Older adults made up 90% of US COVID deaths in 2023

Hand of elderly man in hospital

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Two studies today in Morbidity and Mortality Weekly Report highlight COVID-19 among older adults, with one finding that this age-group made up 63% of all COVID-related hospitalizations and nearly 90% of deaths in 2023 in the United States, and the other showing lower up-to-date vaccination among Black and multiracial nursing home residents and those in the South and Southeast.

Only 24% had received bivalent COVID vaccine

The COVID-19–Associated Hospitalization Surveillance Network (COVID-NET) Surveillance Team estimated rates of COVID-related hospitalization, in-hospital death, and vaccination status among adults aged 65 and older in 98 counties in 13 states from January to August 2023. They also identified the demographic and clinical characteristics of hospitalized patients in this age-group from January to June 2023.

From January to June, rates of COVID-19 hospitalizations among all adults decreased, including among older adults, but rates stayed elevated among older adults relative to younger ones and began rising in July.

Hospitalization rates in COVID-19 patients aged 65 and older more than doubled over the study period, from 6.8 per 100,000 during the week ending July 15 to 16.4 per 100,000 during the week ending August 26. Roughly one in six older adults hospitalized for COVID-19 were nursing home residents.

Hospitalization rates in COVID-19 patients aged 65 and older more than doubled over the study period.

Adults aged 65 and older accounted for 62.9% (95% confidence interval [CI], 60.1% to 65.7%) of COVID-19 hospitalizations, 61.3% (95% CI, 54.7% to 67.6%) of intensive care unit admissions, and 87.9% (95% CI, 80.5% to 93.2%) of in-hospital deaths. Most hospitalized patients had multiple chronic conditions (90.3%; 95% CI, 87.2% to 92.8%), and only 23.5% (95% CI, 19.5% to 27.7%) had received the recommended bivalent (two-strain) vaccine. A total of 16% had not received any COVID-19 vaccines.

"Adults with increased risk for COVID-19–associated hospitalization, including all adults aged ≥65 years, should reduce their risk for severe COVID-19 by receiving recommended COVID-19 vaccinations, adopting measures to reduce risk for contracting COVID-19, and seeking prompt outpatient antiviral treatment after a positive SARS-CoV-2 test result," the study authors wrote.

Greater proportion of those 75 and older were current

For the second study, researchers from the Centers for Disease Control and Prevention (CDC) mined data from the National Healthcare Safety Network from 1,797 long-term care facilities (LTCs) to evaluate demographic differences in primary and up-to-date COVID-19 vaccination status among residents from October 2022 to May 2023.

Up-to-date status was considered receipt of a bivalent COVID-19 vaccine dose or completion of a primary vaccine series less than 2 months earlier. Over 99% of LTCs in the study were nursing homes. "Long-term care (LTC) facility residents are vulnerable to SARS-CoV-2 infection because of their often-advanced age, medical complexity, and congregate setting," the researchers wrote.

Up-to-date status was substantially lower in nursing home residents in the South (Region 6 of the US Department of Health and Human Services; 37.7%) and Southeast (Region 4; 36.5%) than among those in the Pacific Northwest (Region 10; 53.3%) and Mountain West (Region 8; 59.6%) regions.

Most recent guidance indicates that persons who are aged ≥65 years or who are immunocompromised should consider additional bivalent vaccine doses.

Greater proportions of residents aged 75 years and older were up to date than those aged 30 to 49 (46.0% vs 37.7%, respectively), and women were more likely to be current than men (44.6% vs 42.4%, respectively).

American Indian, Asian, and Native Hawaiian/Pacific Islander residents were the most up to date with COVID-19 vaccines, at 54.6%, 56.2%, and 60.6%, respectively. Current vaccination was lowest among Black (39.9%) and multiracial (42.2%) residents. A lower proportion of Hispanic residents than non-Hispanic residents were current with vaccines (36.5% vs 44.5%).

"Strategies to increase up-to-date COVID-19 vaccination among LTC residents could include and address these geographic and racial differences," the authors wrote. "These findings underscore the importance of improving the understanding of factors contributing to these geographic and demographic differences to guide public health practice and resource allocation."

"Residents of [LTCs] should stay up to date with CDC-recommended COVID-19 vaccines, including getting the updated COVID-19 vaccine," they added. "Most recent guidance indicates that persons who are aged ≥65 years or who are immunocompromised should consider additional bivalent vaccine doses."

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