
||||
---|---|---|---|---|---|---|
NHI (n=218,070) | Medicaid (n=14,320) | NHI (n=7,777) | Medicaid (n=738) | p-value |
||
Age (yr) |
||||||
Mean±SD | 50.2±20.0 | 63.8±17.7 | <0.001 | 47.8±19.1 | 57.5±16.8 | <0.001 |
19-29 | 41,802 (19.2) | 840 (5.9) | <0.001 | 2,039 (26.2) | 79 (10.7) | <0.001 |
30-39 | 39,995 (18.3) | 541 (3.8) | 903 (11.6) | 17 (2.3) | ||
40-49 | 33,040 (15.2) | 1,355 (9.5) | 1,047 (13.5) | 87 (11.8) | ||
50-59 | 30,600 (14.0) | 2,638 (18.4) | 1,536 (19.8) | 195 (26.4) | ||
60-69 | 26,631 (12.2) | 3,156 (22.0) | 1,139 (14.6) | 195 (26.4) | ||
70-79 | 22,949 (10.5) | 2,721 (19.0) | 650 (8.4) | 104 (14.1) | ||
80-89 | 19,257 (8.8) | 2,389 (16.7) | 391 (5.0) | 48 (6.5) | ||
>89 | 3,796 (1.7) | 680 (4.7) | 72 (0.9) | 13 (1.8) | ||
Sex2 | <0.001 | <0.001 | ||||
Male | 102,964 (47.2) | 7,379 (51.5) | 3,127 (40.2) | 348 (47.2) | ||
Female | 115,106 (52.8) | 6,941 (48.5) | 4,650 (59.8) | 390 (52.8) | ||
Charlson comorbidity index score |
||||||
Mean±SD | 2.2±1.7 | 2.4±1.6 | <0.001 | 1.7±1.0 | 2.0±1.1 | <0.001 |
1 | 37,850 (17.4) | 3,227 (22.5) | <0.001 | 1,229 (15.8) | 91 (12.3) | <0.001 |
2 | 29,667 (13.6) | 3,305 (23.1) | 862 (11.1) | 165 (22.4) | ||
≥3 | 24,905 (11.4) | 3,802 (26.6) | 387 (5.0) | 65 (8.8) | ||
Comorbidities |
||||||
Hypertension | 48,930 (22.4) | 5,999 (41.9) | <0.001 | 1,372 (17.6) | 208 (28.2) | <0.001 |
Hyperlipidemia | 38,384 (17.6) | 3,852 (26.9) | <0.001 | 1,224 (15.7) | 183 (24.8) | <0.001 |
Diabetes mellitus | 29,495 (13.5) | 4,470 (31.2) | <0.001 | 777 (10.0) | 145 (19.6) | <0.001 |
Asthma | 15,375 (7.1) | 1,761 (12.3) | <0.001 | 383 (4.9) | 33 (4.5) | 0.585 |
COPD | 37,010 (17.0) | 3,694 (25.8) | <0.001 | 1,021 (13.1) | 84 (11.4) | 0.177 |
Atherosclerosis | 2,161 (1.0) | 331 (2.3) | <0.001 | 31 (0.4) | 11 (1.5) | <0.001 |
Heart failure | 5,282 (2.4) | 942 (6.6) | <0.001 | 84 (1.1) | 17 (2.3) | 0.003 |
Stroke | 9,384 (4.3) | 1,741 (12.2) | <0.001 | 198 (2.5) | 61 (8.3) | <0.001 |
Myocardial infarction | 1,565 (0.7) | 262 (1.8) | <0.001 | 32 (0.4) | 6 (0.8) | 0.118 |
Renal failure | 8,091 (3.7) | 1,792 (12.5) | <0.001 | 56 (0.7) | 17 (2.3) | <0.001 |
Chronic liver disease | 16,894 (7.7) | 2,175 (15.2) | <0.001 | 457 (5.9) | 83 (11.2) | <0.001 |
Fracture | 14,394 (6.6) | 2,080 (14.5) | <0.001 | 344 (4.4) | 62 (8.4) | <0.001 |
Osteoarthritis | 33,865 (15.5) | 4,131 (28.8) | <0.001 | 1,063 (13.7) | 159 (21.5) | <0.001 |
Rheumatoid arthritis | 3,152 (1.4) | 315 (2.2) | <0.001 | 105 (1.4) | 9 (1.2) | 0.768 |
Psychiatric disorders | 33,143 (15.2) | 6,133 (42.8) | <0.001 | 857 (11.0) | 386 (52.3) | <0.001 |
Thyroid disorders | 11,993 (5.5) | 1,067 (7.5) | <0.001 | 389 (5.0) | 52 (7.0) | 0.017 |
Osteoporosis | 11,052 (5.1) | 1,533 (10.7) | <0.001 | 413 (5.3) | 54 (7.3) | 0.022 |
