Your browser doesn't support javascript.
COVID-19 Risk Factors and Mortality Outcomes Among Medicare Patients Receiving Long-term Dialysis.
Salerno, Stephen; Messana, Joseph M; Gremel, Garrett W; Dahlerus, Claudia; Hirth, Richard A; Han, Peisong; Segal, Jonathan H; Xu, Tao; Shaffer, Dan; Jiao, Amy; Simon, Jeremiah; Tong, Lan; Wisniewski, Karen; Nahra, Tammie; Padilla, Robin; Sleeman, Kathryn; Shearon, Tempie; Callard, Sandra; Yaldo, Alexander; Borowicz, Lisa; Agbenyikey, Wilfred; Horton, Golden M; Roach, Jesse; Li, Yi.
  • Salerno S; University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor.
  • Messana JM; Department of Biostatistics, University of Michigan, Ann Arbor.
  • Gremel GW; University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor.
  • Dahlerus C; Division of Nephrology, University of Michigan Health System, Ann Arbor.
  • Hirth RA; Department of Health Policy and Management, University of Michigan, Ann Arbor.
  • Han P; University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor.
  • Segal JH; University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor.
  • Xu T; Division of Nephrology, University of Michigan Health System, Ann Arbor.
  • Shaffer D; University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor.
  • Jiao A; Department of Health Policy and Management, University of Michigan, Ann Arbor.
  • Simon J; University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor.
  • Tong L; Department of Biostatistics, University of Michigan, Ann Arbor.
  • Wisniewski K; University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor.
  • Nahra T; Division of Nephrology, University of Michigan Health System, Ann Arbor.
  • Padilla R; University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor.
  • Sleeman K; University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor.
  • Shearon T; University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor.
  • Callard S; University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor.
  • Yaldo A; University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor.
  • Borowicz L; University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor.
  • Agbenyikey W; University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor.
  • Horton GM; University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor.
  • Roach J; University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor.
  • Li Y; University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor.
JAMA Netw Open ; 4(11): e2135379, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1520147
ABSTRACT
Importance There is a need for studies to evaluate the risk factors for COVID-19 and mortality among the entire Medicare long-term dialysis population using Medicare claims data.

Objective:

To identify risk factors associated with COVID-19 and mortality in Medicare patients undergoing long-term dialysis. Design, Setting, and

Participants:

This retrospective, claims-based cohort study compared mortality trends of patients receiving long-term dialysis in 2020 with previous years (2013-2019) and fit Cox regression models to identify risk factors for contracting COVID-19 and postdiagnosis mortality. The cohort included the national population of Medicare patients receiving long-term dialysis in 2020, derived from clinical and administrative databases. COVID-19 was identified through Medicare claims sources. Data were analyzed on May 17, 2021. Main Outcomes and

Measures:

The 2 main outcomes were COVID-19 and all-cause mortality. Associations of claims-based risk factors with COVID-19 and mortality were investigated prediagnosis and postdiagnosis.

Results:

Among a total of 498 169 Medicare patients undergoing dialysis (median [IQR] age, 66 [56-74] years; 215 935 [43.1%] women and 283 227 [56.9%] men), 60 090 (12.1%) had COVID-19, among whom 15 612 patients (26.0%) died. COVID-19 rates were significantly higher among Black (21 787 of 165 830 patients [13.1%]) and Hispanic (13 530 of 86 871 patients [15.6%]) patients compared with non-Black patients (38 303 of 332 339 [11.5%]), as well as patients with short (ie, 1-89 days; 7738 of 55 184 patients [14.0%]) and extended (ie, ≥90 days; 10 737 of 30 196 patients [35.6%]) nursing home stays in the prior year. Adjusting for all other risk factors, residing in a nursing home 1 to 89 days in the prior year was associated with a higher hazard for COVID-19 (hazard ratio [HR] vs 0 days, 1.60; 95% CI 1.56-1.65) and for postdiagnosis mortality (HR, 1.31; 95% CI, 1.25-1.37), as was residing in a nursing home for an extended stay (COVID-19 HR, 4.48; 95% CI, 4.37-4.59; mortality HR, 1.12; 95% CI, 1.07-1.16). Black race (HR vs non-Black HR, 1.25; 95% CI, 1.23-1.28) and Hispanic ethnicity (HR vs non-Hispanic HR, 1.68; 95% CI, 1.64-1.72) were associated with significantly higher hazards of COVID-19. Although home dialysis was associated with lower COVID-19 rates (HR, 0.77; 95% CI, 0.75-0.80), it was associated with higher mortality (HR, 1.18; 95% CI, 1.11-1.25). Conclusions and Relevance These results shed light on COVID-19 risk factors and outcomes among Medicare patients receiving long-term chronic dialysis and could inform policy decisions to mitigate the significant extra burden of COVID-19 and death in this population.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Medicare / Renal Dialysis / COVID-19 / Kidney Diseases Type of study: Etiology study / Observational study / Prognostic study / Risk factors Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: JAMA Netw Open Year: 2021 Document Type: Article

Full text: Available Collection: International databases Database: MEDLINE Main subject: Medicare / Renal Dialysis / COVID-19 / Kidney Diseases Type of study: Etiology study / Observational study / Prognostic study / Risk factors Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: JAMA Netw Open Year: 2021 Document Type: Article