Covid-19 and excess mortality in medicare beneficiaries.

Autor: Greenwald SD; Health Data Analytics Institute, Dedham, MA, United States of America., Chamoun NG; Health Data Analytics Institute, Dedham, MA, United States of America., Manberg PJ; Health Data Analytics Institute, Dedham, MA, United States of America., Gray J; Health Data Analytics Institute, Dedham, MA, United States of America., Clain D; Health Data Analytics Institute, Dedham, MA, United States of America., Maheshwari K; Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States of America.; Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States of America., Sessler DI; Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2022 Feb 02; Vol. 17 (2), pp. e0262264. Date of Electronic Publication: 2022 Feb 02 (Print Publication: 2022).
DOI: 10.1371/journal.pone.0262264
Abstrakt: We estimated excess mortality in Medicare recipients in the United States with probable and confirmed Covid-19 infections in the general community and amongst residents of long-term care (LTC) facilities. We considered 28,389,098 Medicare and dual-eligible recipients from one year before February 29, 2020 through September 30, 2020, with mortality followed through November 30th, 2020. Probable and confirmed Covid-19 diagnoses, presumably mostly symptomatic, were determined from ICD-10 codes. We developed a Risk Stratification Index (RSI) mortality model which was applied prospectively to establish baseline mortality risk. Excess deaths attributable to Covid-19 were estimated by comparing actual-to-expected deaths based on historical (2017-2019) comparisons and in closely matched concurrent (2020) cohorts with and without Covid-19. Overall, 677,100 (2.4%) beneficiaries had confirmed Covid-19 and 2,917,604 (10.3%) had probable Covid-19. A total of 472,329 confirmed cases were community living and 204,771 were in LTC. Mortality following a probable or confirmed diagnosis in the community increased from an expected incidence of about 4.0% to actual incidence of 7.5%. In long-term care facilities, the corresponding increase was from 20.3% to 24.6%. The absolute increase was therefore similar at 3-4% in the community and in LTC residents. The percentage increase was far greater in the community (89.5%) than among patients in chronic care facilities (21.1%) who had higher baseline risk of mortality. The LTC population without probable or confirmed Covid-19 diagnoses experienced 38,932 excess deaths (34.8%) compared to historical estimates. Limitations in access to Covid-19 testing and disease under-reporting in LTC patients probably were important factors, although social isolation and disruption in usual care presumably also contributed. Remarkably, there were 31,360 (5.4%) fewer deaths than expected in community dwellers without probable or confirmed Covid-19 diagnoses. Disruptions to the healthcare system and avoided medical care were thus apparently offset by other factors, representing overall benefit. The Covid-19 pandemic had marked effects on mortality, but the effects were highly context-dependent.
Competing Interests: We have read the journal’s policy and the authors of this manuscript have the following competing interests: Greenwald, Chamoun, Manberg, Gray and Clain are employees of and hold equity positions in Health Data Analytics Institute. Dr. Sessler is a paid consultant and holds equity interest in Health Data Analytics Institute. Dr. Maheshwari received no compensation from Health Data Analytics Institute. This does not alter our adherence to PLOS ONE policies on sharing data and materials. There are no patents, products in development or marketed products associated with this research to declare.
Databáze: MEDLINE
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