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June 23, 2020

Black Medicare beneficiaries are almost 4x more likely to be hospitalized with Covid-19, data shows

Daily Briefing

    CMS data released Monday showed that Black Medicare beneficiaries were nearly four times as likely to be hospitalized from Covid-19 as white beneficiaries, while two new analyses suggest that areas where a majority of residents are people of color are less likely than predominantly white areas to have testing sites for the new coronavirus.

    10 takeaways: How to build true health equity amid a global pandemic

    US Covid-19 cases surpass 2.3M, death toll tops 120K

    The new data comes as U.S. officials as of Tuesday morning reported 2,322,100 cases of the new coronavirus—up from 2,291,700 cases as of Monday morning.

    Data from the New York Times shows that 26 states—Alabama, Arizona, Arkansas, California, Delaware, Florida, Georgia, Hawaii, Idaho, Kansas, Louisiana, Mississippi, Missouri, Montana, Nevada, North Carolina, Ohio, Oklahoma, Oregon, South Carolina, Tennessee, Texas, Utah, Washington, West Virginia, and Wyoming—saw their growth rates of newly reported cases of the novel coronavirus rise over the past 14 days.

    On Monday, Florida became the seventh state—behind California, Illinois, Massachusetts, New Jersey, New York, and Texas—to report a total of more than 100,000 new coronavirus cases since the country's epidemic began. In recent weeks, Florida's coronavirus outbreak has worsened as officials lifted the state's stay-at-home order and other measures intended to curb the virus' spread.

    Similarly, California's coronavirus outbreak has appeared to intensify in recent weeks. On Saturday, California reported a record high of 3,574 hospitalizations related to the new coronavirus. As of Sunday, the state had 3,702 hospitalized patients with confirmed cases of the novel coronavirus, including 1,199 patients in intensive care. The spike in hospitalizations came as California entered the second phase of its reopening plan, which allows child care, retail, and some other business to resume operations.

    Meanwhile, the New York Times' data shows that the growth rates of newly reported cases over the past two weeks remained mostly stable in Guam and nine states: Alaska, Colorado, Connecticut, Iowa, Massachusetts, Nebraska, New Jersey, New York, and South Dakota.

    In addition, Puerto Rico, Washington, D.C., and 15 states—Illinois, Indiana, Kentucky, Maine, Maryland, Michigan, Minnesota, New Hampshire, New Mexico, North Dakota, Pennsylvania, Rhode Island, Vermont, Virginia, and Wisconsin—saw their growth rates of newly confirmed cases decrease over the past 14 days, according to the data.

    As of Tuesday morning, officials had reported a total of 120,345 U.S. deaths linked to the new coronavirus—up from 119,985 deaths reported as of Monday morning.

    Black Medicare beneficiaries more likely to be hospitalized for new coronavirus

    As the numbers of new coronavirus cases and related deaths continue to rise in the United States, a preliminary analysis of Medicare data released by CMS on Monday revealed racial disparities among Medicare beneficiaries who were hospitalized for Covid-19, the disease caused by the virus.

    The preliminary report is based on an analysis of Medicare claims and encounter data from Jan. 1 through May 16. The agency's analysis focused on records that contained the official ICD-10-CM diagnosis code for Covid-19, which was created on April 1, as well as data with other diagnosis codes linked to the novel coronavirus, such as ICD-10-CM diagnosis codes for "acute respiratory stress syndrome" and "other viral pneumonia."

    According to the analysis, more than 325,000 Medicare beneficiaries were diagnosed with Covid-19 and nearly 110,000 beneficiaries with the disease were hospitalized during the period spanning Jan. 1 through May 16. The analysis showed 50% of hospitalizations lasted less than eight days, while 9% lasted 21 days or longer.

    CMS found that 81,227 of the beneficiaries with Covid-19 who were hospitalized were enrolled in traditional, fee-for-service Medicare coverage—and many of those patients had comorbidities, including some conditions that have been associated with a higher risk of developing a severe case of Covid-19. The analysis showed that 79% of those patients had hypertension, 60% had hyperlipidemia, 50% had chronic kidney disease, 50% had anemia, and 50% had diabetes.

    CMS also found notable racial disparities in coronavirus cases and hospitalization rates among the Medicare beneficiaries included in the data. According to the analysis, Black and Hispanic Medicare beneficiaries were more likely to be diagnosed with coronavirus infections and hospitalized when compared with beneficiaries of other races/ethnicities. Specifically, CMS found:

    • 1,107 Black beneficiaries were diagnosed with the coronavirus and 465 were hospitalized;
    • 692 Hispanic beneficiaries were diagnosed with the virus and 258 were hospitalized;
    • 455 Asian beneficiaries were diagnosed with the virus and 187 were hospitalized; and
    • 417 white beneficiaries were diagnosed with the virus and 123 were hospitalized.

    The hospitalization rate among Black beneficiaries was 465 hospitalizations per 100,000 beneficiaries, meaning Black beneficiaries who were diagnosed with the new coronavirus were about four times more likely than white beneficiaries to be hospitalized.

    According to the analysis, 28% of all hospitalized beneficiaries died in the hospital. An additional 27% were discharged to their homes, 21% were discharged to skilled nursing facilities, and the remainder were discharged to other health care settings.

    Analyses highlight racial disparities in access to coronavirus testing

    Meanwhile, two separate analyses suggest that areas where a majority of residents are people of color are less likely than predominantly white areas to have testing sites for the new coronavirus, Axios' "Vitals" reports.

    In one the analyses, researchers Kyle Slugg and Peter Walker of the COVID Tracking Project found that U.S. ZIP codes where the population is at minimum 75% white on average have one coronavirus testing site for every 14,500 people. In comparison, ZIP codes where the population is at minimum 75% people of color have one coronavirus testing site per every 23,300 people, the researchers found.

    According to "Vitals," Slugg's and Walker's analysis included only ZIP codes that have at least one coronavirus testing site. However, nearly two-thirds of rural counties in America don't have any testing sites at all, a separate analysis by the Surgo Foundation found. The analysis estimated that 35% of the rural Black population lives in a "highly vulnerable testing desert," "Vitals" reports (Knutson, Axios, 6/22; Wamsley, NPR, 6/22; Alonso-Zaldivar, Associated Press, 6/23; Godoy, "Shots," NPR, 6/22; Christ, Modern Healthcare, 6/22; Luhby, CNN, 6/22; Baker, "Vitals," Axios, 6/23; Stein, Inside Health Policy, 6/22 [subscription required]; New York Times, 6/23).

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