Study reveals patients hospitalized with COVID-19 faced nearly twice the rates of death after discharge as patients with Flu

Aug. 22, 2023
Post-discharge risk of death has declined over the course of the pandemic, though inequities persist.

In a new study, researchers from the Richard A. and Susan F. Smith Center for Outcomes Research at Beth Israel Deaconess Medical Center (BIDMC) used national Medicare data to characterize the long-term risk of death and hospital readmission after being hospitalized with COVID-19 among beneficiaries 65 years and older.

The study, which appears in the BMJ, demonstrates that among individuals who were admitted to the hospital with COVID-19 and were discharged alive, the risk of post-discharge death was nearly twice that observed in those who were discharged alive from an influenza-related hospital admission.

The research, led by Smith Center investigators and funded by the National Health, Lung, and Blood Institute, compared outcomes for more than one million Medicare beneficiaries admitted to the hospital with COVID-19 between March 2020 and August 2022 and a historical cohort of nearly 58,000 Medicare beneficiaries admitted to the hospital for influenza between March 2018 and August 2019.

The physician-researchers observed that patients hospitalized for COVID-19 had a higher in-hospital mortality compared with the influenza cohort (17% vs 3%), but this increased risk of death after COVID-19 hospitalization persisted at 30 days, 90 days, and 180 days after discharge. The greatest difference in risk between the two groups being concentrated in the first 30 days after discharge.

Within the COVID-19 cohort, significant differences were found in the 180-day risk of post discharge, death by race and socioeconomic status. Individuals enrolled in both Medicaid and Medicare had higher risk of death. Black patients had a higher risk of death or rehospitalization compared with white patients, largely driven by an increased risk of rehospitalization. In contrast, the risk of death was slightly lower in Black patients compared with white patients.

The COVID-19 cohort also experienced a higher risk of hospital readmission at 30 days, and 90 days compared to the flu patients; however, by 180 days, the rate of readmissions were similar between the two groups. The most common reasons for readmission were circulatory conditions, respiratory conditions, sepsis, heart failure and pneumonia. Within the COVID-19 cohort, Black individuals and dual-eligible beneficiaries were more likely to be readmitted than white patients.

Encouragingly, the scientists demonstrated a decline in post-discharge death over the course of the study period.

BIDMC release