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Disparities in Medicare Mortality Rates Occurred During the Pandemic

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Summary

Avalere analysis shows that the COVID-19 pandemic had disproportionate impacts by race and ethnicity on Medicare enrollees.

Healthcare disparities are a longstanding concern. Federal and state policymakers, patient advocates, health plans, providers, and life sciences companies rely on healthcare data to help identify patterns in inequities in healthcare. These patterns enable stakeholders to address disparities.

Unfortunately, the COVID-19 pandemic highlighted widening disparities in mortality rates among ethnicities. Over 600,000 people in the US have died from COVID-19, with nearly 400,000 of these deaths occurring in 2020. The Centers for Disease Control and Prevention (CDC) has found that average life expectancy declined by 1.5 years from 2019 to 2020, and that COVID-19 was responsible for 73.8% of this decrease. In addition, the CDC found wide disparities in mortality rates during this timeframe. Life expectancy declined by 3.0 years for the Hispanic population, by 2.9 years for the non-Hispanic Black population, and by 1.2 years for the non-Hispanic White population.

To date, studies assessing the impact of COVID-19 have examined mortality rates for the entire US population, as well as for those aged 65 and above, but none have focused specifically on the 2020 COVID-19 impacts on Medicare enrollees. Avalere analyzed Medicare enrollment data from 2015 to 2020 to determine how mortality rates changed in 2020 compared to earlier years and found dramatic differences by race and ethnicity. The analysis indicates mortality rates increased by 1.5–3.0 times among ethnic and racial minorities compared to White beneficiaries. These differences persist across multiple age groups.

Mortality Rates Relatively Flat Until 2020

As shown in Figure 1, mortality rates differed by race and ethnicity but were relatively stable for all between 2015 and 2019. In 2020, mortality rates increased for all, with notable differences in the degree of change varying by race/ethnicity. The annual change in mortality rate for White beneficiaries in 2020 vs. 2019 was significantly lower than for beneficiaries in all other racial/ethnic groups, as shown in Figure 2. In relative terms, the increase in mortality was, respectively, 1.5 times higher for Asian, 2.0 times higher for Black, and 3.0 times higher for Hispanic and Native American beneficiaries compared to White beneficiaries. These data are consistent with other studies that have shown dramatic decreases in life expectancy in 2020 due to the pandemic.

Figure 1. Mortality Rates per 1,000 Medicare Enrollees, 2015–2020, by Race/Ethnicity
Figure 1. Mortality Rates per 1,000 Medicare Enrollees, 2015–2020, by Race/Ethnicity
Figure 2. Annual Change in Mortality Rate for Medicare Enrollees, 2019–2020, by Race/Ethnicity
Figure 2. Annual Change in Mortality Rate for Medicare Enrollees, 2019–2020, by Race/Ethnicity

Differences in Mortality by Age

While mortality rates increase with age, mortality rate changes in 2020 compared to 2019 occurred in every age group in the Medicare population—including those under the age of 65 who are eligible for Medicare due to disability or end-stage renal disease—and these increases were often higher in those below the age of 80, as shown in Figure 3. The increase in mortality rates for White beneficiaries was less varied across age groups compared to other racial/ethnic groups of beneficiaries. The mortality rate increases for White beneficiaries ranged from 12% to 15% across age groups. The mortality rates for age cohorts of Native American and Hispanic beneficiaries, however, had wider variation, ranging from 20% to 56% for Native Americans and from 29% to 69% for Hispanics.

Figure 3. Percentage Change in Mortality Rate for Medicare Enrollees, 2019–2020, by Age and Race/Ethnicity
Figure 3. Percentage Change in Mortality Rate for Medicare Enrollees, 2019–2020, by Age and Race/Ethnicity

Conclusion

This analysis shows that even among Medicare enrollees—who, theoretically, have access to the same benefits and typically consistent healthcare coverage—the pandemic had disparate impacts by race/ethnicity. Even so, mortality rates alone cannot provide a full account of how the COVID-19 pandemic has or will continue to influence overall health in the coming years. In 2020, indirect health impacts, lower utilization of preventive services such as cancer screenings, non-emergency care (elective services), and other routine care magnified the impact of COVID-19 on the healthcare system.  As cases continue to increase in the US due to the delta variant, the disparities in mortality rates shown by this study demonstrate the continuing challenges in addressing healthcare disparities among the Medicare population. Measuring differences among racial and ethnic groups is key to identifying opportunities to address racial disparities in response to public health emergencies. Taking the initial step to analyze mortality data closely and explore the potential impacts of COVID-19 on Medicare enrollees provides additional insight into enrollment, healthcare management, and opportunities to reduce mortality rates and mitigate differences among racial/ethnic groups.

To learn more about healthcare disparities, connect with us.

Avalere Health is an Inovalon company, a leading provider of cloud-based platforms empowering data-driven healthcare. We believe in the power of data, informing actionable insights, delivering meaningful impact, and driving stronger patient outcomes and business economics.

Methodology

Avalere analyzed enrollment data from the Centers for Medicare & Medicaid Services (CMS) for a 20% set of Medicare enrollees from 2015 to 2020 under a research data use agreement with the CMS. Avalere identified beneficiary enrollment and characteristics using the Master Beneficiary Summary File. For each year, Avalere tabulated the number of enrollees in Medicare and those who died in that year by age and race/ethnicity, with race/ethnicity assigned by the CMS. The mortality rates were calculated by dividing the number of deaths by the number of enrollees and multiplying by 1,000.

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