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In early May we looked at a report on Race, Ethnicity, and COVID-19-related Deaths in New York City, which found a stark disparity in fatal outcomes among severe COVID-19 patients from minority populations (see chart above) in New York City.
More recently, in MMWR: COVID-19 Case Surveillance — U.S., Jan 22–May 30, 2020, it was reported:
Among cases with known race and ethnicity, 33% of persons were Hispanic, 22% were black, and 1.3% were AI/AN. These findings suggest that persons in these groups, who account for 18%, 13%, and 0.7% of the U.S. population, respectively, are disproportionately affected by the COVID-19 pandemic.
Yesterday, CMS.Gov (The Centers for Medicare and Medicaid Services) published a new analysis of data on hospitalizations for COVID-19, which found that black Medicare patients were nearly 4 times more likely to be hospitalized with the disease than white patients.
Hispanics were more than twice as likely to be hospitalized, and Asian Americans were roughly 50% more likely.
The analysis was published in a CMS blog (see link and some excerpts below). Follow the link to read it in its entirety.
Jun 22, 2020
Medicare COVID-19 Data Release Blog
Seema Verma, Administrator, Centers for Medicare & Medicaid Services
Today, the Centers for Medicare & Medicaid Services (CMS) released preliminary data on COVID-19 derived from Medicare claims. The data provides a highly instructive picture of the impact of COVID-19 on the Medicare population, further confirming a number of long understood patterns in the disease such as the elevated risk for seniors with underlying health conditions. Additionally, in presenting stark socio-economic and racial/ethnic disparities, the data makes the transition from a fee-for-service system to a value-based one that fosters accountability for outcomes more urgent than ever.
Between January 1 and May 16, 2020, over 325,000 Medicare beneficiaries were diagnosed with COVID-19, and nearly 110,000 of those were hospitalized. These new findings come from the snapshot of COVID-19 data that CMS released today.
The snapshot presents preliminary information gathered from Medicare data, and is part of the Trump Administration’s consistent commitment to data transparency throughout the coronavirus pandemic in an effort to inform public health efforts. It also builds on our efforts over the past three years to make data in our programs more available to researchers.
The snapshot breaks down COVID-19 cases and hospitalizations for Medicare beneficiaries by state; race/ethnicity; dual eligibility for Medicare and Medicaid; age; gender; and urban/rural areas. Findings from the snapshot reinforce previous findings by the Centers for Disease Control and Prevention (CDC) that older Americans and those with chronic health conditions are at the highest risk for COVID-19 and should continue to take extra precautions to protect their health and safety. The data also show that COVID-19 has disproportionately impacted racial and ethnic minority groups and lower income adults, further confirming longstanding healthcare disparities in these populations.
(SNIP)
Key Findings on Coronavirus among Medicare Beneficiaries
- Over 325,000 Medicare beneficiaries have been diagnosed with COVID-19 this year through May 16, translating to 518 cases per 100,000 beneficiaries.
- The 110,000 Medicare beneficiaries hospitalized with a COVID-19 diagnosis this year through May 16 translates to 175 hospitalizations per 100,000 beneficiaries. Among those hospitalized with COVID-19, the five most prevalent chronic conditions for Medicare fee-for-service beneficiaries were: hypertension (79%); hyperlipidemia (60%); chronic kidney disease (50%); anemia (50%); and diabetes (50%).
- The snapshot data also show that 28% of hospitalized beneficiaries died in the hospital, and 27% were discharged to their homes. The remainder were discharged to skilled nursing facilities (21%) or other healthcare settings. Half of hospitalizations (50%) were less than 8 days, while 9% were 21 days or longer. Medicare payments for fee-for-service hospitalizations totaled $1.9 billion, with an average of $23,094 per hospitalization.
- Not surprisingly, the COVID-19 hospitalization rate is highest in New York and New Jersey. Additionally, the rates are also higher for Black beneficiaries (465 hospitalizations per 100,000 beneficiaries), Hispanic beneficiaries (258/100K), and among beneficiaries who are age 85 or older (379/100k). But beneficiaries eligible for Medicare because they have end stage renal disease (ESRD) have the highest COVID-19 hospitalization rate, with 1,341 cases per 100,000 beneficiaries. This finding for beneficiaries with ESRD confirms previous CDC findings that “people with chronic kidney disease undergoing dialysis” (i.e., people with ESRD) might be at higher risk for severe illness from COVID-19.[1] Patients with ESRD are also more likely to have chronic comorbidities associated with increased of COVID-19 complications and hospitalization, such as diabetes and heart failure.
- Beneficiaries enrolled in both Medicare and Medicaid (dually eligible individuals or duals) also have a higher rate of COVID-19 hospitalizations, with 473 hospitalizations per 100,000 beneficiaries. For comparison, the rate for beneficiaries enrolled only in Medicare is 112 hospitalizations per 100,000. The rate of COVID-19 hospitalizations for dually eligible individuals is higher across all age, sex, and race/ethnicity groups. This is not unexpected as previous research and analysis have shown that dually eligible individuals experience high rates of chronic illness, with many having long-term care needs and social risk factors which can lead to poor health outcomes. In particular, duals also experience higher rates of poverty.[2]
While the racial disparities are both pronounced and undeniable, the highest risk group - by a factor of 3 - were those patients with end-stage renal disease. The analysis goes on to discuss limitations in the data collection, and urges caution in interpreting the data.
At the same time, CMS views this preliminary data as a call to action:
A Call to Action
CMS is making our snapshot of COVID-19 data available because it’s essential to understanding how the pandemic is affecting Medicare beneficiaries and to respond accordingly. While we’ve long known that seniors are disproportionately at risk for COVID-19, this snapshot suggests the critical importance of social risk factors, particularly income as shown by the higher rate of COVID-19 cases and hospitalizations among dually eligible individuals.