Dementia | 11,885 (5.5) | 2,253 (15.7) | <0.001 | 315 (4.1) | 77 (10.4) | <0.001 |
Cancer | 21,039 (9.6) | 1,834 (12.8) | <0.001 | 253 (3.3) | 31 (4.2) | 0.171 |
Severe incurable disease |
37,628 (17.3) | 4,429 (30.9) | <0.001 | 495 (6.4) | 60 (8.1) | 0.063 |
Concomitant medications |
||||||
ACE inhibitors | 2,427 (1.1) | 396 (2.8) | <0.001 | 68 (0.9) | 12 (1.6) | 0.043 |
ARBs | 40,853 (18.7) | 5,341 (37.3) | <0.001 | 1,096 (14.1) | 172 (23.3) | <0.001 |
β-blockers | 28,367 (13.0) | 4,272 (29.8) | <0.001 | 667 (8.6) | 171 (23.2) | <0.001 |
Calcium channel blockers | 40,060 (18.4) | 5,652 (39.5) | <0.001 | 943 (12.1) | 173 (23.4) | <0.001 |
Diuretics | 14,107 (6.5) | 1,734 (12.1) | <0.001 | 429 (5.5) | 49 (6.6) | 0.205 |
Nitrates | 8,932 (4.1) | 1,469 (10.3) | <0.001 | 103 (1.3) | 20 (2.7) | 0.003 |
Antidiabetic drugs | 28,926 (13.3) | 4,401 (30.7) | <0.001 | 729 (9.4) | 149 (20.2) | <0.001 |
Anxiolytics | 127,676 (58.5) | 12,052 (84.2) | <0.001 | 3,186 (41.0) | 544 (73.7) | <0.001 |
Antipsychotics | 16,336 (7.5) | 4,494 (31.4) | <0.001 | 316 (4.1) | 292 (39.6) | <0.001 |
Antidepressants | 30,304 (13.9) | 5,289 (36.9) | <0.001 | 721 (9.3) | 231 (31.3) | <0.001 |
NSAIDs | 177,366 (81.3) | 11,814 (82.5) | <0.001 | 6,101 (78.4) | 527 (71.4) | <0.001 |
Anticoagulants | 53,794 (24.7) | 7,739 (54.0) | <0.001 | 1,149 (14.8) | 231 (31.3) | <0.001 |
Characteristics | No. of subjects | No. of events | No. of events per 100 patients, % (95% CI) | Unadjusted model | Age- and sex-adjusted model | IPT weighted model |
Age-, sex-, CCI- adjusted model |
---|---|---|---|---|---|---|---|
Risk of SARS-CoV-2 infection | |||||||
NHI | 218,070 | 7,777 | 3.57 (3.49, 3.64) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
Medicaid | 14,320 | 738 | 5.15 (4.79, 5.52) | 1.47 (1.36, 1.59) | 1.54 (1.42, 1.67) | 1.17 (1.05, 1.30) | 1.22 (1.09 1.38) |
Primary composite outcome | |||||||
NHI | 7,777 | 403 | 5.18 (4.69, 5.67) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
Medicaid | 738 | 69 | 9.35 (7.25, 11.45) | 1.89 (1.45, 2.47) | 1.26 (0.95, 1.67) | 1.20 (0.90, 1.60) | 1.10 (0.77, 1.57) |
All-cause death | |||||||
NHI | 7,777 | 238 | 3.06 (2.68, 3.44) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
Medicaid | 738 | 51 | 6.91 (5.08, 8.74) | 2.35 (1.72, 3.21) | 1.68 (1.19, 2.36) | 1.31 (0.95, 1.80) | 1.35 (0.90, 2.02) |
Intensive care unit admission | |||||||
NHI | 7,777 | 171 | 2.20 (1.87, 2.52) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
Medicaid | 738 | 18 | 2.44 (1.33, 3.55) | 1.11 (0.68, 1.82) | 0.74 (0.45, 1.21) | 1.35 (0.84, 2.16) | 0.98 (0.53, 1.79) |
Mechanical ventilation use | |||||||
NHI | 7,777 | 166 | 2.13 (1.81, 2.46) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
Medicaid | 738 | 22 | 2.98 (1.75, 4.21) | 1.41 (0.90, 2.21) | 0.86 (0.55, 1.37) | 0.96 (0.58, 1.57) | 0.77 (0.41, 1.42) |
