Covid-19 and excess mortality in medicare beneficiaries

• Published in: PloS one Vol. 17; no. 2; p. e0262264
• Main Authors: Greenwald, Scott D, Chamoun, Nassib G, Manberg, Paul J, Gray, Josh, Clain, David, Maheshwari, Kamal, Sessler, Daniel I
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 02.02.2022; Public Library of Science (PLoS)
• Subjects: Aged; Aged, 80 and over; Anesthesiology; Beneficiaries; Biology and Life Sciences; Chronic illnesses; Coronaviruses; COVID-19; COVID-19 - economics; COVID-19 - mortality; Data analysis; Disease transmission; Fatalities; Female; Government programs; Health aspects; Health risks; Humans; Incidence; Infections; Insurance Benefits - trends; Long-term care; Long-Term Care - trends; Long-term care facilities; Male; Medicaid; Medicare; Medicare - trends; Medicine and Health Sciences; Mortality; Mortality risk; Older people; Pandemics; Patients; Population; Risk; Risk Factors; Safety and security measures; SARS-CoV-2 - pathogenicity; Severe acute respiratory syndrome coronavirus 2; Skilled Nursing Facilities - trends; Social aspects; Social interactions; Social isolation; Social Sciences; Supervision; United States; United States; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0262264

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.