COVID-19 Risk Factors and Mortality Outcomes Among Medicare Patients Receiving Long-term Dialysis.
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, andParticipants:
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 andMeasures:
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 498â¯169 Medicare patients undergoing dialysis (median [IQR] age, 66 [56-74] years; 215â¯935 [43.1%] women and 283â¯227 [56.9%] men), 60â¯090 (12.1%) had COVID-19, among whom 15â¯612 patients (26.0%) died. COVID-19 rates were significantly higher among Black (21â¯787 of 165â¯830 patients [13.1%]) and Hispanic (13â¯530 of 86â¯871 patients [15.6%]) patients compared with non-Black patients (38â¯303 of 332â¯339 [11.5%]), as well as patients with short (ie, 1-89 days; 7738 of 55â¯184 patients [14.0%]) and extended (ie, ≥90 days; 10â¯737 of 30â¯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.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Medicare
/
Renal Dialysis
/
COVID-19
/
Kidney Diseases
Type of study:
Cohort study
/
Experimental Studies
/
Observational study
/
Prognostic study
/
Randomized controlled trials
Topics:
Long Covid
Limits:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
North America
Language:
English
Journal:
JAMA Netw Open
Year:
2021
Document Type:
Article
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