Values are presented as number (%). COVID-19, coronavirus disease 2019; NHI, National Health Insurance; SD, standard deviation; COPD, chronic obstructive pulmonary disease; ACE, angiotensin converting enzyme; ARB, angiotensin-receptor II blocker; NSAID, non-steroidal anti-inflammatory drug. The chi-square test for categorical variables and the t-test for continuous variables were used to determine statistically significant differences between health insurance types. Assessed on cohort entry (the date when subjects received the test for COVID-19 or the date when subjects tested positive for COVID-19). Assessed in the year prior to cohort entry. Severe incurable diseases are Medicaid eligibility criteria, which include rare or incurable diseases.
Values are presented as odds ratio (95% confidence interval). SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; COVID-19, coronavirus disease 2019; IPT, inverse probability of treatment; CCI, Charlson comorbidity index score; NHI, National Health Insurance. IPT-weighted multivariable logistic regression model (considered our sensitivity analysis) for the risk of SARS-CoV-2 infection, in which the propensity score was estimated by including age, sex, CCI, hypertension, hyperlipidemia, diabetes mellitus, asthma, chronic obstructive pulmonary disease, atherosclerosis, heart failure, myocardial infarction, stroke, renal failure, chronic liver disease, fractures, osteoarthritis, psychiatric disorders, thyroid disorders, dementia, malignancy, severe incurable diseases, angiotensin converting enzyme inhibitors, angiotensin-receptor II blockers, β-blockers, calcium channel blockers, diuretics, nitrates, antidiabetic medications including insulin, anxiolytics, antipsychotics, antidepressants, non-steroidal anti-inflammatory drugs, and anticoagulants in the multivariable logistic regression model (c-statistic, 0.719). IPT-weighted multivariable logistic regression model (considered our sensitivity analysis) for the risk of worsened clinical outcomes, in which the propensity score was estimated by including age, CCI, hypertension, hyperlipidemia, diabetes mellitus, asthma, chronic obstructive pulmonary disease, atherosclerosis, heart failure, myocardial infarction, renal failure, chronic liver disease, fractures, osteoarthritis, psychiatric disorders, osteoporosis, dementia, malignancy, severe incurable diseases, and use of angiotensin converting enzyme inhibitors, angiotensin-receptor II blockers, β-blockers, calcium channel blockers, diuretics, nitrates, antidiabetic medications including insulin, anxiolytics, antipsychotics, antidepressants, and anticoagulants in the multivariable logistic regression model (c-statistic, 0.779).