An analysis of 28 million Medicare and dual-eligible patients found significant differences in mortality between people in the community and people in long-term care facilities during the first nine months of the Covid-19 pandemic.
Across the two settings, researchers also found stark differences in mortality based on whether or not patients had tested positive for Covid-19.
The study was conducted by researchers at the Cleveland Clinic and Massachusetts-based startup Health Data Analytics Institute (HDAI). They used a model to estimate patients’ mortality risk based on their age and underlying medical conditions.
They published their findings in a preprint on April 7, which has not yet been peer-reviewed.
The results currently extend through the end of December, which means they haven’t yet taken into account the effect of mass vaccinations — and the effect of variants, with B.1.1.7 now the dominant strain in the U.S.
During the first nine months of the pandemic, mortality in the community increased from 4% to 7.6% for people covered by Medicare who had a Covid-19 diagnosis. For people in long-term care facilities, mortality increased from 20.3% to 24.6%.
Across both groups, researchers found a case fatality rate of between 3% and 4%.
They also found stark differences in how patients fared who hadn’t been diagnosed with Covid-19. During the nine months, people in long-term care facilities experienced 35% more excess deaths than historical estimates.
“In nursing facilities, those who didn’t have Covid experienced just as high of a morality increase as those who had confirmed Covid,” said Dr. Daniel Sessler, a co-author of the study and chair of the Department of Outcomes Research at Cleveland Clinic. He also holds an equity stake in HDAI.
The results, he said, could suggest there was a broader propagation of the disease than known, or that patients suffered from isolation and limited access to care.
By contrast, people covered by Medicare in the community experienced 6% fewer deaths than estimated, despite fewer patients going in for preventive care and screenings.
“We were very worried. All of these are conditions that require chronic management,” Sessler said. “Everyone’s expectation was that mortality would go up in the community… Fortunately, that’s not what seems to have happened.”
That said, both he and HDAI CEO Nassib Chamoun were cautious in their future predictions. The pandemic isn’t over, and in some patients who had Covid-19, a host of symptoms continue to linger. They also worried that the lag in screenings and unmanaged conditions, such as hypertension, could result in worse health conditions later on.
“If these conditions have gone unchecked for 6, 9, 12 months. Are we going to start seeing more complications in the broader population?” Chamoun said. “That’s another factor that we are closely monitoring, that could be the calm before the storm.”
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