In general age 65 was a tipping-point for increased hospitalizations and mortality among Americans with Covid-19, but Covid-19 morbidity and economic burden were greatest among racial and ethnic minority populations, according to an analysis of 28.1 million Medicare claims.
The Covid-19 disease burden among adults ages ≥65 was substantially higher than in the general U.S. population, with hospitalization rates >60 times higher, at 966 per 100,000 Medicare fee-for-service (FFS) beneficiaries, and the mortality rate 2.5 times higher at 4.2%, reported Yuping Tsai, PhD, of the CDC National Center for Immunization and Respiratory Diseases in Atlanta, and colleagues in Annals of Internal Medicine.
Tsai’s group reported that non-Hispanic Black and Hispanic patients made up 8.4% and 6.9% of patients with outpatient visits only, respectively, but they accounted for 17.2% and 13.8% of hospitalized patients requiring ventilator support and 13.6% and 11.5% of inpatient deaths. For Asian/Pacific Islander (AAPI) older adults, those data came in at 2.1%, 2.9%, and 2.9%, respectively
However, a “novel finding from this study is that costs of Covid-19-related hospitalization decreased with age for the 5 medical outcomes considered,” specifically outpatient visits only, all hospitalizations, hospitalizations without ventilator support and death, hospitalizations with ventilator support, and in-hospital death, they wrote.
Reasons for this may include less aggressive care for older people with Covid-19, higher mortality rates, and the lower likelihood of younger adults requiring Covid-19-related hospitalization, they said.
While the authors reported that the results “show that the economic burden of Covid-19 is greater than previous studies have suggested,” that data needs to be taken with a grain of salt, pointed out David Blumenthal, MD, MPP, and Gretchen A. Jacobson, PhD, both of The Commonwealth Fund in New York City, in an editorial accompanying the study.
An “important limitation of the study is that it did not include Medicare spending for posthospitalization rehabilitative care received at a skilled-nursing facility or at home,” they explained. “These expenses could significantly add to the total Medicare spending for people with Covid-19.” Other study limitations included the lack of data on Medicare beneficiaries who were also on managed care. The study also did not include asymptomatic patients or those with minor Covid-19 symptoms, those who did not seek medical care, or those who died before doing so.
Even then, spending on Covid-19 would have accounted for about 3% of 2020 Medicare dollars, and still less than per capita spending on care of heart disease, diabetes, cancer, and more, Blumenthal and Jacobson noted.
But positive financial findings do not make up for the “huge human costs of the pandemic, which caused about 300 000 deaths and incalculable suffering for adults older than 65 years and their loved ones in the United States in 2020,” they acknowledged, although vaccines have lowered those rates.
Blumenthal and Jacobson said that a strength of the current study is that it “adds to the substantial evidence that people of color accounted for a disproportionate share of hospitalizations and deaths during the pandemic. Claims data also provide insights into the severity and treatment of conditions in a way that raw counts of hospitalizations and deaths cannot. For example, the study found that Black, Hispanic, and AAPI older adults were more likely to receive ventilator support during hospitalization than non-Hispanic White patients.”
“Pandemics can change the history of nations, and we are just beginning to understand how Covid-19 may be changing ours,” Blumenthal and Jacobson wrote.
Tsai and co-authors conducted a retrospective, observational study in Medicare FFS beneficiaries who had a Covid-19–related medical encounter from April 2020 through December 2020.
They reported that among 28.1 million Medicare FFS beneficiaries, 4.2% sought Covid-19-related medical care. In addition, they found that:
- 23.0% had an inpatient stay.
- 4.2% died during hospitalization.
- 57.0% were female.
- 79.6% were non-Hispanic White.
- 77.2% lived in an urban county.
Medicare FFS costs for Covid-19-related medical care were $6.3 billion, and nearly 93% of the costs were for hospitalizations, the authors noted, with the following breakdown:
- Mean hospitalization cost: $21,752.
- Mean length of stay (LOS): 9.2 days.
- Mean hospitalization cost and LOS if patient needed a ventilator: $49,441; 17.1 days.
- Mean hospitalization cost and LOS if patient died: $32,015; 11.3 days.
- Mean cost per outpatient visit: $164.
They also found that patients, ages ≥75 years, were more likely to be hospitalized, although their hospitalizations were tied to lower costs versus younger patients. Male sex and non-white race/ethnicity were linked with higher probability of being hospitalized and higher medical costs.
The authors reported that the probability of being hospitalized was higher among non-Hispanic Black (10.8 percentage points, 95% CI 9.6 to 11.9), Hispanic patients (8.8 percentage points, 95% CI 7.6 to 10.0), and AAPI (5.4 percentage points, 95% CI 1.8 to 9.0) patients versus non-Hispanic white patients.
Tsai’s group noted that these higher rates among minorities may continue to be a problem because a “nationally representative survey conducted in December 2020 tracked the public’s attitudes and experiences with Covid-19 vaccination and reported that 35% of Black adults definitely or probably would not get vaccinated.”
“Taken together, our findings suggest that identifying effective strategies to promote Covid-19 vaccine uptake among disproportionately affected racial and ethnic minority populations is critical,” they emphasized.
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A Medicare claims analysis found that patients ages 65 years and older were at increased risk for hiospitalization and mortality associated with Covid-19.
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The disease and economic burden of Covid-19 was higher among racial and ethnic minority populations than among non-Hispanic White patients.
Shalmali Pal, Contributing Writer, BreakingMED™
Tsai and co-authors, as well as Blumenthal and Jacobson, reported no relationships relevant to the contents of this paper to disclose.
Cat ID: 190
Topic ID: 79,190,282,464,931,730,933,190,926,255,927,60,928,925,934
