COVID-19's Impact on Hospitalization Outcomes

While it is widely believed that the COVID-19 pandemic has had a disproportionately negative impact on racial and ethnic minorities in the United States, important evidence to support this continues to emerge. Regarding overall mortality (amongst all populations in all settings), research has found that Black and Hispanic populations have experienced age-adjusted death rates that are more than double those among White populations. While some research has been done regarding differences in case mortality rates overall in hospitals, little has been done to study the impact on older Americans more specifically, a population that is more susceptible to COVID-19 complications and mortality.

Amongst those with traditional Medicare patients (typically those older than 65 years old), did hospitalizations and racial and ethnic disparities in hospitalization outcomes change during the COVID-19 pandemic? Avant-garde Health’s Xiaoran (Luka) Zhang and Derek Haas partnered with researchers Dr. Zirui Song (Harvard Medical School and Massachusetts General Hospital), Dr. Lindsey Patterson (Harvard Medical School), and Dr. C. Lowry Barnes (University of Arkansas for Medical Sciences) to explore the data in a new JAMA Network article titled “Racial and Ethnic Disparities in Hospitalization Outcomes Among Medicare Beneficiaries During the COVID-19 Pandemic.”

The team found that amongst nearly 32 million beneficiaries who were hospitalized between January 2019 and February 2021 (representing just over 14 million hospitalizations), there were similar declines in non-COVID-19 and inclines in COVID-19 hospitalizations among Medicare beneficiaries of different racial and ethnic minority groups. During this timeframe, White Medicare enrollees experienced a COVID-19 hospitalization rate of 1.4 per 1000 beneficiaries per month, compared with 2.8 and 3.6 hospitalizations per 1000 beneficiaries per month for Black and Hispanic enrollees, respectively.

However, the story became different when looking specifically at mortality within those hospitalized (see figure below). Those from non-White racial and ethnic minority groups did experience higher in-hospital mortality from COVID-19. This was primarily due to a large disparity between Hispanic and White Medicare enrollees. Hispanic Medicare enrollees experienced an in-hospital COVID-19 mortality rate that was 3.5 percentage points higher than White patients. Additionally, mortality for non-COVID-19 hospitalizations was higher amongst racial and ethnic minority groups, driven by a large disparity between Black and White patients. Black Medicare enrollee in-hospital non-COVID-19 mortality increased by 0.5 percentage points more than it increased for White patients (representing a nearly 18% increase for Black versus White patients when compared to pre-pandemic levels).

Overall, the COVID-19 pandemic has had an outsized impact on racial and ethnic minorities in the United States, a finding further supported by our research on Medicare enrollees’ hospitalizations specifically. Avant-garde Health is committed to helping our partners provide the highest quality care to all patients and will continue to work to partner with other researchers to produce important studies such as this one.