(16) Long-Term Health Events and Healthcare Utilization After COVID-19 Hospitalization Among Children and Adults Insured by Medicaid, North Carolina, United States, 2020-2021

Publication Number: 1061

Background: The extent of post-acute COVID-19 health complications remains poorly understood, particularly in vulnerable populations including children and the under-insured.

Objectives: This study aims to characterize the frequency of clinical events, including diagnoses, procedures and dispensed prescriptions, and health system encounters through 6-months after discharge, among patients hospitalized for COVID-19 as compared to patients hospitalized for non-COVID-19 respiratory conditions.

Methods: We extracted claims from all children and adults enrolled in North Carolina State Medicaid as of 01 April 2020. We identified a subject’s first hospitalization for COVID-19 (defined as a primary ICD-10 diagnosis of U07.1) and assessed frequencies and event rates of clinical outcomes through 6-months following discharge, including clinical diagnoses, medical procedures, initiation of prescription drugs, and health system usage. We compared these frequencies to patients hospitalized with non-COVID-19 respiratory disease.

Results: In total, 5,742 Medicaid recipients were hospitalized with COVID-19 as the primary diagnosis, of which 57% (n=3,289) occurred in 2020, and 43% (n=2,453) in 2021. Patients in the COVID-19 population were predominately female (59%, n=3,366), older (mean age [SD]: 58.3 [20.4] years), and largely identified as Black (49%; n=2,819) or white (47%; n=2,690) races. At 3-months following COVID-19 hospitalization, outpatient diagnoses of acute respiratory distress syndrome (n=183) and pulmonary embolism (n=148) were infrequent as primary or secondary diagnoses. We found no primary diagnoses of chronic respiratory failure, heart failure, or myocardial infarctions at 3 months-post-discharge, with analysis of additional outcomes ongoing.

Conclusions: Improved understanding of long-term health consequences associated with COVID-19 infection and hospitalization is critical to inform patient care as the pandemic progresses. Medicaid data provides a unique opportunity to study this question in under-insured individuals, particularly due to statewide holds on Medicaid disenrollment as a result of the COVID-19 pandemic, and timeliness of data availability. Analyses of the comparator cohort and baseline comorbidity profiles are underway and will serve to contextualize the observed post-acute COVID-19 event frequencies and approximate counterfactual scenarios.