Hospitalizations and Mortality From Non–SARS-CoV-2 Causes Among Medicare Beneficiaries at US Hospitals During the SARS-CoV-2 Pandemic

Dang, Alexander; Thakker, Ravi; Li, Shuang; Hommel, Erin; Mehta, Hemalkumar B.; Goodwin, James S.

doi:10.1001/jamanetworkopen.2022.1754

Cited by 46 publications

(67 citation statements)

References 37 publications

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“…Although some positive consequences have resulted from these challenges, including the move to routine virtual health care and the increased attention on staffing and supply chain sustainability, these positive consequences have been overwhelmed by the pandemic's negative impacts on health. Dang et al 1 Perhaps the most striking finding from the study 1 was that increased mortality was observed in hospitals with more COVID-19-related admissions, confirming the far-reaching consequences of COVID-19-related strain on the health care system. Strain, which is defined as nearing or exceeding the limits of the care team's ability to provide high-quality care to all patients who require it, 2 is a phenomenon that is intimately familiar to clinicians during COVID-19 but that can be challenging to quantify and study.…”

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confidence: 63%

The COVID-19 Pandemic Strikes Again and Again and Again

Myers

Vincent

2022

JAMA Netw Open

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The COVID-19 pandemic has proven relentlessly challenging for health care. Although some positive consequences have resulted from these challenges, including the move to routine virtual health care and the increased attention on staffing and supply chain sustainability, these positive consequences have been overwhelmed by the pandemic's negative impacts on health. Dang et al 1 tally yet one more adverse outcome of COVID-19: among Medicare patients, mortality after hospitalization for non-COVID-19 diagnoses increased significantly. In a retrospective study of more than 8.4 million Medicare admissions between January 2019 and September 2021 occurring at 4626 US hospitals, 30-day risk-adjusted mortality among patients without COVID-19 increased by more than 20%, from 9.43% before COVID-19 to 11.48% after COVID-19.Perhaps the most striking finding from the study 1 was that increased mortality was observed in hospitals with more COVID-19-related admissions, confirming the far-reaching consequences of COVID-19-related strain on the health care system. Strain, which is defined as nearing or exceeding the limits of the care team's ability to provide high-quality care to all patients who require it, 2 is a phenomenon that is intimately familiar to clinicians during COVID-19 but that can be challenging to quantify and study. Strain is typically measured through metrics of how busy the hospital is, such as occupancy, acuity, turnover, admissions, discharges, and/or the need for organ support therapy. 3 Prior work 3 has shown that during periods of high hospital strain, borderline patients with common illnesses like sepsis and acute respiratory failure are far less likely to be admitted to the intensive care unit compared with periods of low strain. This is a stark example of how strain can impact routine care processes and even patient outcomes in severe illness.The COVID-19 pandemic has strained health systems around the world in unprecedented ways, with all health systems grappling with limitations in staffing (physicians, nurses, respiratory therapists, and pharmacists), supplies (medications, tests, ventilators, high-flow oxygen machines, and vaccines), and space (hospital beds, subacute nursing facility beds, and dialysis units). During the pandemic's inpatient surges, COVID-19-specific mortality was already known to increase. 4 However, the study by Dang et al 1 confirms a lingering concern that clinicians have feared might also be true: elderly patients admitted to hospitals with diagnoses other than COVID-19 are more likely to die during surges, even after adjusting for patient and hospital characteristics. This work is important because it quantifies a very serious source of harm that is not part of the daily COVID-19 case or death counts highlighted in the media.We are left to wonder what factors are associated with this increased mortality. Multiple studies have shown that health care delivery has changed during COVID-19, and, early on, patients were afraid to present to acute care, so even the incidence of acute...

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confidence: 63%

The COVID-19 Pandemic Strikes Again and Again and Again

Myers

Vincent

2022

JAMA Netw Open

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“…Third, some unmeasured confounders could not be adjusted for in the analysis, such as behaviors that are associated with getting vaccinated and mortality. Fourth, there could be variation in outcome by medical center, as previous literature has demonstrated worse outcomes in areas with more cases of COVID‐19 [ 20 ]. However, matching by medical center was not feasible due to power.…”

