Mortality and Transitions-Of-Care After COVID-19 Hospitalization Among US Medicare Patients: A Retrospective Claims Analysis

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Black, Anan Zhou, Michelle A. Silver, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7085733/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background: The patient burden from COVID-19 extends beyond acute hospitalization, especially for older adults. The objective of this study was to describe post-discharge care settings and mortality rates after a COVID-19 hospitalization among adults aged ≥65 years in the United States. Methods: This retrospective observational study used the Medicare fee-for-service dataset. We identified Medicare patients hospitalized with COVID-19 from September 2023–February 2024. The date of discharge was the index date. Patients were followed until death, end of enrollment, or six months post-index. Pre- and post- hospitalization care settings, all-cause mortality, and readmission rates were analyzed. Patients were stratified by COVID-19 severity (general ward, intensive care unit [ICU], invasive mechanical ventilation [IMV]) and age (65-74, ≥75 years old). Results: A total of 67,358 patients were included; most were female (55.6%), white (84.9%), and on average 80.8 years (standard deviation: 8.1). The majority (96.4%) had ≥1 high-risk condition as defined by the Centers for Disease Control and Prevention (CDC). The median (interquartile range) length of stay was 5.0 (3.0–7.0) days. During index hospitalization, 4.4% of patients were admitted to the ICU and 5.1% required IMV. Post-discharge, 50.5% of patients who resided at home pre-hospitalization (self-care or under care) required increased care. Less than half (47.8%) of patients who were home (self-care) pre-hospitalization returned home (self-care) upon discharge. A total of 11,658 (17.4%) patients died within 6-months of hospital discharge. Mortality rates increased for patients requiring higher levels of care: 7.1% of patients discharged home (self-care), 13.0% of patients discharged home (under care), and 31.8% discharged to any healthcare facility died within six months. Mortality was higher in those with more severe COVID-19 and those aged ≥75 years. The COVID-19-related readmission rate was 4.5% within six months of discharge, and 3.2% occurred within 30 days. Conclusion: The proportion of older adults who lost independence and required care (under care at home or at a healthcare facility) more than doubled after COVID-19 hospitalization, making the post-discharge period a particularly vulnerable time for patients, who are at risk for death and hospital readmission. COVID-19 older adults post-hospitalization mortality transitions-of-care Figures Figure 1 Figure 2 BACKGROUND COVID-19 continues to have substantial morbidity and mortality rates, particularly in the older population.( 1 ) In the 2023–2024 COVID-19 season (October 2023-September 2024), the overall cumulative rate of COVID-19-associated hospitalization in the United States (US) was 821.1 per 100,000 adults aged ≥ 65 years.( 2 ) In the same age group, estimated cumulative mortality count from September 2023-August 2024 was 36,357;( 3 ) prior studies have reported increased mortality rates due to COVID-19 in older adults compared to the pre-pandemic period.( 4 – 6 ) In 2022, it was found that COVID-19 deaths occur primarily during hospitalization (59%), though 15% and 14% of total COVID-19 deaths occurred in the decedent’s home and a long-term care facility, respectively.( 7 ) Advanced age and certain comorbid conditions are well-defined risk factors for developing severe COVID-19 disease and experiencing worse clinical outcomes.( 4 , 8 ) A large proportion of individuals ≥ 65 years have at least one comorbid condition and require long-term care, especially after a hospitalization. There are limited data related to the patient burden post-COVID-19 hospitalization in more recent years, including data related to loss of independence, mortality, readmission rates and healthcare resource utilization, especially in long-term care settings. The objective of this study is to describe post-discharge care settings and patient mortality occurring after a COVID-19 hospitalization among adults aged ≥ 65 years in the US. A better understanding of the longitudinal COVID-19 patient journey will allow for more accurate estimations of mortality and burden, as well as potential guidance for public health policy. METHODS Study design and data source This is a retrospective observational study that utilized a 100% Medicare fee-for-service (FFS) dataset. This study uses secondary data and is exempt from Institutional Review Board review. The study time frame (March 2023–August 2024) was selected to provide the most recently available data. Eligible patients had an inpatient admission for COVID-19 from September 2023–February 2024. The index date was the date of hospital discharge. The baseline period was six months prior to hospital admission and patients were followed until the first occurrence of six months post-index, death, or end of enrollment. Refer to Figure S1 for the study design schema. Study population Patients included in the analysis had to meet the following inclusion criteria to be eligible: age-based eligibility for Medicare (≥ 65 years old); inpatient admission with COVID-19 (U07.1 code in the first or second position) between September 1, 2023, and February 29, 2024; and ≥ 6 months of enrollment in Medicare parts A, B, and D prior to the index hospitalization. Exclusion criteria included any of the following: admission to the hospital for non-COVID-19-related reasons (e.g., unintentional injury, physical trauma, or poisoning) coupled with a positive COVID-19 test result, prior hospital admission for COVID-19 during the pre-index baseline period (six months pre-hospitalization), enrollment in Medicare Part C (Medicare Advantage), or a planned readmission per discharge code on index admission claim. Patient demographics and clinical and hospitalization characteristics Patient demographics captured included age, sex, race/ethnicity, census region, and Medicaid-Medicare dual enrollment status. Clinical characteristics were captured in the baseline period and comprised of the following: high-risk comorbid conditions (as defined by the Center for Disease Control and Prevention [CDC]), Charlson comorbidity index (CCI) score, pre-hospitalization care setting, receipt of any COVID-19 vaccination, COVID-19 infection, and receipt of antiviral treatment. Comorbid conditions were identified in all FFS files and vaccination data were identified using Current Procedural Terminology-4 (CPT-4) and Healthcare Common Procedure Coding System (HCPCS) codes. The pre-hospitalization care setting was defined as the location of the most recent claim within the 30 days prior to the index hospital admission. If no claims were found, the patient was assumed to be at home under self-care. If multiple claims were found on the date closest to index hospital admission, the following hierarchy was applied in accordance with level of care: hospice, inpatient admission, skilled nursing facility (SNF)/other facilities, home (under care), and home (self-care). Characteristics of the index hospitalization included COVID-19 hospitalization severity, which was evaluated based on intensive care unit (ICU) admission and invasive mechanical ventilation (IMV) usage and grouped into three mutually exclusive categories: general ward, ICU (without IMV), and IMV (with or without ICU). ICU admission and IMV usage were identified by revenue codes, HCPCS codes, and/or CPT-4 codes. Patients without codes for ICU or IMV were classified as general ward. Length of stay (LOS) for the index hospitalization and inpatient antiviral treatment were also assessed. Patient demographics, clinical, and hospitalization characteristics were stratified by post-discharge care setting. Hospitalization characteristics were also stratified by COVID-19 hospitalization severity. Measured outcomes Patient outcomes of interest included first post-discharge care setting, hospital readmissions (COVID-19-related and all-cause), and mortality. Hospital readmissions and mortality were stratified by post-discharge care setting, COVID-19 hospitalization severity, and age group. The follow-up time periods of interest for these outcomes were 30, 60, 90, and 180 days. The first post-discharge care setting was identified using claims within a 7-day window following hospital discharge. The claim dated closest to discharge was used. If multiple claims were found on the same date post-discharge, the location of the claim with the latest end date was used. If multiple claims found on the same date post-discharge had the same start and through date, the following hierarchy was applied to identify the discharge location: hospice, inpatient readmission, SNF/other facilities, home (under-care), home (self-care). If no claims were present, a patient referral location available on inpatient claims was used to determine the post-discharge care setting. Post-discharge care settings were grouped into 3 categories: home (self-care), home (under care), and any healthcare facility. “Home (self-care)” was assigned if there were no claims for another location within seven days post-discharge or if discharge status stated home with no care. “Home (under care)” included those with a home health claim within seven days post-discharge as well as those who did not have any claims within those seven days if their discharge status stated home with care. “Any healthcare facility” was assigned for those with a claim within seven days of discharge for any other location, including an SNF, inpatient rehabilitation facility (IRF), hospice, intermediate care facility (ICF), long-term care facility (LTCH), psychiatric inpatient unit, or other type of health care institutions as defined by discharge status code. All-cause and COVID-19-related (cause-specific) readmissions were identified as any subsequent hospitalization to a critical access hospital or inpatient hospital (psychiatric inpatient facilities and IRFs were not included), within 30, 60, 90, and 180 days of discharge. Cause-specific readmissions followed the same methodology, requiring COVID-19 codes to be in the first or second diagnosis position. As follow-up time is variable within the population, readmission