One-year outcomes and health care utilization in survivors of severe acute respiratory syndrome.
BACKGROUND
Severe Acute Respiratory Syndrome (SARS) became a global epidemic in 2003. Comprehensive information on 1-year outcomes and health care utilization is lacking. Research conducted during the SARS outbreak may help inform research planning for future public health emergencies. The objective of this study was to evaluate the 1-year outcomes in survivors of SARS and their family caregivers.


METHODS
The study was prospective and observational. We evaluated 117 SARS survivors from Toronto, Ontario. Patients were interviewed and underwent physical examination, pulmonary function testing, chest radiography, a 6-minute-walk test, quality-of-life measures, and self-report of health care utilization. At 1 year, informal caregivers were identified for a survey on caregiver burden.


RESULTS
The enrolled survivors of SARS were young (median age, 42 years), and most were women (67%) and health care workers (65%). At 1 year after hospital discharge, pulmonary function measures were in the normal range, but 18% of patients had a significant reduction in distance walked in 6 minutes. The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) domains were 0.3 to 1.0 SD below normal at 1 year. Of the patients, 17% had not returned to work by 1 year. Fifty-one patients required 668 visits to psychiatry or psychology practitioners. During the SARS epidemic, informal caregivers reported a decline of 1.6 SD below normal on the mental component score of the SF-36.


CONCLUSIONS
Most SARS survivors had good physical recovery from their illness, but some patients and their caregivers reported a significant reduction in mental health 1 year later. Strategies to ameliorate the psychological burden of an epidemic on the patient and family caregiver should be considered as part of future pandemic planning.
Tansey
Catherine M
CM
Department of Medicine, University Health Network, and Mount Sinai Hospital, Toronto, Ontario, Canada.
Louie
Marie
M
Loeb
Mark
M
Gold
Wayne L
WL
Muller
Matthew P
MP
de Jager
JoAnne
J
Cameron
Jill I
JI
Tomlinson
George
G
Mazzulli
Tony
T
Walmsley
Sharon L
SL
Rachlis
Anita R
AR
Mederski
Barbara D
BD
Silverman
Mike
M
Shainhouse
Zev
Z
Ephtimios
Issa E
IE
Avendano
Monica
M
Downey
James
J
Styra
Rima
R
Yamamura
Deborah
D
Gerson
Marvin
M
Stanbrook
Matthew B
MB
Marras
Theodore K
TK
Phillips
Elizabeth J
EJ
Zamel
Noë
N
Richardson
Susan E
SE
Slutsky
Arthur S
AS
Herridge
Margaret S
MS
D000328:Adult; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D004185:Disability Evaluation; D004196:Disease Outbreaks; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012129:Respiratory Function Tests; D045169:Severe Acute Respiratory Syndrome / Q000453:epidemiology / Q000503:physiopathology / Q000534:rehabilitation*; D011795:Surveys and Questionnaires; D016138:Walking / Q000502:physiology