Natural History of Coronavirus Disease 2019: Risk Factors for Hospitalizations and Deaths Among >26 Million US Medicare Beneficiaries

Abstract Background The current study was performed to evaluate risk factors for severe coronavirus disease 2019 (COVID-19) outcomes among Medicare beneficiaries during the pandemic’s early phase. Methods In a retrospective cohort study covering Medicare fee-for-service beneficiaries, we separated o...

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Bibliographic Details
Published in:The Journal of infectious diseases 2021-03, Vol.223 (6), p.945-956
Main Authors: Izurieta, Hector S, Graham, David J, Jiao, Yixin, Hu, Mao, Lu, Yun, Wu, Yue, Chillarige, Yoganand, Wernecke, Michael, Menis, Mikhail, Pratt, Douglas, Kelman, Jeffrey, Forshee, Richard
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Cognitive ability
Comorbidity
Congestive heart failure
Coronaviruses
COVID-19
COVID-19 - mortality
Death
End-stage renal disease
Ethnic Groups
Female
Hospitalization - statistics & numerical data
Humans
Kidney diseases
Male
Medicare
Medicare - statistics & numerical data
Minority Groups
Nursing Homes
Pandemics
Patients
Population studies
Retrospective Studies
Risk Factors
SARS-CoV-2 - isolation & purification
Severity of Illness Index
United States - epidemiology
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Summary:Abstract Background The current study was performed to evaluate risk factors for severe coronavirus disease 2019 (COVID-19) outcomes among Medicare beneficiaries during the pandemic’s early phase. Methods In a retrospective cohort study covering Medicare fee-for-service beneficiaries, we separated out elderly residents in nursing homes (NHs) and those with end-stage renal disease (ESRD) from the primary study population of individuals age ≥65 years. Outcomes included COVID-19 hospital encounters and COVID-19-associated deaths. We estimated adjusted odds ratios (ORs) using logistic regression. Results We analyzed 25 333 329 elderly non-NH beneficiaries without ESRD, 653 966 elderly NH residents, and 292 302 patients with ESRD. COVID-related death rates (per 10 000) were much higher among elderly NH residents (275.7) and patients with ESRD (60.8) than in the primary study population (5.0). Regression-adjusted clinical predictors of death among the primary population included immunocompromised status (OR, 1.43), frailty index conditions such as cognitive impairment (3.16), and other comorbid conditions, including congestive heart failure (1.30). Demographic-related risk factors included male sex (OR, 1.77), older age (3.09 for 80- vs 65-year-olds), Medicaid dual-eligibility status (2.17), and racial/ethnic minority. Compared with whites, ORs were higher for blacks (2.47), Hispanics (3.11), and Native Americans (5.82). Results for COVID-19 hospital encounters were consistent. Conclusions Frailty, comorbid conditions, and race/ethnicity were strong risk factors for COVID-19 hospitalization and death among the US elderly. This observational study quantified the degree of elevated risk of coronavirus disease 2019–associated deaths and hospitalizations among elderly Medicare beneficiaries who were older, male, of lower socioeconomic status, or immunocompromised or who had comorbid conditions. Risk was also substantially higher among nursing home residents and those with end-stage renal disease.
ISSN:0022-1899
1537-6613
DOI:10.1093/infdis/jiaa767