rates are reported as a percentage of those who were readmitted within the periods of interest (30, 60, 90, and 180 days), conditional on having the appropriate amount of follow-up time for each. Mortality (all-cause) was identified through the master beneficiary summary file in the FFS dataset using the date of death. As follow-up time is variable within the population, mortality was reported as a percentage of those who died within the periods of interest (30, 60, 90, and 180 days), conditional on having the appropriate amount of follow-up time for each. Statistical analysis Descriptive statistics were utilized to summarize patient demographic, clinical, and hospitalization characteristics, post-discharge care setting, mortality, and readmissions. Counts and percentages were reported for categorical variables. Continuous variables were summarized using means and standard deviations (SD) as well as medians and interquartile ranges (IQR). RESULTS Study population A total of 67,358 patients met the inclusion criteria and were included in the analysis (see Table S1 for details of patient attrition). Overall, most patients were female (55.6%) and white (84.9%) with an average age of 80.8 (SD: 8.1) years. The mean CCI score was 3.7 (SD: 2.7) and nearly all patients had at least one high-risk condition, as defined by the CDC(9), that increases likelihood of severe COVID-19 (excluding age; 96.4%). See Table 1 for patient demographics and Table S2 for disease characteristics. Table 1 Patient demographic, clinical, and hospitalization characteristics stratified by post-discharge care location ƒ First Post-Discharge Care Setting Characteristic Overall Home (self-care) Home (under care) Any healthcare facility 1 Patient count N (%) 67358 (100.0%) 25962 (38.5%) 17248 (25.6%) 24148 (35.9%) Demographic Characteristics Age 2 Mean (SD) 80.8 (8.1) 78.2 (7.5) 82.0 (7.8) 82.6 (8.1) Age group 2 65–75 years 16666 (24.7%) 9089 (35.0%) 3236 (18.8%) 4341 (18.0%) 75+ years 50692 (75.3%) 16873 (65.0%) 14012 (81.2%) 19807 (82.0%) Beneficiary sex Female 37427 (55.6%) 13728 (52.9%) 9952 (57.7%) 13747 (56.9%) Male 29931 (44.4%) 12234 (47.1%) 7296 (42.3%) 10401 (43.1%) Race/ethnicity White, non-Hispanic 57169 (84.9%) 22069 (85.0%) 14427 (83.6%) 20673 (85.6%) Black, non-Hispanic 3821 (5.7%) 1260 (4.9%) 1038 (6.0%) 1523 (6.3%) Hispanic all races 2942 (4.4%) 1128 (4.3%) 849 (4.9%) 965 (4.0%) Asian/Pacific Islander, non-Hispanic 1780 (2.6%) 662 (2.5%) 555 (3.2%) 563 (2.3%) American Indian, non-Hispanic 308 (0.5%) 193 (0.7%) 49 (0.3%) 66 (0.3%) Other/Unknown 1338 (2.0%) 650 (2.5%) 330 (1.9%) 358 (1.5%) US census region Northeast 18311 (27.2%) 6078 (23.4%) 5388 (31.2%) 6845 (28.3%) Midwest 16509 (24.5%) 7162 (27.6%) 3526 (20.4%) 5821 (24.1%) South 21888 (32.5%) 8328 (32.1%) 5593 (32.4%) 7967 (33.0%) West 10650 (15.8%) 4394 (16.9%) 2741 (15.9%) 3515 (14.6%) Medicaid-Medicare dual enrollment at index Full dual 12105 (18.0%) 3089 (11.9%) 2813 (16.3%) 6203 (25.7%) Nondual 53123 (78.9%) 22070 (85.0%) 13828 (80.2%) 17225 (71.3%) Partial dual 2130 (3.2%) 803 (3.1%) 607 (3.5%) 720 (3.0%) Clinical Characteristics High-risk comorbidities Any high-risk condition 3 64919 (96.4%) 24697 (95.1%) 16768 (97.2%) 23454 (97.1%) CCI score at baseline Mean (SD) 3.7 (2.7) 3.2 (2.5) 3.9 (2.7) 4.1 (2.7) Pre-hospitalization care setting Any healthcare facility 9967 (14.8%) 1621 (6.2%) 1366 (7.9%) 6980 (28.9%) Home (under care) 9125 (13.5%) 1264 (4.9%) 4092 (23.7%) 3769 (15.6%) Home (self-care) 48266 (71.7%) 23077 (88.9%) 11790 (68.4%) 13399 (55.5%) Vaccination in baseline period COVID-19 vaccination during baseline 10306 (15.3%) 4329 (16.7%) 2606 (15.1%) 3371 (14.0%) No COVID-19 vaccination during baseline 57052 (84.7%) 21633 (83.3%) 14642 (84.9%) 20777 (86.0%) Preadmission COVID-19 infection COVID-19 in 180 days prior to admission 31325 (46.5%) 11692 (45.0%) 7953 (46.1%) 11680 (48.4%) No baseline COVID-19 36033 (53.5%) 14270 (55.0%) 9295 (53.9%) 12468 (51.6%) Preadmission antiviral treatment Baseline AV treatment 9308 (13.8%) 3966 (15.3%) 2452 (14.2%) 2890 (12.0%) No baseline AV treatment 58050 (86.2%) 21996 (84.7%) 14796 (85.8%) 21258 (88.0%) Hospitalization Characteristics COVID-19 hospitalization severity General ward 60972 (90.5%) 24181 (93.1%) 15689 (91.0%) 21102 (87.4%) ICU without IMV 2965 (4.4%) 934 (3.6%) 718 (4.2%) 1313 (5.4%) IMV with or without ICU 3421 (5.1%) 847 (3.3%) 841 (4.9%) 1733 (7.2%) Length of stay (days) Mean (SD) 5.8 (4.9) 4.1 (2.5) 5.6 (3.6) 7.7 (6.7) Median (IQR) 5.0 (3.0–7.0) 4.0 (3.0–5.0) 5.0 (3.0–7.0) 6.0 (4.0–9.0) Inpatient antiviral treatment Antiviral treatment during index admission 33046 (49.1%) 12101 (46.6%) 9174 (53.2%) 11771 (48.7%) No Antiviral treatment during index admission 34312 (50.9%) 13861 (53.4%) 8074 (46.8%) 12377 (51.3%) AV: antiviral, CCI: Charlson Comorbidity Index, ICU: intensive care unit, IMV: invasive mechanical ventilation, IQR: interquartile range, SD: standard deviation, US: United States 1. Any healthcare facility included: skilled nursing facilities, inpatient rehabilitation facilities, hospice, intermediate care facilities, long-term care hospitals, psychiatric inpatient unit, and other types of health care institutions. 2. Age as of index date (date of hospital discharge) Additional comorbidity data is presented in Supplemental Table S2. <> The pre-hospitalization care setting for the majority of patients (71.7%) was home (self-care); 13.5% of patients were home under care and 14.8% were admitted from a healthcare facility. During the baseline period, 15.3% of patients received a COVID-19 vaccine. During the index hospitalization, 90.5% of patients were admitted to the general ward, 4.4% to the ICU without IMV, and 5.1% received IMV (with or without ICU). The average LOS was 5.8 (SD: 4.9) days (median 5.0, IQR: 3.0–7.0 days), with patients receiving IMV (with or without ICU) experiencing the longest LOS (average 9.3, SD: 8.0 days) (Table 2). Table 2 Hospitalization characteristics stratified by COVID-19 hospitalization severity Characteristic COVID-19 Hospitalization Severity Overall General Ward ICU without IMV IMV with or without ICU Patient Count N (%) 67358 (100.0%) 60972 (90.5%) 2965 (4.4%) 3421 (5.1%) Length of stay, days (continuous) Mean (SD) 5.8 (4.9) 5.5 (4.6) 7.7 (5.3) 9.3 (8.0) Median (IQR) 5.0 (3.0–7.0) 4.0 (3.0–6.0) 6.0 (4.0–10.0) 7.0 (5.0–11.0) Length of stay, days (categorical) 1 to 3 days 19305 (28.7%) 18464 (30.3%) 407 (13.7%) 434 (12.7%) 4 to 6 days 30158 (44.8%) 27853 (45.7%) 1158 (39.1%) 1147 (33.5%) 7+ days 17895 (26.6%) 14655 (24.0%) 1400 (47.2%) 1840 (53.8%) Inpatient antiviral treatment Antiviral treatment during index admission 33046 (49.1%) 29309 (48.1%) 1511 (51.0%) 2226 (65.1%) No Antiviral treatment during index admission 34312 (50.9%) 31663 (51.9%) 1454 (49.0%) 1195 (34.9%) ICU: intensive care unit, IMV: invasive mechanical ventilation, IQR: interquartile range, SD: standard deviation Post-discharge care setting Patients were discharged to home (self-care) (38.5%), home (under care) (25.6%), or any healthcare facility (35.9%). Transitions from the pre- to post-hospitalization setting can be seen in Fig. 1 and Table S3. The percentage of patients who resided in their home under care increased from pre- to post-hospitalization (13.5–25.6%), as did the percentage of patients in a healthcare facility (14.8–35.9%). The percentage of patients who resided in their home (self-care) decreased from 71.1–38.5%. Less than half (47.8%) of patients who were home under self-care pre-hospitalization returned there upon discharge. Of those eligible for an increased level of care (i.e., those who resided at home [self-care or under care]), 50.5% required increased care following hospitalization for COVID-19. The average age was older for patients discharged to any healthcare facility (82.6 [SD: 8.1] years) than those discharged to home (self-care) (78.2 [SD: 7.5] years) or home (under care) (82.0 [SD: 7.8] years). Patients discharged to any healthcare facility also had a higher baseline CCI average (4.1 [SD: 2.7]) compared to those discharged to home under care (3.2 [SD: 2.5]) and home (self-care) (3.9 [SD: 2.7]). The subgroup discharged to any healthcare facility also had a higher proportion of patients requiring IMV (with or without ICU) (7.2% vs 3.3% and 4.9%, respectively) and a longer average LOS during the index hospitalization (7.7 [SD: 6.7] days vs 4.1 [SD: 2.5] and 5.6 [SD: 3.6], respectively). COVID-19-related hospital readmissions A total of 2,543 (4.5%) of patients were readmitted to the hospital for COVID-19 within 6 months of discharge; 3.2% of readmissions occurred within 30 days, 3.7% within 60 days and 4.0% within 90 days. Rates of COVID-related readmissions within 6 months were higher for those discharged to any healthcare facility (6.0%) compared to home (self-care) (3.7%) and home (under-care) (4.4%). This trend was observed at all time points (Table 3). Table 3 COVID-19-related hospital readmissions at various time points stratified by post-discharge care setting First Post-Discharge Care Setting Overall Home (self-care) Home (under care) Any healthcare facility 1 Patient count N (%) 67358 (100.0%) 25962 (38.5%) 17248 (25.6%) 24148 (35.9%) Patients readmitted within 30 days or had at least 30 days follow-up Was not readmitted within 30 days follow-up 61248 (96.8%) 24910 (97.3%) 16276 (97.0%) 20062 (96.1%) Readmitted between discharge and 30 days follow-up 2025 (3.2%) 699 (2.7%) 512 (3.0%) 814 (3.9%) Patients readmitted within 60 days or had at least 60 days follow-up Was not readmitted within 60 days follow-up 58832 (96.3%) 24476 (96.9%) 15737 (96.5%) 18619 (95.4%) Readmitted between discharge and 60 days follow-up 2262 (3.7%) 785 (3.1%) 574 (3.5%) 903 (4.6%) Patients readmitted within 90 days or had at least 90 days follow-up Was not readmitted within 90 days follow-up 57169 (96.0%) 24136 (96.7%) 15390 (96.2%) 17643 (94.9%) Readmitted between discharge and 90 days follow-up 2383 (4.0%) 828 (3.3%) 608 (3.8%) 947 (5.1%) Patients readmitted within 180 days or had at least 180 days follow-up Was not readmitted within 180 days follow-up 53434 (95.5%) 23301 (96.3%) 14435 (95.6%) 15698 (94.0%) Readmitted between discharge and 180 days follow-up 2543 (4.5%) 888 (3.7%) 659 (4.4%) 996 (6.0%) Note: Readmissions are reported as a percentage of those who had the full amount of follow up time at each period of interest (30, 60, 90, and 180 days) and those who were readmitted within said period of interest. Rates at each time period are cumulative. 