Post-hospitalization non-COVID deaths rose among Medicare patients after start of pandemic

Hospitalizations for non-COVID diagnoses have fallen among Medicare beneficiaries since the start of the pandemic, but more hospitalized patients are dying in the 30 days after being admitted, according to results of a new study.

Researchers looked at data for 8.4 million Medicare patients hospitalized for non-COVID illnesses between January 2019 and September 2021. They found that admissions dropped sharply in March and April of 2020, and though they increased somewhat thereafter, were still below pre-pandemic levels by September 2021.

In contrast, 30-day mortality rates among this cohort increased to 12.4% in March 2020 and 13.5% in April, compared to 8.9% and 10.2% during the same months in 2019. The overall 30-day rate during the study period rose from 9.4% in 2019 to 11.5% from April 2020 through September, 2021.

The authors note that the upturn in mortality rates among these patients from the prepandemic to the pandemic eras varied according to several factors. Black and Hispanic patients saw greater increases in their odds of death than white patients.

Increases in 30-day mortality were also larger among patients eligible for Medicaid, those admitted from the community rather than nursing homes, lived in ZIP codes associated with low educational levels, and were admitted to hospitals with lower quality ratings and/or high COVID caseloads.

The rises in mortality rates also varied according to the admitting diagnosis. Patients hospitalized for pneumonia, cellulitis and urinary tract infection had the greatest mortality increases compared to the time before the pandemic, while those admitted with alcohol-related diagnoses saw no increase.

The authors offer two possible explanations for higher post-pandemic mortality rates. First, that hospitalized patients were sicker and more advanced in their illness due to their fear of COVID exposure or lack of access to outpatient and emergency care.

Second, that the pandemic created a shortage of hospital personnel and resources— such as intensive care unit beds—that resulted in lower-quality care for all patients. This hypothesis is supported, they say, by the greater increases in mortality rates seen in rural hospitals, smaller hospitals and those not affiliated with a medical school since the start of the pandemic.

The authors note that the uncertain duration of the pandemic could cause patients with non-COVID illnesses to continue delaying or avoiding care, leading to ongoing excess morbidity and mortality. In light of that possibility, they say, clinicians and health care policymakers need to develop strategies to provide optimal care for these patients, especially those who are poor or members of racial and ethnic minority groups.

The study, “Hospitalizations and Mortality From Non–SARS-CoV-2 Causes Among Medicare Beneficiaries at US Hospitals During the SARS-CoV-2 Pandemic” was published March 9 on JAMA Network Open.