Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Sep 22, 2020
Date Accepted: Dec 14, 2020
Date Submitted to PubMed: Dec 18, 2020
COVID-19-associated hospitalization rates and severe outcomes among Veterans from 5 Veteran Affairs Medical Centers, February 27-July 17, 2020: Hospital-Based Surveillance
ABSTRACT
Background:
COVID-19 has disproportionately affected older adults and certain racial and ethnic groups in the US. Data quantifying the disease burden, as well as describing clinical outcomes during hospitalization among these groups, is needed.
Objective:
To describe interim COVID-19 hospitalization rates, severe outcomes, and prevalence of underlying conditions by age group, race and ethnicity among Veterans in a multi-site surveillance network.
Methods:
We implemented a COVID-19 surveillance platform in 5 Veterans Affairs Medical Centers (VAMCs: Atlanta, Bronx, Houston, Palo Alto, and Los Angeles), collectively serving >396,000 patients annually. We actively identified SARS-CoV-2 positive inpatient cases through screening of admitted patients and review of laboratory test results. We abstracted medical charts for demographic and clinical data and calculated incidence per 100,000 person-years among Veterans by catchment area.
Results:
From February 27– July 17 2020, we identified 621 laboratory-confirmed hospitalized COVID-19 cases. Median age was 70 years, 66% were aged ≥65 years, and 94% were male. The highest percentage of COVID-19 diagnoses were among non-Hispanic Blacks (52%), followed by non-Hispanic Whites (25%) and Hispanic or Latinos (18%). Hospitalization rates were highest among Veterans who were aged >85 years, Hispanic or Latino, and non-Hispanic Black (430, 343 and 332/100,000, respectively). Overall, 11.6% of patients required mechanical ventilation, 26.6% were admitted to the intensive care unit (ICU), and 16.9% died in hospital. Veterans who were aged ≥65 had 4.4 times higher case fatality rate than those <65 years.
Conclusions:
COVID-19 surveillance at 5 VAMCs across the US demonstrated higher hospitalization rates and severe outcomes in older Veterans, and higher hospitalization rates in Hispanic or Latino and non-Hispanic Black Veterans compared to non-Hispanic White Veterans. These data highlight the need for targeted prevention and control efforts in Veterans, with special attention to increasing age, Hispanic or Latino and non-Hispanic Black Veterans.
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