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Published on: October 14, 2016
Changes in Healthcare Utilization Patterns and Outcomes for an Acute Cerebrovascular Events Medicare Cohort:
Osvaldo J Laurido-Soto1,2, R J Waken3,4, Fengxian Wang3,5
1Department of Neurology, Washington University School of Medicine, Saint Louis, Missouri, USA, ojlaurido-soto@wustl.edu.
Insights
The COVID-19 pandemic altered healthcare for stroke patients, increasing outpatient visits and mortality, especially in socially vulnerable areas. Emergency and inpatient care decreased post-stroke.
Area of Science:
- Public Health
- Epidemiology
- Health Services Research
Background:
- The COVID-19 pandemic significantly impacted healthcare delivery for cerebrovascular diseases.
- Long-term effects on healthcare utilization and mortality after cerebrovascular events remain understudied.
Purpose of the Study:
- To analyze changes in healthcare utilization and mortality following acute cerebrovascular events in the late COVID-19 period compared to pre-COVID.
- To investigate disparities in these outcomes based on rurality and social vulnerability.
Main Methods:
- Utilized Medicare fee-for-service and Medicare Advantage data from 2018-2022.
- Employed Poisson-lognormal regression to compare healthcare utilization (outpatient, ED, hospitalizations) and mortality rates one year post-event between pre-COVID (2018-2019) and late-COVID (2021-2022) periods.
- Adjusted for age, sex, race, and analyzed outcomes by rurality and Social Vulnerability Index (SVI) quartiles.
Main Results:
- Outpatient visit rates increased (IRR=1.14) while emergency department visits (IRR=0.92) and hospitalizations (IRR=0.94) decreased in the late-COVID period.
- Mortality rates were significantly higher in the late-COVID period (IRR=1.24).
- Increased mortality was most pronounced in socially disadvantaged areas (SVI quartiles 3 and 4).
Conclusions:
- Medicare beneficiaries experiencing acute cerebrovascular events faced altered healthcare utilization and increased mortality in the late-COVID era compared to pre-COVID.
- Socially vulnerable populations experienced the most significant increases in mortality post-stroke during the late-COVID period.
Introduction:
The coronavirus 2019 pandemic disrupted medical care delivery for cerebrovascular disease. Little is known about the long-term changes in healthcare utilization and mortality among people who suffered cerebrovascular events.
Methods:
We used 2018-2022 data to identify all Medicare fee-for-service and Medicare Advantage beneficiaries with a diagnosis code for an acute cerebrovascular event (stroke, transient ischemic attack, hemorrhage). We used Poisson-lognormal regression models with an offset term (beneficiary years) to model incident rate ratios (IRR) for late COVID (2021-2022) versus pre-COVID (2018-2019) for outpatient visits, emergency department (ED) visits, hospitalizations, and mortality in the year following the index event, adjusting for age, sex, and race. We examined patterns overall and by rurality (urban, micropolitan, rural) and quartile (q) of social vulnerability index.
Results:
We identified 7,071,072 and 7,065,171 unique beneficiaries in the pre-COVID and late-COVID periods, respectively, with an acute cerebrovascular event. Our cohort was predominantly non-Hispanic white (73%), female (54%), and urban (83%). Compared to pre-COVID, outpatient care utilization in the year following the acute event was higher in 2021-2022 (IRR = 1.14, 95% confidence interval [CI]: 1.13-1.14), while ED visits (IRR = 0.92, 95% CI: 0.91-0.92) and inpatient hospitalizations (IRR = 0.94, 95% CI: 0.94-0.95) were lower. Mortality was higher during the late-COVID versus pre-COVID period (IRR = 1.24, 95% CI: 1.23-1.25). The mortality differences were similar across rural strata but higher in more socially disadvantaged areas (IRR 1.20, 1.22, 1.24, 1.27 for q1 [reference], p interaction = q2 = 0.12, q3 = 0.01, and q4 < 0.001).
Conclusions:
Medicare beneficiaries who sustained acute cerebrovascular events had marked differences over the subsequent year in healthcare utilization patterns and increased mortality in the late-COVID period compared with their utilization and outcomes pre-COVID. The differences in mortality were the most pronounced for beneficiaries in socially disadvantaged areas.
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