1. Any healthcare facility included: skilled nursing facilities, inpatient rehabilitation facilities, hospice, intermediate care facilities, long-term care hospitals, psychiatric inpatient unit, and other types of health care institutions. Readmission rates for COVID-19 within six months post-discharge were also higher for patients who received IMV during the index hospitalization compared to those admitted to the general ward (4.4%) or the ICU (5.2%) on index hospitalization (Table 4). Among patients aged 65–74 years, 4.4% were readmitted for COVID-19 within 6 months post-discharge; a similar rate (4.6%) of those aged ≥ 75 years were readmitted. All-cause hospital readmissions are reported in Table S4 and Table S5. Table 4 COVID-19-related hospital readmissions at various time points stratified by COVID-19 hospitalization severity and age group COVID-19 Hospitalization Severity Age Group Overall General Ward ICU without IMV IMV with or without ICU Age 65–74 Age 75+ Patient count N (%) 67358 (100.0%) 60972 (90.5%) 2965 (4.4%) 3421 (5.1%) 16666 (24.7%) 50692 (75.3%) Patients readmitted within 30 days or had at least 30 days follow-up Was not readmitted within 30 days follow-up 61248 (96.8%) 55878 (96.9%) 2553 (96.4%) 2817 (96.0%) 15509 (96.7%) 45739 (96.8%) Readmitted between discharge and 30 days follow-up 2025 (3.2%) 1814 (3.1%) 95 (3.6%) 116 (4.0%) 532 (3.3%) 1493 (3.2%) Patients readmitted within 60 days or had at least 60 days follow-up Was not readmitted within 60 days follow-up 58832 (96.3%) 53813 (96.4%) 2405 (95.9%) 2614 (95.0%) 15054 (96.2%) 43778 (96.3%) Readmitted between discharge and 60 days follow-up 2262 (3.7%) 2020 (3.6%) 103 (4.1%) 139 (5.0%) 598 (3.8%) 1664 (3.7%) Patients readmitted within 90 days or had at least 90 days follow-up Was not readmitted within 90 days follow-up 57169 (96.0%) 52346 (96.1%) 2320 (95.6%) 2503 (94.3%) 14712 (95.9%) 42457 (96.0%) Readmitted between discharge and 90 days follow-up 2383 (4.0%) 2124 (3.9%) 108 (4.4%) 151 (5.7%) 629 (4.1%) 1754 (4.0%) Patients readmitted within 180 days or had at least 180 days follow-up Was not readmitted within 180 days follow-up 53434 (95.5%) 49034 (95.6%) 2153 (94.8%) 2247 (93.5%) 13982 (95.6%) 39452 (95.4%) Readmitted between discharge and 180 days follow-up 2543 (4.5%) 2271 (4.4%) 117 (5.2%) 155 (6.5%) 650 (4.4%) 1893 (4.6%) ICU: intensive care unit, IMV: invasive mechanical ventilation Note: Readmissions are reported as a percentage of those who had the full amount of follow up time at each period of interest (30, 60, 90, and 180 days) and those were readmitted within said period of interest. Rates at each time period are cumulative. All-Cause Mortality A total of 11,658 (17.4%) patients died within six months of hospital discharge; 6.6% of the deaths occurred within 30 days, 10.0% within 60 days, and 12.3% within 90 days post-hospitalization (Fig. 2; Table S6). Mortality rates varied by post-discharge care setting (Fig. 2). A total of 7.1% of patients discharged to home (self-care) died within six months of hospital discharge, whereas 13.0% of patients discharged to home (under care) and 31.8% discharged to any healthcare facility died within six months (Table S6). Of those admitted to the general ward on index hospitalization, 16.4% died within six months of discharge, compared to 23.9% of those admitted to the ICU and 31.0% who received IMV (Table 5). Mortality rates within six months post-discharge were higher in patients aged ≥ 75 years than those aged 64–75 years (19.1% and 12.4%, respectively). This trend was similar regardless of post-discharge care location (Table 5). Table 5 Mortality at various time points stratified by COVID-19 hospitalization severity and age group Characteristic COVID-19 Hospitalization Severity Age Group Overall General Ward ICU without IMV IMV with or without ICU Age 65–74 Age 75+ Patient count N (%) 67358 (100.0%) 60972 (90.5%%) 2965 (4.4%) 3421 (5.1%) 16666 (24.7%) 50692 (75.3%) Patients who died within 30 days or had at least 30 days follow-up Did not die within 30 days follow-up 62877 (93.4%) 57350 (94.1%) 2627 (88.7%) 2900 (84.8%) 15964 (95.9%) 46913 (92.6%) Died between discharge and 30 days follow-up 4426 (6.6%) 3572 (5.9%) 336 (11.3%) 518 (15.2%) 690 (4.1%) 3736 (7.4%) Patients who died within 60 days or had at least 60 days follow-up Did not die within 60 days follow-up 60533 (90.0%) 55349 (90.9%) 2478 (83.8%) 2706 (79.2%) 15532 (93.3%) 45001 (88.9%) Died between discharge and 60 days follow-up 6711 (10.0%) 5522 (9.1%) 480 (16.2%) 709 (20.8%) 1108 (6.7%) 5603 (11.1%) Patients who died within 90 days or had at least 90 days follow-up Did not die within 90 days follow-up 58893 (87.7%) 53897 (88.6%) 2397 (81.1%) 2599 (76.2%) 15197 (91.4%) 43696 (86.4%) Died between discharge and 90 days follow-up 8279 (12.3%) 6906 (11.4%) 559 (18.9%) 814 (23.8%) 1423 (8.6%) 6856 (13.6%) Patients who died within 180 days or had at least 180 days follow-up Did not die within 180 days follow-up 55154 (82.6%) 50589 (83.6%) 2235 (76.1%) 2330 (69.0%) 14463 (87.6%) 40691 (80.9%) Died between discharge and 180 days follow-up 11658 (17.4%) 9912 (16.4%) 701 (23.9%) 1045 (31.0%) 2049 (12.4%) 9609 (19.1%) ICU: intensive care unit, IMV: invasive mechanical ventilation Note: Mortality is reported as a percentage of those who had the full amount of follow up time at each period of interest (30, 60, 90, and 180 days) and those that died within said period of interest. Rates at each time period are cumulative. DISCUSSION In this analysis of older patients with a high prevalence (96.4%) of high-risk comorbidities, COVID-19 hospitalization served as a catalyst for requiring increased levels of care and a loss of independence, as exhibited by less than half of patients who resided in their home under self-care prior to being hospitalized with COVID-19 returning to their home without care post-discharge. Patients with more severe COVID-19 during the index hospitalization and who were older (aged ≥ 75 years) experienced increased care requirements upon discharge. Individuals in this study spent several days (5.8 on average) in the hospital despite most being admitted to the general ward and considered to have low-severity COVID-19. Increased readmission rates were observed for those who transitioned to a healthcare facility and those who were admitted to the ICU or required IMV during the index hospitalization. The mortality rate within six months of hospital discharge was 17.4%. This increased for those of advanced age, with more severe COVID-19, and for those who required increased care upon discharge. Data are limited regarding the patient journey following a COVID-19 hospitalization, especially for elderly patients in more recent years. Our findings align with a previous study by Yehoshua et al., which demonstrated that more severe COVID-19 (as measured by ICU admission and IMV usage) and advanced age were associated with worse outcomes (increased LOS, higher inpatient mortality and hospitalization cost).( 10 ) Our findings also align with a recently published study by Roberts et al., which reported that approximately 50% of high-risk Medicare patients hospitalized with COVID-19 were discharged home under self-care in early 2022.( 11 ) Readmission rates from our study align with findings from other research in older patients with COVID-19. For example, the Agency for Healthcare Research and Quality reported that the rate of 30-day all-cause readmissions for Medicare patients aged ≥ 65 years was 15.9% on average during the pre-pandemic stage (2016–2019)( 12 ) and Oseran et al. reported a 30-day all-cause readmission for Medicare patients admitted to the hospital with COVID-19 (2020–2022) of 16.0%.( 13 ) The 30-day all-cause readmission rate from our study was 17.6% (Table S4). Both all-cause and COVID-19-related readmissions increased with higher post-discharge care requirements and COVID-19 hospitalization severity. Readmissions increased slightly in the ≥ 75 years age group. Notably, COVID-19 readmissions represented approximately 10% of all-cause readmissions 180 days post-discharge. Our study found that a total of 11,780 (17.4%) patients died within 180 days of being discharged from a COVID-19 hospitalization, with most deaths occurring within 30 days, suggesting that the immediate period post-hospital discharge represents a particularly vulnerable time for older patients. Mortality was highest in patients requiring increased levels of care post-discharge, those with higher COVID-19 severity (i.e., required ICU stay or IMV), and those aged ≥ 75 years. Our findings align with other studies that have reported increased mortality in older patients after a COVID-19 hospitalization.( 11 , 13 , 14 ) A study of US veterans hospitalized with COVID-19 in 2020 found a three-fold increased risk for death in the first year post-hospitalization compared to controls.( 14 ) Oseran et al. examined all-cause mortality rates in Medicare patients post-COVID-19 hospitalization compared to historical control patients with influenza. The average 30-day all-cause mortality was 10.9% and 3.9%, respectively, and the 180-day mortality rate was 19.1% versus 10.5%-- nearly double for the COVID-19 cohort compared to the influenza cohort.( 13 ) Roberts et al. reported a 30-day all-cause mortality rate for high-risk Medicare patients hospitalized for COVID-19 in December 2022 of 6.25%.( 11 ) This estimate aligns closely with the 30-day all-cause mortality rate reported in our study (6.6%). Limitations This study has a number of limitations. First, the mortality data reported in this study are for all causes as the specific cause of death is not reported in the data source. Further investigation is warranted to determine mortality rates due to COVID-19 in the post-hospitalization setting. The CDC suggests that mortality due to COVID-19 is often underreported and only counting deaths in which COVID-19 was recorded on the death certificate would substantially understate the true impact.( 15 ) As such, adjustments are made in burden estimates by the CDC to account for underreporting, with preliminary estimates in the 2024–2025 season of 29,000–47,000 COVID-19 deaths (data as of April 26, 2025).