During the Covid-19 Pandemic, Older People with Obesity, Alzheimer’s Disease, and Severe Mental Health Conditions Were Most Likely to Die

Older adults with respiratory diseases or cancer were less likely to die, perhaps because of extra safety precautions

CHICAGO, May 25, 2022 – During 2020, Medicare beneficiaries experienced 15% higher mortality compared to 2019. Following vaccine availability, excess mortality decreased to 12% in 2021 (Figure 1), according to a new NORC Spotlight on Health. Mortality rates varied considerably based on the number and type of other chronic conditions beneficiaries had. These findings come from an analysis of Medicare mortality data from 2019 to 2021, conducted by experts at NORC at the University of Chicago.

Older adults who died of COVID-19 had four more chronic conditions on average than people who died from other causes.

Medicare beneficiaries who died of COVID-19 during 2020 suffered from 16 chronic conditions on average. In comparison, Medicare beneficiaries who died in 2020 from all causes of death averaged 12 chronic conditions (Figure 2). The average Medicare beneficiary lives with 6.6 chronic conditions, researchers say.

According to researchers, the average Medicare beneficiary who died of COVID-19 in March 2020 had 16.3 chronic conditions—a figure that would decrease to 13.4 in September 2021, suggesting the most vulnerable older adults died at the start of the pandemic.

People with intellectual disabilities, serious mental health conditions, and Alzheimer’s disease experienced the highest increased risk of death in 2020.

Researchers found that the risk of death was highest among Medicare beneficiaries most likely in need of professional caregiving, especially early in the pandemic before vaccines became available. Patients with one of these conditions—e.g., Alzheimer’s, schizophrenia, autism, etc. —were 21.5% more likely to die in 2020 compared to 2019 (Figure 3). Medicare beneficiaries with Alzheimer’s were particularly vulnerable throughout the pandemic. These beneficiaries carried a 24.4% excess mortality risk—the heightened death rate imposed by the pandemic—compared to 2019. Risk of excess mortality among Alzheimer’s patients declined noticeably, however, as vaccines were widely distributed. By 2021, Alzheimer’s patients had an excess mortality rate of just 8.3% above 2019 levels.

Obesity, according to the NORC analysis, affected the likelihood of COVID-19 mortality. Overall, obese Medicare enrollees were 20.6% more likely to die during the pandemic compared to 2019 (Figure 4).

“The conditions that put Medicare enrollees most at risk in the early months were obesity and mental health and intellectual conditions like Alzheimer’s disease. Lapses in care or transmission of the virus from caregivers to patients clearly played a role in these deaths,” said Caroline Pearson, senior vice president at NORC.

Excess mortality was typically lower among Medicare enrollees with cancer and pulmonary diseases like asthma and chronic obstructive pulmonary disease (COPD). Increased risk of death across beneficiaries with cancers in 2020 was 8.2%, compared to 15.1% for all Medicare enrollees (Figure 5). The increased risk was 13.4% for Medicare enrollees with COPD and 13.9% for those with asthma (Figure 6).

“Surprisingly, Medicare beneficiaries with cancer and pulmonary diseases had considerably lower excess death rates in the early months of the pandemic, compared to the average Medicare enrollee, perhaps because they were being extra careful,” said Alex Hartzman, analytics director at NORC at the University of Chicago. “Older adults with cancer or pulmonary diseases may have taken extra precautions as the pandemic has run its course across the U.S., being more inclined to follow public health warnings given their health status. People with these chronic, potentially life-threatening conditions may have been more likely to follow masking and social distancing recommendations.”

Experts from NORC say these findings have implications for the nation’s response to future pandemics.

“Nursing homes and in-home caregivers need clear plans in place to quickly change the way they provide care to decrease the risk of transmissible infections and implement those plans at the earliest stages of a new outbreak,” said Pearson. “The health system needs to draw lessons from how patients with cancers and pulmonary diseases were cared for given their low excess death rates.”

NORC utilized Medicare Fee-for-Service claims, enrollment, chronic condition, and mortality data from January 2019 to September 2021 in this analysis. Excess mortality is calculated as the percent difference between the observed and expected mortality rate of the population; for any given observed time period in 2020 and 2021, the expected mortality of a population is the mortality rate of the same period in 2019 (to account for seasonality). At the time this analysis was conducted, data through September 2021 was available with sufficient run-out. Annualized 2021 estimates are made with respect to the first 9 months of the year.

About NORC at the University of Chicago
NORC at the University of Chicago conducts research and analysis that decision-makers trust. As a nonpartisan research organization and a pioneer in measuring and understanding the world, we have studied almost every aspect of the human experience and every major news event for more than eight decades. Today, we partner with government, corporate, and nonprofit clients around the world to provide the objectivity and expertise necessary to inform the critical decisions facing society.

For more information, contact Eric Young at NORC at young-eric@norc.org or
(703) 217-6814 (cell).