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Background <p>The patient burden from COVID-19 extends beyond acute hospitalization, especially for older adults. The objective of this study was to describe post-discharge care settings and mortality rates after a COVID-19 hospitalization among adults aged ≥ 65 years in the United States.</p> Methods <p>This retrospective observational study used the Medicare fee-for-service dataset. We identified Medicare patients hospitalized with COVID-19 from September 2023–February 2024. The date of discharge was the index date. Patients were followed until death, end of enrollment, or six months post-index. Pre- and post- hospitalization care settings, all-cause mortality, and readmission rates were analyzed. Patients were stratified by COVID-19 severity (general ward, intensive care unit [ICU], invasive mechanical ventilation [IMV]) and age (65–74, ≥ 75 years old).</p> Results <p>A total of 67,358 patients were included; most were female (55.6%), white (84.9%), and on average 80.8 years (standard deviation: 8.1). The majority (96.4%) had ≥ 1 high-risk condition as defined by the Centers for Disease Control and Prevention (CDC). The median (interquartile range) length of stay was 5.0 (3.0–7.0) days. During index hospitalization, 4.4% of patients were admitted to the ICU and 5.1% required IMV. Post-discharge, 50.5% of patients who resided at home pre-hospitalization (self-care or under care) required increased care. Less than half (47.8%) of patients who were home (self-care) pre-hospitalization returned home (self-care) upon discharge.</p> <p>A total of 11,658 (17.4%) patients died within 6-months of hospital discharge. Mortality rates increased for patients requiring higher levels of care: 7.1% of patients discharged home (self-care), 13.0% of patients discharged home (under care), and 31.8% discharged to any healthcare facility died within six months. Mortality was higher in those with more severe COVID-19 and those aged ≥ 75 years. The COVID-19-related readmission rate was 4.5% within six months of discharge, and 3.2% occurred within 30 days.</p> Conclusion <p>The proportion of older adults who lost independence and required care (under care at home or at a healthcare facility) more than doubled after COVID-19 hospitalization, making the post-discharge period a particularly vulnerable time for patients, who are at risk for death and hospital readmission.</p>

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Mortality and transitions-of-care after COVID-19 hospitalization among US Medicare patients: a retrospective claims analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月28日

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  • Alon Yehoshua,
  • Rachel M. Black,
  • Anan Zhou,
  • Michelle A. Silver,
  • Yu Han,
  • Santiago MC Lopez,
  • Manuela Di Fusco,
  • Benjamin Yarnoff,
  • Rajeev M. Nepal,
  • Maria M. Fernandez,
  • Mohammad Ashraf Chaudhary,
  • Tara Ahi

摘要

Background

The patient burden from COVID-19 extends beyond acute hospitalization, especially for older adults. The objective of this study was to describe post-discharge care settings and mortality rates after a COVID-19 hospitalization among adults aged ≥ 65 years in the United States.

Methods

This retrospective observational study used the Medicare fee-for-service dataset. We identified Medicare patients hospitalized with COVID-19 from September 2023–February 2024. The date of discharge was the index date. Patients were followed until death, end of enrollment, or six months post-index. Pre- and post- hospitalization care settings, all-cause mortality, and readmission rates were analyzed. Patients were stratified by COVID-19 severity (general ward, intensive care unit [ICU], invasive mechanical ventilation [IMV]) and age (65–74, ≥ 75 years old).

Results

A total of 67,358 patients were included; most were female (55.6%), white (84.9%), and on average 80.8 years (standard deviation: 8.1). The majority (96.4%) had ≥ 1 high-risk condition as defined by the Centers for Disease Control and Prevention (CDC). The median (interquartile range) length of stay was 5.0 (3.0–7.0) days. During index hospitalization, 4.4% of patients were admitted to the ICU and 5.1% required IMV. Post-discharge, 50.5% of patients who resided at home pre-hospitalization (self-care or under care) required increased care. Less than half (47.8%) of patients who were home (self-care) pre-hospitalization returned home (self-care) upon discharge.

A total of 11,658 (17.4%) patients died within 6-months of hospital discharge. Mortality rates increased for patients requiring higher levels of care: 7.1% of patients discharged home (self-care), 13.0% of patients discharged home (under care), and 31.8% discharged to any healthcare facility died within six months. Mortality was higher in those with more severe COVID-19 and those aged ≥ 75 years. The COVID-19-related readmission rate was 4.5% within six months of discharge, and 3.2% occurred within 30 days.

Conclusion

The proportion of older adults who lost independence and required care (under care at home or at a healthcare facility) more than doubled after COVID-19 hospitalization, making the post-discharge period a particularly vulnerable time for patients, who are at risk for death and hospital readmission.