( 1 ) Second, it is possible that patients transitioned to higher levels of care for reasons unrelated to COVID-19. Despite this potential limitation, the comparison to pre-hospitalization locations in our analysis indicates that a COVID-19 hospitalization serves as a catalyst for requiring higher levels of care for many patients. Third, pre-hospital and post-discharge settings were identified using claims data. The care setting identified in claims closest to admission/discharge and discharge status was used if no claims within the period in question were available. If there were no claims within seven days and no care setting was identified on discharge status, the care setting was assumed to be home (self-care), but this assumption may not be accurate. Fourth, all healthcare facilities were grouped into a single, broad category to help with interpretation of results, but we acknowledge that there are inherent differences in various healthcare settings. A more granular look at post-discharge care locations by type of care facility can be found in Table S7. Finally, vaccination data in the baseline period are likely underreported in this study due to the possibly that patients may have received a vaccine prior to the six-month baseline period as well as the potential to receive vaccination through sources not identified in claims.( 16 ) CONCLUSION This study showed that hospitalization for COVID-19 in the ≥ 65-year-old population is associated with poor outcomes including loss of independence, increased care requirements, increased mortality, and high rate of readmission to the hospital, even in recent seasons. The post-hospitalization period represents a particularly vulnerable time for elderly patients; particular attention during this transitional period is warranted to ensure that these patients receive required care. Lapo et al. reported that the loss of functionality experienced by elderly patients after a COVID-19 hospitalization can be improved with inpatient rehabilitation.( 17 ) Beyond the loss of independence experienced by many older patients who transition to higher levels of care, there are substantial cost implications. Further research is warranted to determine the economic impact of increased healthcare utilization required post-COVID-19 hospitalization. This highlights the potential benefit of preventative measures in avoiding severe disease leading to hospitalization, including vaccination and antiviral use. Such practices may further improve public health and avoid costly, lesser-known downstream effects of infection. Abbreviations AV: Antiviral CCI: Charlson Comorbidity Index CDC: Centers for Disease Control and Prevention COVID-19: Coronavirus disease 2019 CPT-4: Current Procedural Terminology, 4th edition FFS: Fee-for-service HCPCS: Healthcare Common Procedure Coding System ICF: Intermediate care facility ICU: Intensive care unit IMV: Invasive mechanical ventilation IQR: Interquartile range IRF: Inpatient rehabilitation facility LOS: Length of stay LTCH: Long-term care facility SNF: Skilled nursing facility SD: Standard deviation US: United States Declarations Ethics approval and consent to participate This study was conducted in accordance with the principles of the Declaration of Helsinki. Consent for publication Not applicable. Availability of data and materials The data that support the findings of this study are available from The Centers for Medicare and Medicaid Services (CMS) and were obtained through a restricted data use agreement for the current study. Competing interests Authors AY, SMCL, MDF, RMN, MMF, MAC, TA are employed by Pfizer Inc. and may hold stock or stock options of Pfizer. Author RMB is employed by AESARA Inc. Authors AZ, MAS, and YH are employed by Genesis Research Group. Author BY is employed by Evidera Inc. AESARA, Inc. and Genesis Research Group received funding from Pfizer in connection with the study and the development of this manuscript. All authors declare no other competing interests. Funding This study was sponsored by Pfizer. Authors’ contributions All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article. All authors contributed to study conceptualization and design, analysis and interpretation of data, draft of the paper and revision of manuscript, and final approval of the version to be published. All authors agree to be accountable for all aspects of work. Acknowledgements Not applicable. References Preliminary Estimates of COVID-19 Burden for 2024-2025 [Internet]. 2024 [cited 2025 May 5]. Available from: https://www.cdc.gov/covid/php/surveillance/burden-estimates.html. COVID-NET: Coronavirus Disease 2019 (COVID-19) Hospitalization Surveillance Network [Internet]. 2024 [cited 2025 April 10]. Available from: https://covid.cdc.gov/covid-data-tracker/#covidnet-hospitalization-network. Panagiotakopoulos L. Use of 2025–2026 COVID-19 Vaccines: Work Group Considerations. Advisory Committee on Immunization Practices (ACIP); 2025 April 15; Atlanta, Georgia Tarazi WW, Finegold K, Sheingold SH, Wong Samson L, Zuckerman R, Bosworth A. COVID-19-Related Deaths And Excess Deaths Among Medicare Fee-For-Service Beneficiaries. Health Affairs. 2021;40(6):879-85. Greenwald SD, Chamoun NG, Manberg PJ, Gray J, Clain D, Maheshwari K, et al. Covid-19 and excess mortality in medicare beneficiaries. PLOS ONE. 2022;17(2):e0262264. Geriatric Medicine Research Collaborative, Covid Collaborative, Welch C. Age and frailty are independently associated with increased COVID-19 mortality and increased care needs in survivors: results of an international multi-centre study. Age Ageing. 2021;50(3):617-30. Ahmad FB, Cisewski JA, Xu J, Anderson RN. COVID-19 Mortality Update — United States, 2022. MMWR Morb Mortal Wkly Rep. 2023. Underlying Medical Conditions Associated with Higher Risk for Severe COVID-19: Information for Healthcare Professionals [Internet]. 2023 [cited 2025 May 7]. Available from: https://archive.cdc.gov/www_cdc_gov/coronavirus/2019-ncov/hcp/clinical-care/underlyingconditions.html. Underlying Conditions and the Higher Risk for Severe COVID-19 [Internet]. [cited 2023 November 1]. Available from: https://www.cdc.gov/covid/hcp/clinical-care/underlying-conditions.html. Yehoshua A, D. CA, Manuela DF, E. RA, Elizabeth T, C. LSM, et al. Health outcomes and economic burden among patients with a COVID-19-associated hospitalization in the United States during the predominance of the XBB and JN.1 omicron lineages. Journal of Medical Economics. 2024;27(1):1372-8. Roberts AI, Santostefano CM, Chen Z, McGarry BE, White EM, Resnik LJ, et al. Trends in hospital discharge outcomes among high-risk Medicare beneficiaries before and during the COVID-19 pandemic. Health Affairs Scholar. 2025;3(4). KR Fingar MB, HJ Jiang. Characteristics Of 30-Day All-Cause Hospital Readmissions, 2016-2020 [Internet]. Rockville, MD: Agency for Healthcare Research and Quality; 2023. (HCUP Statistical Brief #304). Available from: www.hcup-us.ahrq.gov/reports/statbriefs/sb304-readmissions-2016-2020.pdf Oseran AS, Song Y, Xu J, Dahabreh IJ, Wadhera RK, de Lemos JA, et al. Long term risk of death and readmission after hospital admission with covid-19 among older adults: retrospective cohort study. BMJ. 2023;382:e076222. Cai M, Xie Y, Topol EJ, Al-Aly Z. Three-year outcomes of post-acute sequelae of COVID-19. Nature Medicine. 2024;30(6):1564-73. How CDC Estimates the Burden of COVID-19 in the US [Internet]. 2024 [cited 2025 April 14]. Available from: https://www.cdc.gov/covid/php/surveillance/about-burden-estimates.html. Medicare COVID-19 Vaccine Analysis [Internet]. 2024 [cited 2025 May 6]. Available from: https://www.cms.gov/data-research/cms-covid-19-data-products/medicare-covid-19-vaccine-analysis. Lapo HM, Sardeli AV, Mariano LO, Howroyd FJ, Sokoll PR, Sapey E, et al. Functionality loss due to COVID-19 hospitalisation in older adults recovers with inpatient rehabilitation: A systematic review and meta-analysis. Experimental Gerontology. 2024;198:112617. Additional Declarations Competing interest reported. Authors AY, SMCL, MDF, RMN, MMF, MAC, and TA are employed by Pfizer Inc. and may hold stock or stock options of Pfizer. Author RMB is employed by AESARA Inc. Authors AZ, MAS, and YH are employed by Genesis Research Group. Author BY is employed by Evidera Inc. AESARA, Inc. and Genesis Research Group received funding from Pfizer in connection with the study and the development of this manuscript. All authors declare no other competing interests. Supplementary Files COVID19TOCManuscriptSupplement.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 15 Oct, 2025 Reviews received at journal 28 Sep, 2025 Reviews received at journal 23 Sep, 2025 Reviewers agreed at journal 18 Sep, 2025 Reviewers agreed at journal 18 Sep, 2025 Reviewers invited by journal 09 Sep, 2025 Editor assigned by journal 26 Aug, 2025 Editor invited by journal 01 Aug, 2025 Submission checks completed at journal 31 Jul, 2025 First submitted to journal 31 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7085733","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":515100868,"identity":"2733ae29-7ef0-4242-9213-3b6c51448294","order_by":0,"name":"Alon Yehoshua","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAUlEQVRIiWNgGAWjYDACdgiVwMDAA6QqGPjZCGphRtFyhkGyjTQtjG0Mkg2EdPA3Mx97wNhmk8fPf/aYxM95dyT4+A8f+8BQYxONS4vEYbZ0A8a2tGLJGXlpkr3bnkmwMRxLnsFwLC0Xp3WHecwkGNsOJ264AWTwbjtcx8bYY8zA2HAYpxZ5iJb/iRvOnzGT/DvnsAQbM/9nvFoMIFoOJG44kGMmzdsA1MLGw4xXi+FhtjSJhHPJiTNn5BhbyxwD+oWHzZghAY9f5I43H5P4UGaX2M9/xvDmm5o7EvL9hx8zfKixwe19EEhExPgBCJWATzkY/EHXMgpGwSgYBaMACQAAC/pTsjpHe+QAAAAASUVORK5CYII=","orcid":"","institution":"Pfizer Inc","correspondingAuthor":true,"prefix":"","firstName":"Alon","middleName":"","lastName":"Yehoshua","suffix":""},{"id":515100869,"identity":"dd9533b7-58e2-4d61-96c9-060a1740a0fd","order_by":1,"name":"Rachel M. 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Silver","email":"","orcid":"","institution":"Genesis Research Group","correspondingAuthor":false,"prefix":"","firstName":"Michelle","middleName":"A.","lastName":"Silver","suffix":""},{"id":515100873,"identity":"c1f78742-6204-4bce-9e57-a18166630ce0","order_by":4,"name":"Yu Han","email":"","orcid":"","institution":"Genesis Research Group","correspondingAuthor":false,"prefix":"","firstName":"Yu","middleName":"","lastName":"Han","suffix":""},{"id":515100874,"identity":"a1c5ec92-0c79-40e5-9ab7-23232ad751a9","order_by":5,"name":"Santiago MC Lopez","email":"","orcid":"","institution":"Pfizer Inc","correspondingAuthor":false,"prefix":"","firstName":"Santiago","middleName":"MC","lastName":"Lopez","suffix":""},{"id":515100875,"identity":"18a62269-014c-40af-a48f-4c8cbf905ff6","order_by":6,"name":"Manuela Di Fusco","email":"","orcid":"","institution":"Pfizer Inc","correspondingAuthor":false,"prefix":"","firstName":"Manuela","middleName":"Di","lastName":"Fusco","suffix":""},{"id":515100876,"identity":"055ed522-defd-4662-a471-b41c126ffbd5","order_by":7,"name":"Benjamin Yarnoff","email":"","orcid":"","institution":"Evidera Inc","correspondingAuthor":false,"prefix":"","firstName":"Benjamin","middleName":"","lastName":"Yarnoff","suffix":""},{"id":515100877,"identity":"189bd1aa-2666-488d-9000-039912112d23","order_by":8,"name":"Rajeev M. 