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Publication Briefs

Early Months of COVID Pandemic Increased Overall Death Rates Comparably for General Population and Veterans within VA


BACKGROUND:
During the first year of the COVID-19 pandemic, there was a substantial increase in the rate of death in the U.S., largely as a result of COVID. Further, the association between the pandemic and death rates varied substantially among subpopulations (i.e., by differences in ethnicity/race and age). This study sought to quantify excess all-cause mortality during the first nine months of the COVID-19 pandemic among Veterans compared with the general US population, adjusting for age, sex, race, ethnicity, and geographic region. Investigators analyzed data from VA and the CDC’s National Center for Health Statistics (NCHS) for deaths occurring between January 1, 2014 and December 31, 2020 for three populations: Veterans enrolled in VA healthcare (n = 10,939,936), VA healthcare active users (n = 7,047,401), and the general US population (n = 328,329,953). VA active users were Veterans with at least one diagnosis in VA’s electronic health record (EHR) in the two years prior to each study time point, indicating at least one VA clinical encounter.

FINDINGS:

  • In 2020, 85% of the overall increase in the US death rate was directly associated with COVID-19. Comparable data are not yet available for VA.
  • Veterans receiving VA healthcare had similar relative increases in mortality compared with the general US population during the first 9 months of the COVID-19 pandemic. However, the absolute pre-pandemic death rate was higher among VA patients, which translated to higher absolute excess death rates among Veterans.
  • The relative increase in deaths was smaller among the White population than in other racial and ethnic groups. These patterns were consistent between the general and VA populations, but the disparities were less pronounced in VA, particularly among young age groups.
  • VA’s patient population differed from the general U.S. population. VA’s population was predominantly male (>85% vs. 49%); older (61 years vs. 39 years); and had a larger proportion of White (73% vs 61%) and Black (17% vs. 13%) individuals and a smaller proportion of Hispanic individuals (7% vs. 18%).

IMPLICATIONS:

  • Future work could focus on estimating excess deaths with individual-level analyses, evaluating variations with comorbid conditions. Although this type of analysis would be challenging to do in the general US population due to a lack of EHR data, VA is well equipped to do so.

LIMITATIONS:

  • Race/ethnicity data were missing for 24% of VA enrollees and for 7% to 14% of VA active users.
  • Analyses could not adjust for clinical factors that may affect risk of death during pandemic.

AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D. Drs. Rose, Asch, and Vashi are part of HSR&D’s Center for Innovation to Implementation (Ci2i). Drs. Rentsch, King Jr., and Justice are with HSR&D’s Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center. Drs. Columbo, Korves, Lucas, Davies, and Young-Xu are with the White River Junction VA Medical Center. Dr. Weinberger is with the VA Connecticut Healthcare System.


Weinberger D, Rose L, Rentsch C, Asch S, Columbo J, King Jr. J, Korves C, Lucas B, Taub C, Young-Xu Y, Vashi A, Davies L, and Justice A. Excess Mortality among Patients in the Veterans Affairs Health System Compared with the Overall US Population During the First Year of the COVID-19 Pandemic. JAMA Network Open. May 8, 2023;6(5):e2312140.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.


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