Relationship between COVID-19 Comorbidities and Mortality Uncovered by FAIR Health Study

November 12, 2020

A new study from FAIR Health, in collaboration with the West Health Institute and Marty Makary, MD, MPH, from Johns Hopkins University School of Medicine, shows the relationship between preexisting comorbidities of COVID-19 and mortality in privately insured patients. The study has been released as a white paper entitled Risk Factors for COVID-19 Mortality among Privately Insured Patients: A Claims Data Analysis. It has been featured prominently in the New York Times, Washington Post, CBS News, Axios, STAT and Modern Healthcare.

Across all age groups, the top three comorbidity risk factors for death from COVID-19 were, in order from highest to lowest risk, developmental disorders (e.g., developmental disorders of speech and language, developmental disorders of scholastic skills, central auditory processing disorders), lung cancer, and intellectual disabilities and related conditions (e.g., Down syndrome and other chromosomal anomalies; mild, moderate, severe and profound intellectual disabilities; congenital malformations, such as certain disorders that cause microcephaly). As detailed in the white paper, these findings are supported by recent scientific literature.

There are several possible reasons for the high COVID-19 mortality risk in people with developmental disorders and intellectual disabilities. These include greater prevalence of comorbid chronic conditions, disproportionate representation as workers in essential services, and increased COVID-19 transmission in group residential settings.

In patients under age 70, lung cancer conferred the highest risk of COVID-19 mortality. In that age cohort, patients with COVID-19 and lung cancer were nearly seven times more likely to die than patients who had COVID-19 but not lung cancer.

The findings were based on an analysis of data from the nation’s largest private healthcare claims database, the FAIR Health National Private Insurance Claims (FH NPIC®) repository. Evaluating all patients in FH NPIC’s longitudinal dataset, FAIR Health identified 467,773 patients diagnosed with COVID-19 from April 1, 2020, through August 31, 2020. Relationships were examined between the outcome of mortality (dependent variable) and the following independent variables: age, gender and preexisting comorbidities. The results of this analysis could help inform protocols for vaccine distribution as well as prevention and treatment protocols.

Among the other study findings:

  • Chronic kidney disease (CKD) and heart failure. Across all age groups, patients with COVID-19 and CKD were nearly twice as likely to die as patients who had COVID-19 but not CKD. Patients with COVID-19 and heart failure were more than one and a half times as likely to die as patients who had COVID-19 but not heart failure.
  • All age groups versus patients under age 70. The risk of COVID-19 mortality was generally higher for a comorbidity for patients under age 70 than it was for the same comorbidity for patients of all age groups.
  • Lack of comorbidities. Lack of comorbidities was partially protective against COVID-19 mortality, but not completely. Of COVID-19 patients who died, 83.29 percent had a preexisting comorbidity, while 16.71 percent did not, per the medical claims data.
  • Multiple comorbidities. As a patient’s number of comorbidities increased, so did the odds of dying from COVID-19.
  • Gender. Males accounted for 60.07 percent of total COVID-19 deaths, females for 39.93 percent.
  • Age. Patients over age 69 accounted for 4.82 percent of COVID-19 diagnoses but 42.43 percent of total deaths from COVID-19.
  • Mortality rate. Of patients diagnosed with COVID-19, 0.59 percent died.

FAIR Health President Robin Gelburd commented: “By delving into our unparalleled repository of private healthcare claims, FAIR Health has been able to produce actionable findings that can inform public health recommendations and policies, particularly those related to protocols for vaccine distribution, as well as prevention and treatment protocols. We thank our collaborators in this work, the West Health Institute and Dr. Marty Makary.”

Tim Lash, Chief Strategy Officer and Executive Vice President, the West Health Institute, stated: “The West Health Institute is proud to partner with FAIR Health on this timely, important analysis of risk factors for COVID-19 mortality. As we edge closer to a vaccine for the SARS-CoV-2 virus, the insights generated by this analysis will be critical to informing vaccine distribution among the most vulnerable.”

Dr. Makary, a professor of surgery at the Johns Hopkins University School of Medicine and a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health, said: “FAIR Health has made a valuable contribution to the literature on risk factors for COVID-19 mortality. The findings in this report could help inform vaccine and therapeutics allocation efforts.”

For the complete white paper, click here.