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Fernandez","email":"","orcid":"","institution":"Pfizer Inc","correspondingAuthor":false,"prefix":"","firstName":"Maria","middleName":"M.","lastName":"Fernandez","suffix":""},{"id":515100879,"identity":"73f19923-9436-4684-8bc0-21ed7853c669","order_by":10,"name":"Mohammad Ashraf Chaudhary","email":"","orcid":"","institution":"Pfizer Inc","correspondingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"Ashraf","lastName":"Chaudhary","suffix":""},{"id":515100880,"identity":"be92d5ed-91c7-415b-bc99-efcb0cefc711","order_by":11,"name":"Tara Ahi","email":"","orcid":"","institution":"Pfizer Inc","correspondingAuthor":false,"prefix":"","firstName":"Tara","middleName":"","lastName":"Ahi","suffix":""}],"badges":[],"createdAt":"2025-07-09 16:08:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7085733/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7085733/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91513036,"identity":"37e9ad3a-b299-412c-8e1a-e11ee3e2c5a5","added_by":"auto","created_at":"2025-09-17 08:56:22","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":179246,"visible":true,"origin":"","legend":"\u003cp\u003eTransitions of care settings pre-hospitalization to post-hospitalization\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7085733/v1/27b2acce53b550bb96856d3b.png"},{"id":91509617,"identity":"851919f2-5d7c-4c5b-bd1f-6282ae31ce60","added_by":"auto","created_at":"2025-09-17 08:40:22","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":50094,"visible":true,"origin":"","legend":"\u003cp\u003eMortality at various time points stratified by post-discharge care setting\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7085733/v1/cfad1027081188356557b00e.png"},{"id":91513576,"identity":"8b2052fd-ecd5-47a9-81c1-f0d4572a2d67","added_by":"auto","created_at":"2025-09-17 09:04:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2241712,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7085733/v1/62da3ea4-6a91-4979-a021-eef7e4173d7d.pdf"},{"id":91511318,"identity":"5ff474be-5d72-404b-83e8-e251d3f28c02","added_by":"auto","created_at":"2025-09-17 08:48:22","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":78737,"visible":true,"origin":"","legend":"","description":"","filename":"COVID19TOCManuscriptSupplement.docx","url":"https://assets-eu.researchsquare.com/files/rs-7085733/v1/1f7843d2abf17741398b0d4e.docx"}],"financialInterests":"Competing interest reported. Authors AY, SMCL, MDF, RMN, MMF, MAC, and TA are employed by Pfizer Inc. and may hold stock or stock options of Pfizer. Author RMB is employed by AESARA Inc. Authors AZ, MAS, and YH are employed by Genesis Research Group. Author BY is employed by Evidera Inc. AESARA, Inc. and Genesis Research Group received funding from Pfizer in connection with the study and the development of this manuscript. All authors declare no other competing interests.","formattedTitle":"Mortality and Transitions-Of-Care After COVID-19 Hospitalization Among US Medicare Patients: A Retrospective Claims Analysis","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eCOVID-19 continues to have substantial morbidity and mortality rates, particularly in the older population.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) In the 2023–2024 COVID-19 season (October 2023-September 2024), the overall cumulative rate of COVID-19-associated hospitalization in the United States (US) was 821.1 per 100,000 adults aged ≥ 65 years.(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) In the same age group, estimated cumulative mortality count from September 2023-August 2024 was 36,357;(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) prior studies have reported increased mortality rates due to COVID-19 in older adults compared to the pre-pandemic period.(\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e–\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) In 2022, it was found that COVID-19 deaths occur primarily during hospitalization (59%), though 15% and 14% of total COVID-19 deaths occurred in the decedent’s home and a long-term care facility, respectively.(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eAdvanced age and certain comorbid conditions are well-defined risk factors for developing severe COVID-19 disease and experiencing worse clinical outcomes.(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) A large proportion of individuals ≥ 65 years have at least one comorbid condition and require long-term care, especially after a hospitalization. There are limited data related to the patient burden post-COVID-19 hospitalization in more recent years, including data related to loss of independence, mortality, readmission rates and healthcare resource utilization, especially in long-term care settings.\u003c/p\u003e\u003cp\u003eThe objective of this study is to describe post-discharge care settings and patient mortality occurring after a COVID-19 hospitalization among adults aged ≥ 65 years in the US. A better understanding of the longitudinal COVID-19 patient journey will allow for more accurate estimations of mortality and burden, as well as potential guidance for public health policy.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cstrong\u003eStudy design and data source\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis is a retrospective observational study that utilized a 100% Medicare fee-for-service (FFS) dataset. This study uses secondary data and is exempt from Institutional Review Board review. The study time frame (March 2023\u0026ndash;August 2024) was selected to provide the most recently available data. Eligible patients had an inpatient admission for COVID-19 from September 2023\u0026ndash;February 2024. The index date was the date of hospital discharge. The baseline period was six months prior to hospital admission and patients were followed until the first occurrence of six months post-index, death, or end of enrollment. Refer to Figure \u003cspan class=\"InternalRef\"\u003eS1\u003c/span\u003e for the study design schema.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients included in the analysis had to meet the following inclusion criteria to be eligible: age-based eligibility for Medicare (\u0026ge;\u0026thinsp;65 years old); inpatient admission with COVID-19 (U07.1 code in the first or second position) between September 1, 2023, and February 29, 2024; and \u0026ge;\u0026thinsp;6 months of enrollment in Medicare parts A, B, and D prior to the index hospitalization.\u003c/p\u003e\n\u003cp\u003eExclusion criteria included any of the following: admission to the hospital for non-COVID-19-related reasons (e.g., unintentional injury, physical trauma, or poisoning) coupled with a positive COVID-19 test result, prior hospital admission for COVID-19 during the pre-index baseline period (six months pre-hospitalization), enrollment in Medicare Part C (Medicare Advantage), or a planned readmission per discharge code on index admission claim.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient demographics and clinical and hospitalization characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatient demographics captured included age, sex, race/ethnicity, census region, and Medicaid-Medicare dual enrollment status. Clinical characteristics were captured in the baseline period and comprised of the following: high-risk comorbid conditions (as defined by the Center for Disease Control and Prevention [CDC]), Charlson comorbidity index (CCI) score, pre-hospitalization care setting, receipt of any COVID-19 vaccination, COVID-19 infection, and receipt of antiviral treatment. Comorbid conditions were identified in all FFS files and vaccination data were identified using Current Procedural Terminology-4 (CPT-4) and Healthcare Common Procedure Coding System (HCPCS) codes. The pre-hospitalization care setting was defined as the location of the most recent claim within the 30 days prior to the index hospital admission. If no claims were found, the patient was assumed to be at home under self-care. If multiple claims were found on the date closest to index hospital admission, the following hierarchy was applied in accordance with level of care: hospice, inpatient admission, skilled nursing facility (SNF)/other facilities, home (under care), and home (self-care).\u003c/p\u003e\n\u003cp\u003eCharacteristics of the index hospitalization included COVID-19 hospitalization severity, which was evaluated based on intensive care unit (ICU) admission and invasive mechanical ventilation (IMV) usage and grouped into three mutually exclusive categories: general ward, ICU (without IMV), and IMV (with or without ICU). ICU admission and IMV usage were identified by revenue codes, HCPCS codes, and/or CPT-4 codes. Patients without codes for ICU or IMV were classified as general ward. Length of stay (LOS) for the index hospitalization and inpatient antiviral treatment were also assessed.\u003c/p\u003e\n\u003cp\u003ePatient demographics, clinical, and hospitalization characteristics were stratified by post-discharge care setting. Hospitalization characteristics were also stratified by COVID-19 hospitalization severity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasured outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatient outcomes of interest included first post-discharge care setting, hospital readmissions (COVID-19-related and all-cause), and mortality. Hospital readmissions and mortality were stratified by post-discharge care setting, COVID-19 hospitalization severity, and age group. The follow-up time periods of interest for these outcomes were 30, 60, 90, and 180 days.