Mortality Trends in Pre-COVID-19 and COVID-19 Eras Among Oldest Veterans.

Jessica Palmer, Maithri Kondapaka, Brock A Beamer, Tariq Siddiqui, John D Sorkin, Wilbur H Chen, Raya Elfadel Kheirbek
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Abstract

Background: The COVID-19 pandemic has had a profound impact on older adults, particularly those with existing comorbidities. To inform targeted healthcare strategies for this heterogeneous group, this study seeks to analyze and compare mortality trends among various geriatric age groups within the Veterans Affairs (VA) Health Care System, both during the COVID-19 era and the pre-COVID era, while accounting for demographic and clinical factors such as age, gender, race, and comorbidities.

Methods: A retrospective cohort study using Veterans Affairs Informatics and Computing Infrastructure (VINCI) data. Two samples were analyzed: Veterans alive during the pre-COVID era (January 2019 - December 2019) and during the COVID era (January 2020 - December 2020). Propensity score matching was used to control for age, sex, race, BMI, and comorbidities.

Results: The primary outcome was mortality. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to compare mortality across age groups. Unmatched analyses, adjusted for age, sex, race, BMI, and comorbidities, showed that mortality significantly increased during the COVID era for age groups 70-79 (OR 1.38), 80-89 (OR 1.14), and 90-99 (OR 1.20), all with p-values < 0.0001. No significant increase was observed in centenarians (OR 1.103, 95% CI 0.90-1.35, p=0.345). Matched analysis confirmed these findings.

Conclusions: In a large cohort of older Veterans, COVID-19 had a significant impact on mortality in older adults aged 70-99, highlighting the need for targeted public health interventions. The lack of significant increase in mortality for centenarians is notable and warrants further study to identify possible protective factors in this unique population.

2019冠状病毒病前和2019冠状病毒病时期老年退伍军人死亡率趋势
背景:2019冠状病毒病大流行对老年人产生了深远影响,特别是对那些存在合并症的老年人。为了为这一异质群体提供有针对性的医疗保健策略,本研究旨在分析和比较退伍军人事务(VA)医疗保健系统中不同老年年龄组的死亡率趋势,包括在COVID-19时代和前covid时代,同时考虑人口统计学和临床因素,如年龄、性别、种族和合并症。方法:使用退伍军人事务信息学和计算基础设施(VINCI)数据进行回顾性队列研究。分析了两个样本:在COVID前时代(2019年1月至2019年12月)和COVID时代(2020年1月至2020年12月)生活的退伍军人。倾向评分匹配用于控制年龄、性别、种族、BMI和合并症。结果:主要结局为死亡率。计算优势比(ORs)和95%置信区间(CIs)来比较不同年龄组的死亡率。对年龄、性别、种族、BMI和合并症进行校正后的非匹配分析显示,70-79岁年龄组(OR 1.38)、80-89岁年龄组(OR 1.14)和90-99岁年龄组(OR 1.20)的死亡率在COVID时代显著增加,p值均< 0.0001。百岁老人无显著增加(OR 1.103, 95% CI 0.90-1.35, p=0.345)。匹配分析证实了这些发现。结论:在一大批老年退伍军人中,COVID-19对70-99岁老年人的死亡率有显著影响,这凸显了有针对性的公共卫生干预措施的必要性。值得注意的是,百岁老人的死亡率没有显著增加,值得进一步研究,以确定这一独特人群中可能的保护因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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