The COVID-19 pandemic's impact on all-cause mortality disparities in Medicare: By race, income, chronic health, mental/behavioral health, disability

• Published in: General hospital psychiatry 2023-03, Vol.81, p.57-67
• Main Authors: Anderson, Karyn Kai, Maresh, Sha, Ward, Andrew, Koller, Elizabeth A., Connor, Philip, Evans, Melissa, Kiptanui, Zippora, Raja, Meghana M., Thomas, Serena, Wolfe, Thomas, Gill, Christine S.
• Format: Article
• Language: English
• Subjects: Aged; All-cause mortality; Chronic conditions; Chronic Disease; COVID; COVID-19; Disparity; Humans; Medicare; Mental Health; Pandemics; Schizophrenia; United States - epidemiology
• ISSN: 0163-8343; 1873-7714
• DOI: 10.1016/j.genhosppsych.2023.01.013

The Medicare-enrolled population is heterogeneous across race, ethnicity, age, dual eligibility, and a breadth of chronic health, mental and behavioral health, and disability-related conditions, which may be differentially impacted by the COVID-19 pandemic. To quantify changes in all-cause mortality prior-to and in the first year of the COVID-19 pandemic across Medicare's different sociodemographic and health-condition subpopulations. This observational, population-based study used stratified bivariate regression to investigate Medicare fee-for-service subpopulation differences in pre-pandemic (i.e., 2019 versus 2016) and pandemic-related (2020 versus 2019) changes in all-cause mortality. All-cause mortality in the combined Medicare-Advantage (i.e., managed care) and fee-for-service beneficiary population improved by a relative 1% in the ten years that preceded the COVID-19 pandemic, but then escalated by a relative 15.9% in 2020, the pandemic's first year. However, a closer look at Medicare's fee-for-service subpopulations reveals critical differences. All-cause mortality had actually been worsening prior to the pandemic among most psychiatric and disability-related condition groups, all race and ethnicity groups except White Non-Hispanic, and Medicare-Medicaid dual-eligible (i.e., low-income) beneficiaries. Many of these groups then experienced all-cause mortality spikes in 2020 that were over twice that of the overall Medicare fee-for-service population. Of all 61 chronic health conditions studied, beneficiaries with schizophrenia were the most adversely affected, with all-cause mortality increasing 38.4% between 2019 and 2020. This analysis reveals subpopulation differences in all-cause mortality trends, both prior to and in year-one of the COVID-19 pandemic, indicating that the events of 2020 exacerbated preexisting health-related inequities.