Closeup image of older adult patient in bed being checked by doctor with stethoscope; Credit: Getty Images

Mortality rates for Medicare beneficiaries with non-COVID-19-related illness increased both in the hospital and at 30 days post-discharge during the pandemic, according to a new study.

Investigators from the University of Texas and Johns Hopkins University examined  records for more than 8.4 million Medicare beneficiaries admitted to about 4,600 U.S. hospitals. They compared subsequent patient deaths in the year 2019 and between April 2020 and September 2021.

Post-acute mortality rates for illness not related to SARS-CoV-2 infection rose from 9.4% in 2019 to 11.5% during the pandemic time period. These rates were especially high for Black and Hispanic individuals and patients with low socioeconomic status, investigators said. Increases in non-COVID-19 mortality among these patients in the hospital, meanwhile, were higher in lower-quality settings and in hospitals with high SARS-CoV-2 caseloads.

The results dovetail with other pandemic data, the researchers said. Increases in U.S. all-cause mortality during the pandemic is not entirely explained by deaths from SARS-CoV-2 infection. And other studies have shown that these excess pandemic deaths are often among people in disadvantaged communities.

One culprit: delayed care 

Although it was not possible to tease out which played a bigger role, there are two likely reasons for the higher mortality in these cases, the authors wrote. One is that patients hospitalized during the pandemic tended to have more severe disease and a higher risk of death due to delays in care-seeking. The other is that hospitals lacked critical resources such as intensive care unit beds and personnel due to an influx of hospitalized patients with SARS-CoV-2. 

The latter possibility is supported by data that shows greater mortality increases in rural hospitals, smaller hospitals and hospitals that were not affiliated with medical schools during the pandemic, when compared with the prepandemic period, they wrote.

The results suggest a need for improved access to hospital care for all in pandemic times, the authors said.

“Given the uncertain trajectory of the pandemic, healthcare clinicians and policy makers should develop strategies to provide optimal care to patients for non–SARS-CoV-2 illnesses, especially among racial and ethnic minorities and socioeconomically disadvantaged patients,” they concluded.

The study was published in JAMA Network Open.