Excess deaths from COVID‐19 among Medicare beneficiaries with psychiatric diagnoses: Community versus nursing home
- 22 September 2022
- journal article
- research article
- Published by Wiley in Journal of the American Geriatrics Society
- Vol. 71 (1), 167-177
- https://doi.org/10.1111/jgs.18062
Abstract
Background Psychiatric illness may pose an additional risk of death for older adults during the COVID-19 pandemic. Older adults in the community versus institutions might be influenced by the pandemic differently. This study examines excess deaths during the COVID-19 pandemic among Medicare beneficiaries with and without psychiatric diagnoses (depression, anxiety, bipolar disorder, and schizophrenia) in the community versus nursing homes. Methods This is a retrospective cohort study of a 20% random sample of 15,229,713 fee-for-service Medicare beneficiaries, from January 2019 through December 2021. Unadjusted monthly mortality risks, COVID-19 infection rates, and case-fatality rates after COVID-19 diagnosis were calculated. Excess deaths in 2020, compared to 2019 were estimated from multivariable logistic regressions. Results Of all included Medicare beneficiaries in 2020 (N = 5,140,619), 28.9% had a psychiatric diagnosis; 1.7% lived in nursing homes. In 2020, there were 246,422 observed deaths, compared to 215,264 expected, representing a 14.5% increase over expected. Patients with psychiatric diagnoses had more excess deaths than those without psychiatric diagnoses (1,107 vs. 403 excess deaths per 100,000 beneficiaries, p < 0.01). The largest increases in mortality risks were observed among patients with schizophrenia (32.4% increase) and bipolar disorder (25.4% increase). The pandemic-associated increase in deaths with psychiatric diagnoses was only found in the community, not in nursing homes. The increased mortality for patients with psychiatric diagnoses was limited to those with medical comorbidities. The increase in mortality for psychiatric diagnoses was associated with higher COVID-19 infection rates (1-year infection rate = 7.9% vs. 4.2% in 2020), rather than excess case fatality. Conclusions Excess deaths during the COVID-19 pandemic were disproportionally greater in beneficiaries with psychiatric diagnoses, at least in part due to higher infection rates. Policy interventions should focus on preventing COVID-19 infections and deaths among community-dwelling patients with major psychiatric disorders in addition to those living the nursing homes.Funding Information
- National Institutes of Health (P30AG024832, UL1‐TR001439, 1K01AG070329)
This publication has 39 references indexed in Scilit:
- Health Care Utilization, Care Satisfaction, and Health Status for Medicare Advantage and Traditional Medicare Beneficiaries With and Without Alzheimer Disease and Related DementiasJAMA Network Open, 2020
- Construction and Validation of Risk-adjusted Rates of Emergency Department Visits for Long-stay Nursing Home ResidentsMedical Care, 2019
- The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illnessThe Lancet Psychiatry, 2019
- Association between High Proportions of Seriously Mentally Ill Nursing Home Residents and the Quality of Resident CareJournal of the American Geriatrics Society, 2019
- Measuring Frailty in Medicare Data: Development and Validation of a Claims-Based Frailty IndexThe Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 2017
- Comparison of methods to identify long term care nursing home residence with administrative dataBMC Health Services Research, 2017
- Medicare Beneficiaries With Depression: Comparing Diagnoses in Claims Data With the Results of ScreeningPsychiatric Services, 2011
- Identifying Chronic Conditions in Medicare Claims Data: Evaluating the Chronic Condition Data Warehouse AlgorithmHealth Services Research, 2011
- Mental Illness In Nursing Homes: Variations Across StatesHealth Affairs, 2009
- Comorbidity Measures for Use with Administrative DataMedical Care, 1998