\u003c/p\u003e\n\u003cp\u003eThe first post-discharge care setting was identified using claims within a 7-day window following hospital discharge. The claim dated closest to discharge was used. If multiple claims were found on the same date post-discharge, the location of the claim with the latest end date was used. If multiple claims found on the same date post-discharge had the same start and through date, the following hierarchy was applied to identify the discharge location: hospice, inpatient readmission, SNF/other facilities, home (under-care), home (self-care). If no claims were present, a patient referral location available on inpatient claims was used to determine the post-discharge care setting. Post-discharge care settings were grouped into 3 categories: home (self-care), home (under care), and any healthcare facility.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Home (self-care)\u0026rdquo; was assigned if there were no claims for another location within seven days post-discharge or if discharge status stated home with no care. \u0026ldquo;Home (under care)\u0026rdquo; included those with a home health claim within seven days post-discharge as well as those who did not have any claims within those seven days if their discharge status stated home with care. \u0026ldquo;Any healthcare facility\u0026rdquo; was assigned for those with a claim within seven days of discharge for any other location, including an SNF, inpatient rehabilitation facility (IRF), hospice, intermediate care facility (ICF), long-term care facility (LTCH), psychiatric inpatient unit, or other type of health care institutions as defined by discharge status code.\u003c/p\u003e\n\u003cp\u003eAll-cause and COVID-19-related (cause-specific) readmissions were identified as any subsequent hospitalization to a critical access hospital or inpatient hospital (psychiatric inpatient facilities and IRFs were not included), within 30, 60, 90, and 180 days of discharge. Cause-specific readmissions followed the same methodology, requiring COVID-19 codes to be in the first or second diagnosis position. As follow-up time is variable within the population, readmission rates are reported as a percentage of those who were readmitted within the periods of interest (30, 60, 90, and 180 days), conditional on having the appropriate amount of follow-up time for each.\u003c/p\u003e\n\u003cp\u003eMortality (all-cause) was identified through the master beneficiary summary file in the FFS dataset using the date of death. As follow-up time is variable within the population, mortality was reported as a percentage of those who died within the periods of interest (30, 60, 90, and 180 days), conditional on having the appropriate amount of follow-up time for each.\u003c/p\u003e\n\u003ch2\u003eStatistical analysis\u003c/h2\u003e\n\u003cp\u003eDescriptive statistics were utilized to summarize patient demographic, clinical, and hospitalization characteristics, post-discharge care setting, mortality, and readmissions. Counts and percentages were reported for categorical variables. Continuous variables were summarized using means and standard deviations (SD) as well as medians and interquartile ranges (IQR).\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eStudy population\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003cp\u003eA total of 67,358 patients met the inclusion criteria and were included in the analysis (see Table S1 for details of patient attrition). Overall, most patients were female (55.6%) and white (84.9%) with an average age of 80.8 (SD: 8.1) years. The mean CCI score was 3.7 (SD: 2.7) and nearly all patients had at least one high-risk condition, as defined by the CDC(9), that increases likelihood of severe COVID-19 (excluding age; 96.4%). See Table 1 for patient demographics and Table S2 for disease characteristics.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003ePatient demographic, clinical, and hospitalization characteristics stratified by post-discharge care location ƒ\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eFirst Post-Discharge Care Setting\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCharacteristic\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOverall\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHome\u003c/p\u003e\n \u003cp\u003e(self-care)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHome\u003c/p\u003e\n \u003cp\u003e(under care)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAny\u003c/p\u003e\n \u003cp\u003ehealthcare\u003c/p\u003e\n \u003cp\u003efacility\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatient\u0026nbsp;count\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e67358 (100.0%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e25962 (38.5%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e17248 (25.6%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e24148 (35.9%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eDemographic Characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean\u0026nbsp;(SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80.8\u0026nbsp;(8.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78.2\u0026nbsp;(7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82.0\u0026nbsp;(7.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82.6\u0026nbsp;(8.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u0026nbsp;group\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65–75\u0026nbsp;years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16666\u0026nbsp;(24.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9089\u0026nbsp;(35.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3236\u0026nbsp;(18.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4341\u0026nbsp;(18.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75+\u0026nbsp;years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50692\u0026nbsp;(75.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16873\u0026nbsp;(65.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14012\u0026nbsp;(81.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19807\u0026nbsp;(82.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBeneficiary\u0026nbsp;sex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37427\u0026nbsp;(55.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13728\u0026nbsp;(52.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9952\u0026nbsp;(57.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13747\u0026nbsp;(56.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29931\u0026nbsp;(44.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12234\u0026nbsp;(47.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7296\u0026nbsp;(42.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10401\u0026nbsp;(43.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRace/ethnicity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhite,\u0026nbsp;non-Hispanic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57169\u0026nbsp;(84.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22069\u0026nbsp;(85.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14427\u0026nbsp;(83.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20673\u0026nbsp;(85.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBlack,\u0026nbsp;non-Hispanic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3821\u0026nbsp;(5.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1260\u0026nbsp;(4.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1038\u0026nbsp;(6.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1523\u0026nbsp;(6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHispanic\u0026nbsp;all\u0026nbsp;races\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2942\u0026nbsp;(4.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1128\u0026nbsp;(4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e849\u0026nbsp;(4.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e965\u0026nbsp;(4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAsian/Pacific\u0026nbsp;Islander,\u0026nbsp;non-Hispanic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1780\u0026nbsp;(2.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e662\u0026nbsp;(2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e555\u0026nbsp;(3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e563\u0026nbsp;(2.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAmerican\u0026nbsp;Indian,\u0026nbsp;non-Hispanic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e308\u0026nbsp;(0.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e193\u0026nbsp;(0.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49\u0026nbsp;(0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66\u0026nbsp;(0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther/Unknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1338\u0026nbsp;(2.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e650\u0026nbsp;(2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e330\u0026nbsp;(1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e358\u0026nbsp;(1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eUS\u0026nbsp;census\u0026nbsp;region\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNortheast\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18311\u0026nbsp;(27.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6078\u0026nbsp;(23.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5388\u0026nbsp;(31.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6845\u0026nbsp;(28.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMidwest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16509\u0026nbsp;(24.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7162\u0026nbsp;(27.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3526\u0026nbsp;(20.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5821\u0026nbsp;(24.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSouth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21888\u0026nbsp;(32.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8328\u0026nbsp;(32.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5593\u0026nbsp;(32.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7967\u0026nbsp;(33.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10650\u0026nbsp;(15.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4394\u0026nbsp;(16.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2741\u0026nbsp;(15.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3515\u0026nbsp;(14.