Dataset Information

Racial and ethnic differences in COVID-19 hospitalizations by metropolitan status among Medicare beneficiaries, 1 January-31 December 2020.

ABSTRACT:

Background

Risk for COVID-19 hospitalizations increases with increasing age and presence of underlying medical conditions. However, the burden has not been well-assessed in metropolitan and nonmetropolitan areas by race/ethnicity among Medicare population with chronic conditions.

Methods

We used the 2020 Medicare data to estimate COVID-19 hospitalization rates by race/ethnicity among Medicare beneficiaries for COVID-19 by metropolitan status and to assess the association of hospitalizations from COVID-19 with each of selected 29 chronic conditions for patients by metropolitan status and by race/ethnicity.

Results

The COVID-19 hospitalization rate was higher among beneficiaries residing in nonmetropolitan counties than those residing in metropolitan counties in 2020. Approximately 1 in 2 AI/AN, 1 in 3 NHB, Hispanic and A/PI, and 1 in 4 NHW beneficiaries with COVID-19 residing in nonmetropolitan counties were hospitalized. Beneficiaries with COVID-19 and chronic conditions were more likely to be hospitalized compared with those without chronic conditions.

Conclusions

Hospitalization rates among beneficiaries with COVID-19 and chronic conditions were not distributed equally by race/ethnicity and by metropolitan status. Researchers, policymakers and practitioners can use these findings to explore more effective ways of reducing racial/ethnic and geographic disparities among minorities disproportionately affected by COVID-19 and are at highest risk of hospitalization.

SUBMITTER: Chang MH

PROVIDER: S-EPMC8980106 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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Publications

Racial and ethnic differences in COVID-19 hospitalizations by metropolitan status among Medicare beneficiaries, 1 January-31 December 2020.

Chang Man-Huei MH Moonesinghe Ramal R Truman Benedict I BI

Journal of public health (Oxford, England) 20220601 2

<h4>Background</h4>Risk for COVID-19 hospitalizations increases with increasing age and presence of underlying medical conditions. However, the burden has not been well-assessed in metropolitan and nonmetropolitan areas by race/ethnicity among Medicare population with chronic conditions.<h4>Methods</h4>We used the 2020 Medicare data to estimate COVID-19 hospitalization rates by race/ethnicity among Medicare beneficiaries for COVID-19 by metropolitan status and to assess the association of hospit ...[more]

PMID: 34611709

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Project description:BackgroundMedicare disability beneficiaries (MDBs) have disproportionately high risk of opioid use disorder (OUD) and related harms given high rates of comorbidities and high-dose opioid prescribing. Despite this increased risk, little is known about timely receipt of medication for opioid use disorder (MOUD), including potential disparities by patient race/ethnicity or moderation by county-level characteristics.MethodsNational Medicare claims for a sample of MDBs with incident OUD diagnosis between March 2016 and June 2019 were linked with county-level data. Multivariable mixed effects Cox proportional hazards models estimated time (in days) to buprenorphine receipt within 180 days of incident OUD diagnosis. Primary exposures included individual-level race/ethnicity and county-level buprenorphine prescriber availability, percent non-Hispanic white (NHW) residents, and Social Deprivation Index (SDI) score.ResultsThe sample (n=233,079) was predominantly White (72.3%), ≥45 years old (76.3%), and male (54.8%). Black (adjusted hazard ratio [aHR]=0.50; 95% CI, 0.47-0.54), Asian/Pacific Islander (aHR=0.54; 95% CI, 0.41-0.72), Hispanic/Latinx (aHR=0.81; 95% CI, 0.76-0.87), and Other racial/ethnic groups (aHR=0.75; 95% CI, 0.58-0.97) had a lower likelihood of timely buprenorphine than non-Hispanic white beneficiaries after adjusting for individual and county-level confounders. Timely buprenorphine receipt was positively associated with county-level buprenorphine prescriber availability (aHR=1.05; 95% CI, 1.04-1.07), percent non-Hispanic white residents (aHR=1.01; 95% CI, 1.00-1.01), and SDI (aHR=1.06; 95% CI, 1.01-1.10).ConclusionsRacial/ethnic disparities highlight the need to improve access to care for underserved groups. Implementing equity-focused quality and performance measures and developing interventions to increase office-based buprenorphine prescribing in predominantly minority race/ethnicity counties may reduce disparities in timely access to medication for OUD.

Project description:IntroductionIn 2021, HHS Office of Minority Health and CDC developed a composite measure of social vulnerability called the Minority Health Social Vulnerability Index (MHSVI) to assess the needs of communities most vulnerable to COVID-19. The MHSVI extends the CDC Social Vulnerability Index with two new themes on healthcare access and medical vulnerability. This analysis examines COVID-19 vaccination coverage by social vulnerability using the MHSVI.MethodsCounty-level COVID-19 vaccine administration data among persons aged ≥18 years reported to CDC from 12/14/20 to 01/31/22 were analyzed. U.S. counties from 50 states and DC were categorized into tertiles of vulnerability (low, moderate, and high) for the composite MHSVI measure and each of the 34 indicators. Vaccination coverage (≥1 dose, primary series completion, and receipt of a booster dose) was calculated by tertiles for the composite MHSVI measure and each indicator.ResultsCounties with lower per capita income, higher proportion of individuals with no high school diploma, living below poverty, ≥65 years of age, with a disability, and in mobile homes had lower vaccination uptake. However, counties with larger proportions of racial/ethnic minorities and individuals speaking English less than "very well" had higher coverage. Counties with fewer primary care physicians and greater medical vulnerabilities had lower ≥ 1 dose vaccination coverage. Furthermore, counties of high vulnerability had lower primary series completion and receipt of a booster dose. There were no clear patterns in COVID-19 vaccination coverage by tertiles for the composite measure.ConclusionResults from the new components in the MHSVI identify needs to prioritize persons in counties with greater medical vulnerabilities and limited access to health care, who are at greater risk for adverse COVID-19 outcomes. Findings suggest that using a composite measure to characterize social vulnerability might mask disparities in COVID-19 vaccination uptake that would have otherwise been observed using specific indicators.

Dataset Information

Racial and ethnic differences in COVID-19 hospitalizations by metropolitan status among Medicare beneficiaries, 1 January-31 December 2020.

Background

Methods

Results

Conclusions

Publications

Racial and ethnic differences in COVID-19 hospitalizations by metropolitan status among Medicare beneficiaries, 1 January-31 December 2020.

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