Since last spring, there has been a consistent — and justifiable — narrative that long-term care residents are particularly vulnerable to the deadly COVID-19 virus.
New research, however, suggests it’s not so simple.
A team of researchers from the Cleveland Clinic and Health Data Analytics Institute (HDAI) explored how the COVID-19 virus affects actual versus expected mortality rates among the Medicare fee-for-service population.
Specifically, researchers examined tens of millions of individual Medicare claims linked to more than 28 million people to learn how underlying conditions, demographics, setting and other factors contribute to the overall likelihood of death over a given time period.
Using an artificial intelligence tool, they then compared “digital health twins” to help quantify COVID-19’s impact. The Medicare claims data put through the AI tool came from February to November of last year.
“By creating these kind of ‘digital health twins,’ we’re able now to look at the outcomes of both groups and understand how COVID impacted individuals in a way that wasn’t possible when you look at the full population and start evaluating averages of mortality without any regard to the individual profiles of the patients you’re analyzing,” Dr. Daniel Sessler, chair of the Department of Outcomes Research at the Cleveland Clinic and one of the researchers, told Home Health Care News.
Among their results, researchers found that the COVID-19 virus increased an individual’s odds of dying by nearly the exact same degree, regardless of if they were in a long-term care facility or in the broader community.
Prior to the pandemic, Medicare beneficiaries located in the broader community had a 3.96% chance of dying in the coming year. During COVID-19, the mortality rate of that group jumped to 7.50%, an increase of 3.54 percentage points.
In comparison, Medicare beneficiaries located in long-term care facilities had a 20.33% chance of dying in the following year prior to the public health emergency. In pandemic times, their mortality rate rose to 24.62%, an increase of 4.29 percentage points.
“COVID increases mortality by about [4 percentage points],” Nassib Chamoun, president and CEO of HDAI, told HHCN. “It does that in both the community and with long-term care patients. It was a little surprising because people say that people in nursing homes are especially susceptible, but it turns out that the increase in mortality in skilled nursing facilities is [similar to] the community.”
Sessler and Chamoun note that their research is not claiming one setting is safer than another. Instead, they say, it reinforces how a person’s age and clinical characteristics play a far greater role in their actual versus expected mortality.
That’s why long-term care residents have a higher mortality baseline to start with — they’re often sicker and frailer.
“The underlying composite of disease, as predicted by the risk model, is the biggest single predictor of likelihood of somebody dying,” Chamoun said. “That means these are individuals that are at risk, and something like COVID acted as an accelerant or a catalyst for their underlying condition.”
That’s not the only interesting takeaway from the research.
In addition to the somewhat surprising stats on long-term care facilities, the research also used AI to compare actual versus expected mortality rates between individuals with COVID or suspected COVID to those that likely never had the virus.
To avoid exposure, many hospitals and health systems paused elective procedures. Similarly, a lot of people decided to skip trips to the doctor or forgo the routine care they normally needed.
As a result of that, some predicted that there would be unforeseen, potentially fatal consequences among the non-COVID population. That doesn’t appear to be happening — at least not yet.
Mortality rates for Medicare beneficiaries in the community, in fact, actually decreased in the pandemic environment, according to the research.
“There was a major concern that people were avoiding routine health care for things like heart disease, diabetes, pulmonary failure, kidney injury, [contributing to] mortality increasing in the community, that lots of people who didn’t get COVID would still die as a consequence of COVID because of behavioral changes,” Sessler said. “We specifically evaluated mortality in the community among people who did not have a suspected or confirmed COVID diagnosis, and the results were completely surprising. Mortality went down.”
Sessler and Chamoun’s research revealed several other interesting takeaways as well, but the overarching idea is that it’s still far too early to fully comprehend how COVID-19 has affected the U.S, particularly for older, vulnerable populations.