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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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| Published in: | The Journal of infectious diseases 2021-03, Vol.223 (6), p.945-956 |
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| container_issue | 6 |
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| container_title | The Journal of infectious diseases |
| container_volume | 223 |
| creator | 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 |
| description | 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. |
| doi_str_mv | 10.1093/infdis/jiaa767 |
| format | article |
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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.</description><identifier>ISSN: 0022-1899</identifier><identifier>EISSN: 1537-6613</identifier><identifier>DOI: 10.1093/infdis/jiaa767</identifier><identifier>PMID: 33325510</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>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</subject><ispartof>The Journal of infectious diseases, 2021-03, Vol.223 (6), p.945-956</ispartof><rights>Published by Oxford University Press for the Infectious Diseases Society of America 2020. 2020</rights><rights>Published by Oxford University Press for the Infectious Diseases Society of America 2020.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c357t-d7584ae776c962f1f88673afb52129504e9d9d299bd7a02ea4a8dd67aeee38e43</citedby><cites>FETCH-LOGICAL-c357t-d7584ae776c962f1f88673afb52129504e9d9d299bd7a02ea4a8dd67aeee38e43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,1591,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33325510$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Izurieta, Hector S</creatorcontrib><creatorcontrib>Graham, David J</creatorcontrib><creatorcontrib>Jiao, Yixin</creatorcontrib><creatorcontrib>Hu, Mao</creatorcontrib><creatorcontrib>Lu, Yun</creatorcontrib><creatorcontrib>Wu, Yue</creatorcontrib><creatorcontrib>Chillarige, Yoganand</creatorcontrib><creatorcontrib>Wernecke, Michael</creatorcontrib><creatorcontrib>Menis, Mikhail</creatorcontrib><creatorcontrib>Pratt, Douglas</creatorcontrib><creatorcontrib>Kelman, Jeffrey</creatorcontrib><creatorcontrib>Forshee, Richard</creatorcontrib><title>Natural History of Coronavirus Disease 2019: Risk Factors for Hospitalizations and Deaths Among >26 Million US Medicare Beneficiaries</title><title>The Journal of infectious diseases</title><addtitle>J Infect Dis</addtitle><description>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.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cognitive ability</subject><subject>Comorbidity</subject><subject>Congestive heart failure</subject><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>COVID-19 - mortality</subject><subject>Death</subject><subject>End-stage renal disease</subject><subject>Ethnic Groups</subject><subject>Female</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Humans</subject><subject>Kidney diseases</subject><subject>Male</subject><subject>Medicare</subject><subject>Medicare - statistics & numerical data</subject><subject>Minority Groups</subject><subject>Nursing Homes</subject><subject>Pandemics</subject><subject>Patients</subject><subject>Population studies</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>SARS-CoV-2 - isolation & purification</subject><subject>Severity of Illness Index</subject><subject>United States - epidemiology</subject><issn>0022-1899</issn><issn>1537-6613</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNqF0T1vFDEQBmALgcgRaCmRJRooNvHH2l5TIIUL4ZASkIDUq7n1GHzsrQ_PbqTQ53-z6A4KGqop5plXI72MPZXiRAqvT9MQQ6LTTQJw1t1jC2m0q6yV-j5bCKFUJRvvj9gjoo0QotbWPWRHWmtljBQLdvcBxqlAz1eJxlxueY58mUse4CaVifh5IgRCroT0r_inRN_5BXSzJB5z4atMuzRCn37CmPJAHIbAzxHGb8TPtnn4yl8ry69S389bfv2ZX2FIHRTkb3DAmLoEJSE9Zg8i9IRPDvOYXV-8_bJcVZcf371fnl1WnTZurIIzTQ3onO28VVHGprFOQ1wbJZU3okYffFDer4MDoRBqaEKwDhBRN1jrY_Zin7sr-ceENLbbRB32PQyYJ2pV7YRVVphmps__oZs8lWH-rlVGNk5ra8SsTvaqK5moYGx3JW2h3LZStL8LavcFtYeC5oNnh9hpvcXwl_9pZAYv9yBPu_-F_QKXc5wU</recordid><startdate>20210329</startdate><enddate>20210329</enddate><creator>Izurieta, Hector S</creator><creator>Graham, David J</creator><creator>Jiao, Yixin</creator><creator>Hu, Mao</creator><creator>Lu, Yun</creator><creator>Wu, Yue</creator><creator>Chillarige, Yoganand</creator><creator>Wernecke, Michael</creator><creator>Menis, Mikhail</creator><creator>Pratt, Douglas</creator><creator>Kelman, Jeffrey</creator><creator>Forshee, Richard</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20210329</creationdate><title>Natural History of Coronavirus Disease 2019: Risk Factors for Hospitalizations and Deaths Among >26 Million US Medicare Beneficiaries</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c357t-d7584ae776c962f1f88673afb52129504e9d9d299bd7a02ea4a8dd67aeee38e43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cognitive ability</topic><topic>Comorbidity</topic><topic>Congestive heart failure</topic><topic>Coronaviruses</topic><topic>COVID-19</topic><topic>COVID-19 - mortality</topic><topic>Death</topic><topic>End-stage renal disease</topic><topic>Ethnic Groups</topic><topic>Female</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Humans</topic><topic>Kidney diseases</topic><topic>Male</topic><topic>Medicare</topic><topic>Medicare - statistics & numerical data</topic><topic>Minority Groups</topic><topic>Nursing Homes</topic><topic>Pandemics</topic><topic>Patients</topic><topic>Population studies</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>SARS-CoV-2 - isolation & purification</topic><topic>Severity of Illness Index</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Izurieta, Hector S</creatorcontrib><creatorcontrib>Graham, David J</creatorcontrib><creatorcontrib>Jiao, Yixin</creatorcontrib><creatorcontrib>Hu, Mao</creatorcontrib><creatorcontrib>Lu, Yun</creatorcontrib><creatorcontrib>Wu, Yue</creatorcontrib><creatorcontrib>Chillarige, Yoganand</creatorcontrib><creatorcontrib>Wernecke, Michael</creatorcontrib><creatorcontrib>Menis, Mikhail</creatorcontrib><creatorcontrib>Pratt, Douglas</creatorcontrib><creatorcontrib>Kelman, Jeffrey</creatorcontrib><creatorcontrib>Forshee, Richard</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Izurieta, Hector S</au><au>Graham, David J</au><au>Jiao, Yixin</au><au>Hu, Mao</au><au>Lu, Yun</au><au>Wu, Yue</au><au>Chillarige, Yoganand</au><au>Wernecke, Michael</au><au>Menis, Mikhail</au><au>Pratt, Douglas</au><au>Kelman, Jeffrey</au><au>Forshee, Richard</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Natural History of Coronavirus Disease 2019: Risk Factors for Hospitalizations and Deaths Among >26 Million US Medicare Beneficiaries</atitle><jtitle>The Journal of infectious diseases</jtitle><addtitle>J Infect Dis</addtitle><date>2021-03-29</date><risdate>2021</risdate><volume>223</volume><issue>6</issue><spage>945</spage><epage>956</epage><pages>945-956</pages><issn>0022-1899</issn><eissn>1537-6613</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>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.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>33325510</pmid><doi>10.1093/infdis/jiaa767</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
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| 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 |
| title | Natural History of Coronavirus Disease 2019: Risk Factors for Hospitalizations and Deaths Among >26 Million US Medicare Beneficiaries |
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