Mathematical Statistician US Food and Drug Administration Silver Spring, United States
Background: Evidence has emerged suggesting that COVID-19 can have significant long-term sequelae, commonly referred to as long COVID or post-COVID conditions. Nevertheless, the natural history of long COVID is not well studied, particularly in older individuals.
Objectives: This study aims to characterize long COVID in the U.S. Medicare population through its incidence, patient demographics, and concurrent diagnoses.
Methods: This retrospective descriptive study utilized Medicare claims data for Fee-for-Service beneficiaries. For claims to be included, both the submission and service dates must fall between April 1, 2020 and May 21, 2022. The main outcome, long COVID, was defined as at least one post-COVID condition diagnosis (ICD-10-CM diagnosis code U09.9 or B94.8) ≥28 days following initial COVID-19 diagnosis.
Results: From April 1, 2020 to May 21, 2022, 193,691 (0.6%) of 31,847,927 studied Medicare beneficiaries had been diagnosed with post-COVID conditions, regardless of whether they had a prior COVID-19 diagnosis recorded on health care claims. This proportion was higher among nursing home residents (1.0%) than among community-dwelling beneficiaries (0.6%). Of those diagnosed with post-COVID conditions, 19.0% of community-dwelling, 4.7% of nursing home, and 6.8% of end-stage renal disease beneficiaries had no prior COVID-19 claim. Of beneficiaries with a COVID-19 claim, 142,255 (4.5%) community-dwelling, 13,384 (2.5%) nursing home, and 3,774 (4.7%) end-stage renal disease beneficiaries were diagnosed with post-COVID conditions; and 3.4% of community-dwelling and 2.0% of nursing home beneficiaries met our long COVID definition. There were no significant sex, age, or race differences between long COVID cases and COVID-19 cases without a subsequent post-COVID condition diagnosis. When comparing diagnoses concurrent with long COVID and COVID-19, certain codes (G72 and J84) for myopathies and interstitial pulmonary diseases were disproportionately present with long COVID.
Conclusions: In this large study of the U.S. Medicare population, nearly 194,000 (0.6%) eligible beneficiaries had a post-COVID condition diagnosis on a health care claim. The rate was higher among nursing home residents compared to community-dwelling beneficiaries, which highlights the substantial burden of COVID-19 on nursing homes. We found minimal demographic differences between long COVID and COVID-19 cases, and comparatively low long COVID rates among Medicare beneficiaries with a prior COVID-19 diagnosis relative to other studies. Our finding that certain codes for myopathies and interstitial pulmonary diseases were differentially associated with long COVID deserves investigation.
