Racial and Ethnic Disparities in Hospitalization Outcomes among Medicare Beneficiaries during the COVID-19 Pandemic

Abstract

Importance: The COVID-19 pandemic has disproportionately affected racial and ethnic minority populations. However, racial and ethnic disparities in hospitalization outcomes during the pandemic - for both COVID-19 and non-COVID-19 hospitalizations - are poorly understood, especially among older populations. Objective: To assess racial and ethnic differences in hospitalization outcomes during the COVID-19 pandemic among Medicare beneficiaries. Design, Setting, and Participants: In the 100% traditional Medicare inpatient data, there were 31771054 unique beneficiaries in cross-section just before the pandemic (February 2020), among whom 26225623 were non-Hispanic White, 2797462 were Black, 692994 were Hispanic, and 2054975 belonged to other racial and ethnic minority groups. There were 14021285 hospitalizations from January 2019 through February 2021, of which 11353581 were among non-Hispanic White beneficiaries, 1656856 among Black beneficiaries, 321090 among Hispanic beneficiaries, and 689758 among beneficiaries of other racial and ethnic minority groups. Sensitivity analyses tested expanded definitions of mortality and alternative model specifications. Exposures: Race and ethnicity in Medicare claims from the Social Security Administration. Main Outcomes and Measures: In-hospital mortality and mortality inclusive of discharges to hospice, deaths during 30-day readmissions, and 30-day all-cause mortality. Secondary outcomes included discharges to hospice and discharges to postacute care. Results: The decline in non-COVID-19 and emergence of COVID-19 hospitalizations were qualitatively similar among beneficiaries of different racial and ethnic minority groups through February 2021. In-hospital COVID-19 mortality was not significantly different among Black patients relative to White patients, but was 3.5 percentage points higher among Hispanic patients (95% CI, 2.9-4.1; P