Section: Discussionmentioning

confidence: 99%

Adults hospitalized with breakthrough COVID‐19 have lower mortality than matched unvaccinated adults

et al. 2022

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Background Coronavirus disease 2019 (COVID‐19) breakthrough infections are common. Objective Evaluate in‐hospital mortality of patients with COVID‐19 by vaccination status using retrospective cohort study. Methods We generated propensity scores for receipt of full vaccination in adults requiring supplemental oxygen hospitalized at Kaiser Permanente Northern California (1 April 2021 to 30 November 2021) with positive severe acute respiratory syndrome coronavirus 2 polymerase chain reaction tests. Optimal matching of fully vaccinated/unvaccinated patients was performed comparing in‐hospital mortality. Results Of 7305 patients, 1463 (20.0%) were full, 138 (1.9%) were partial, and 5704 (78.1%) were unvaccinated. Fully vaccinated were older than partial or unvaccinated (71.0, 63.0, and 54.0 years, respectively, p < 0.001) with more comorbidities (Comorbidity Point Scores 33.0, 22.0, and 10.0, p < 0.001) and immunosuppressant (11.5%, 8.7%, and 3.0%, p < 0.001) or chemotherapy exposure (2.8%, 0.7%, and 0.4%, p < 0.001). Fewer fully vaccinated patients died compared to matched unvaccinated (9.0% vs. 16.3%, p < 0.0001). Conclusion Fully vaccinated patients are less likely to die compared to matched unvaccinated patients.

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“… 34 Another contributor to excess mortality during the pandemic is an increase in deaths from non‐COVID‐19 causes, presumably from disruption of regular medical care and social services. 28 A recent survey found that forgone medical care was more common among those with mental health problems. 35 The social isolation caused by the pandemic might also more negatively affect the health of patients with psychiatric disorders and can contribute to excess deaths.…”

Section: Discussionmentioning

confidence: 99%

“…COVID‐19 infections were identified as the first Medicare claim (inpatient, SNF, outpatient, and carrier claims) with a diagnosis code of U07.1 in the10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD‐10‐CM) on or after April 1, 2020. 28 COVID‐19 fatality was defined as death within 30 days of first COVID‐19 diagnosis. A sensitivity analysis using death within 60 days was also conducted.…”

Section: Methodsmentioning

confidence: 99%

Excess deaths from COVID‐19 among Medicare beneficiaries with psychiatric diagnoses: Community versus nursing home

Mehta

et al. 2022

J American Geriatrics Society

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Background Psychiatric illness may pose an additional risk of death for older adults during the COVID‐19 pandemic. Older adults in the community versus institutions might be influenced by the pandemic differently. This study examines excess deaths during the COVID‐19 pandemic among Medicare beneficiaries with and without psychiatric diagnoses (depression, anxiety, bipolar disorder, and schizophrenia) in the community versus nursing homes. Methods This is a retrospective cohort study of a 20% random sample of 15,229,713 fee‐for‐service Medicare beneficiaries, from January 2019 through December 2021. Unadjusted monthly mortality risks, COVID‐19 infection rates, and case‐fatality rates after COVID‐19 diagnosis were calculated. Excess deaths in 2020, compared to 2019 were estimated from multivariable logistic regressions. Results Of all included Medicare beneficiaries in 2020 ( N = 5,140,619), 28.9% had a psychiatric diagnosis; 1.7% lived in nursing homes. In 2020, there were 246,422 observed deaths, compared to 215,264 expected, representing a 14.5% increase over expected. Patients with psychiatric diagnoses had more excess deaths than those without psychiatric diagnoses (1,107 vs. 403 excess deaths per 100,000 beneficiaries, p < 0.01). The largest increases in mortality risks were observed among patients with schizophrenia (32.4% increase) and bipolar disorder (25.4% increase). The pandemic‐associated increase in deaths with psychiatric diagnoses was only found in the community, not in nursing homes. The increased mortality for patients with psychiatric diagnoses was limited to those with medical comorbidities. The increase in mortality for psychiatric diagnoses was associated with higher COVID‐19 infection rates (1‐year infection rate = 7.9% vs. 4.2% in 2020), rather than excess case fatality. Conclusions Excess deaths during the COVID‐19 pandemic were disproportionally greater in beneficiaries with psychiatric diagnoses, at least in part due to higher infection rates. Policy interventions should focus on preventing COVID‐19 infections and deaths among community‐dwelling patients with major psychiatric disorders in addition to those living the nursing homes.

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Hospitalizations and Mortality From Non–SARS-CoV-2 Causes Among Medicare Beneficiaries at US Hospitals During the SARS-CoV-2 Pandemic

Cited by 46 publications

References 37 publications

The COVID-19 Pandemic Strikes Again and Again and Again

The COVID-19 Pandemic Strikes Again and Again and Again

Adults hospitalized with breakthrough COVID‐19 have lower mortality than matched unvaccinated adults

Excess deaths from COVID‐19 among Medicare beneficiaries with psychiatric diagnoses: Community versus nursing home

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