Older adults who are hospitalized for COVID-19 have double the rate of death upon discharge as older adults hospitalized for influenza-related complications, according to a new study in The BMJ.
The study was conducted by researchers at the Beth Israel Deaconess Medical Center (BIDMC) in Boston using national Medicare data to characterize the long-term risk of death and hospital readmission after being hospitalized with COVID-19 among beneficiaries 65 years and older.
The researchers compared outcomes of 883,394 Medicare beneficiaries admitted and subsequently discharged from the hospital with COVID-19 from March 2020 to August 2022, with outcomes of 56,409 Medicare beneficiaries admitted and discharged from the hospital for flu from March 2018 to August 2019.
The main outcome was all-cause death within 180 days of discharge.
Risk of in-hospital death 6 times higher
Despite having lower rates of comorbidities, the patients with COVID-19 had a higher risk of dying at 30 days post-hospitalization than flu patients (10.9% vs 3.9%). The higher risk of death rate persisted at 90 day (15.5% vs 7.1%), and at 180 days (19.1% vs 10.5%).
The 30 day risk of death after hospital admission with COVID-19 peaked at 17.9% on 1 May 2020 but decreased to 7.2% by the end of the study period.
"The 30 day risk of death after hospital admission with COVID-19 peaked at 17.9% on 1 May 2020 but decreased to 7.2% by the end of the study period," the authors wrote. "Although this finding may be due to differences in the biology of SARS-CoV-2 and influenza viruses, it may also reflect differences in baseline immunity between cohorts, either from previous infection or from vaccination, though we were unable to evaluate the underlying mechanism in this study."
Patients with COVID-19 also saw a sixfold higher rate of in-hospital deaths; 16.6% of Medicare enrollees died while hospitalized for COVID-19, compared with just 2.7% of those hospitalized for flu.
In addition, the COVID-19 group had longer hospital stays than the flu group (8.6 vs 5.3 days).
"While we did find that rates of death following a hospitalization for COVID-19 steadily declined over the course of the pandemic, the substantial in-hospital and early post-discharge risk of death associated with COVID-19 in this sample of Medicare beneficiaries highlights the need for preventative interventions, particularly in patients at increased long-term risk for adverse outcomes," said first author Andrew S. Oseran, MD, MBA, a research fellow at the Smith Center for Outcomes Research at BIDMC, in a BIDMC press release.
"Our findings suggest the continued need to evaluate clinical and societal interventions that address the glaring inequities in post-discharge outcomes among older adults hospitalized with COVID-19."
The study was funded by the National Health, Lung, and Blood Institute.
As of June 1, 2023, COVID-19 has caused 1.1 million deaths in the United States, with most of this burden concentrated among Medicare beneficiaries, or older Americans, the study authors note.