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedicaid-Medicare\u0026nbsp;dual\u0026nbsp;enrollment\u0026nbsp;at\u0026nbsp;index\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFull\u0026nbsp;dual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12105\u0026nbsp;(18.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3089\u0026nbsp;(11.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2813\u0026nbsp;(16.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6203\u0026nbsp;(25.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNondual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53123\u0026nbsp;(78.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22070\u0026nbsp;(85.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13828\u0026nbsp;(80.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17225\u0026nbsp;(71.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePartial\u0026nbsp;dual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2130\u0026nbsp;(3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e803\u0026nbsp;(3.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e607\u0026nbsp;(3.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e720\u0026nbsp;(3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical Characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHigh-risk\u0026nbsp;comorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAny\u0026nbsp;high-risk\u0026nbsp;condition\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64919\u0026nbsp;(96.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24697\u0026nbsp;(95.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16768\u0026nbsp;(97.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23454\u0026nbsp;(97.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCCI\u0026nbsp;score\u0026nbsp;at\u0026nbsp;baseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean\u0026nbsp;(SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.7\u0026nbsp;(2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.2\u0026nbsp;(2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.9\u0026nbsp;(2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.1\u0026nbsp;(2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-hospitalization\u0026nbsp;care\u0026nbsp;setting\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAny\u0026nbsp;healthcare\u0026nbsp;facility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9967\u0026nbsp;(14.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1621\u0026nbsp;(6.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1366\u0026nbsp;(7.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6980\u0026nbsp;(28.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHome\u0026nbsp;(under care)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9125\u0026nbsp;(13.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1264\u0026nbsp;(4.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4092\u0026nbsp;(23.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3769\u0026nbsp;(15.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHome\u0026nbsp;(self-care)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48266\u0026nbsp;(71.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23077\u0026nbsp;(88.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11790\u0026nbsp;(68.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13399\u0026nbsp;(55.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eVaccination\u0026nbsp;in\u0026nbsp;baseline\u0026nbsp;period\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCOVID-19 vaccination\u0026nbsp;during\u0026nbsp;baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10306\u0026nbsp;(15.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4329\u0026nbsp;(16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2606\u0026nbsp;(15.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3371\u0026nbsp;(14.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u0026nbsp;COVID-19 vaccination\u0026nbsp;during\u0026nbsp;baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57052\u0026nbsp;(84.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21633\u0026nbsp;(83.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14642\u0026nbsp;(84.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20777\u0026nbsp;(86.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreadmission\u0026nbsp;COVID-19 infection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCOVID-19 in\u0026nbsp;180\u0026nbsp;days\u0026nbsp;prior\u0026nbsp;to\u0026nbsp;admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31325\u0026nbsp;(46.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11692\u0026nbsp;(45.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7953\u0026nbsp;(46.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11680\u0026nbsp;(48.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u0026nbsp;baseline\u0026nbsp;COVID-19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36033\u0026nbsp;(53.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14270\u0026nbsp;(55.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9295\u0026nbsp;(53.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12468\u0026nbsp;(51.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreadmission\u0026nbsp;antiviral\u0026nbsp;treatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBaseline\u0026nbsp;AV\u0026nbsp;treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9308\u0026nbsp;(13.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3966\u0026nbsp;(15.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2452\u0026nbsp;(14.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2890\u0026nbsp;(12.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u0026nbsp;baseline\u0026nbsp;AV\u0026nbsp;treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58050\u0026nbsp;(86.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21996\u0026nbsp;(84.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14796\u0026nbsp;(85.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21258\u0026nbsp;(88.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospitalization Characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCOVID-19 hospitalization severity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGeneral\u0026nbsp;ward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60972\u0026nbsp;(90.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24181\u0026nbsp;(93.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15689\u0026nbsp;(91.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21102\u0026nbsp;(87.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eICU\u0026nbsp;without\u0026nbsp;IMV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2965\u0026nbsp;(4.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e934\u0026nbsp;(3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e718\u0026nbsp;(4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1313\u0026nbsp;(5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIMV\u0026nbsp;with\u0026nbsp;or\u0026nbsp;without\u0026nbsp;ICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3421\u0026nbsp;(5.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e847\u0026nbsp;(3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e841\u0026nbsp;(4.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1733\u0026nbsp;(7.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength of stay (days)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean\u0026nbsp;(SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.8\u0026nbsp;(4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.1\u0026nbsp;(2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.6\u0026nbsp;(3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.7\u0026nbsp;(6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.0 (3.0–7.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.0\u0026nbsp;(3.0–5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.0\u0026nbsp;(3.0–7.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.0\u0026nbsp;(4.0–9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eInpatient\u0026nbsp;antiviral\u0026nbsp;treatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAntiviral\u0026nbsp;treatment\u0026nbsp;during\u0026nbsp;index\u0026nbsp;admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33046\u0026nbsp;(49.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12101\u0026nbsp;(46.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9174\u0026nbsp;(53.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11771\u0026nbsp;(48.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u0026nbsp;Antiviral\u0026nbsp;treatment\u0026nbsp;during\u0026nbsp;index\u0026nbsp;admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34312\u0026nbsp;(50.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13861\u0026nbsp;(53.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8074\u0026nbsp;(46.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12377\u0026nbsp;(51.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eAV: antiviral, CCI: Charlson Comorbidity Index, ICU: intensive care unit, IMV: invasive mechanical ventilation, IQR: interquartile range, SD: standard deviation, US: United States\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e1. Any healthcare facility included: skilled nursing facilities, inpatient rehabilitation facilities, hospice, intermediate care facilities, long-term care hospitals, psychiatric inpatient unit, and other types of health care institutions.\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e2. Age as of index date (date of hospital discharge)\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eAdditional comorbidity data is presented in Supplemental Table S2.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026lt;\u0026lt;insert Table 1 here\u0026gt;\u0026gt;\u003c/p\u003e\n\u003cp\u003eThe pre-hospitalization care setting for the majority of patients (71.7%) was home (self-care); 13.5% of patients were home under care and 14.8% were admitted from a healthcare facility. During the baseline period, 15.3% of patients received a COVID-19 vaccine. During the index hospitalization, 90.5% of patients were admitted to the general ward, 4.4% to the ICU without IMV, and 5.1% received IMV (with or without ICU). The average LOS was 5.8 (SD: 4.9) days (median 5.0, IQR: 3.0–7.0 days), with patients receiving IMV (with or without ICU) experiencing the longest LOS (average 9.3, SD: 8.0 days) (Table 2).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eHospitalization characteristics stratified by COVID-19 hospitalization severity\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCharacteristic\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eCOVID-19 Hospitalization Severity\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOverall\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGeneral Ward\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eICU without IMV\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIMV with or without ICU\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatient\u0026nbsp;Count\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e67358 (100.0%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e60972 (90.5%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e2965 (4.4%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e3421 (5.1%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength of stay, days (continuous)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean\u0026nbsp;(SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.8\u0026nbsp;(4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.5\u0026nbsp;(4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.7\u0026nbsp;(5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.3\u0026nbsp;(8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedian\u0026nbsp;(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.0\u0026nbsp;(3.0–7.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.0\u0026nbsp;(3.0–6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.0\u0026nbsp;(4.0–10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.0\u0026nbsp;(5.0–11.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength\u0026nbsp;of\u0026nbsp;stay, days (categorical)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u0026nbsp;to\u0026nbsp;3\u0026nbsp;days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19305\u0026nbsp;(28.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18464\u0026nbsp;(30.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e407\u0026nbsp;(13.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e434\u0026nbsp;(12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u0026nbsp;to\u0026nbsp;6\u0026nbsp;days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30158\u0026nbsp;(44.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27853\u0026nbsp;(45.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1158\u0026nbsp;(39.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1147\u0026nbsp;(33.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7+\u0026nbsp;days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17895\u0026nbsp;(26.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14655\u0026nbsp;(24.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1400\u0026nbsp;(47.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1840\u0026nbsp;(53.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eInpatient\u0026nbsp;antiviral\u0026nbsp;treatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAntiviral\u0026nbsp;treatment\u0026nbsp;during\u0026nbsp;index\u0026nbsp;admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33046\u0026nbsp;(49.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29309\u0026nbsp;(48.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1511\u0026nbsp;(51.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2226\u0026nbsp;(65.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u0026nbsp;Antiviral\u0026nbsp;treatment\u0026nbsp;during\u0026nbsp;index\u0026nbsp;admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34312\u0026nbsp;(50.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31663\u0026nbsp;(51.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1454\u0026nbsp;(49.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1195\u0026nbsp;(34.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eICU: intensive care unit, IMV: invasive mechanical ventilation, IQR: interquartile range, SD: standard deviation\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003ePost-discharge care setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients were discharged to home (self-care) (38.5%), home (under care) (25.6%), or any healthcare facility (35.9%). Transitions from the pre- to post-hospitalization setting can be seen in Fig. 1 and Table S3. The percentage of patients who resided in their home under care increased from pre- to post-hospitalization (13.5–25.6%), as did the percentage of patients in a healthcare facility (14.8–35.9%). The percentage of patients who resided in their home (self-care) decreased from 71.1–38.5%. Less than half (47.8%) of patients who were home under self-care pre-hospitalization returned there upon discharge. Of those eligible for an increased level of care (i.e., those who resided at home [self-care or under care]), 50.5% required increased care following hospitalization for COVID-19.\u003c/p\u003e\n\u003cp\u003eThe average age was older for patients discharged to any healthcare facility (82.6 [SD: 8.1] years) than those discharged to home (self-care) (78.2 [SD: 7.5] years) or home (under care) (82.0 [SD: 7.8] years). Patients discharged to any healthcare facility also had a higher baseline CCI average (4.1 [SD: 2.7]) compared to those discharged to home under care (3.2 [SD: 2.5]) and home (self-care) (3.9 [SD: 2.7]). The subgroup discharged to any healthcare facility also had a higher proportion of patients requiring IMV (with or without ICU) (7.2% vs 3.3% and 4.9%, respectively) and a longer average LOS during the index hospitalization (7.7 [SD: 6.7] days vs 4.1 [SD: 2.5] and 5.6 [SD: 3.6], respectively).\u003c/p\u003e\n\u003cdiv\u003e\n \u003cp\u003e\u003cstrong\u003eCOVID-19-related hospital readmissions\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eA total of 2,543 (4.5%) of patients were readmitted to the hospital for COVID-19 within 6 months of discharge; 3.2% of readmissions occurred within 30 days, 3.7% within 60 days and 4.0% within 90 days. Rates of COVID-related readmissions within 6 months were higher for those discharged to any healthcare facility (6.0%) compared to home (self-care) (3.7%) and home (under-care) (4.4%). This trend was observed at all time points (Table 3).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eCOVID-19-related hospital readmissions at various time points stratified by post-discharge care setting\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eFirst Post-Discharge Care Setting\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOverall\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHome\u003c/p\u003e\n \u003cp\u003e(self-care)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHome\u003c/p\u003e\n \u003cp\u003e(under care)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAny healthcare facility\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatient\u0026nbsp;count\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e67358 (100.0%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e25962 (38.5%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e17248 (25.6%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e24148 (35.9%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatients readmitted within 30 days or had at least 30 days follow-up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWas not readmitted within 30 days follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61248\u0026nbsp;(96.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24910\u0026nbsp;(97.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16276\u0026nbsp;(97.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20062\u0026nbsp;(96.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReadmitted between discharge and 30 days follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2025\u0026nbsp;(3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e699\u0026nbsp;(2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e512\u0026nbsp;(3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e814\u0026nbsp;(3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatients readmitted within 60 days or had at least 60 days follow-up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWas not readmitted within 60 days follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58832\u0026nbsp;(96.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24476\u0026nbsp;(96.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15737\u0026nbsp;(96.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18619\u0026nbsp;(95.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReadmitted between discharge and 60 days follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2262\u0026nbsp;(3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e785\u0026nbsp;(3.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e574\u0026nbsp;(3.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e903\u0026nbsp;(4.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatients readmitted within 90 days or had at least 90 days follow-up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWas not readmitted within 90 days follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57169\u0026nbsp;(96.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24136\u0026nbsp;(96.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15390\u0026nbsp;(96.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17643\u0026nbsp;(94.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReadmitted between discharge and 90 days follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2383\u0026nbsp;(4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e828\u0026nbsp;(3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e608\u0026nbsp;(3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e947\u0026nbsp;(5.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatients readmitted within 180 days or had at least 180 days follow-up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWas not readmitted within 180 days follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53434\u0026nbsp;(95.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23301\u0026nbsp;(96.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14435\u0026nbsp;(95.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15698\u0026nbsp;(94.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReadmitted between discharge and 180 days follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2543\u0026nbsp;(4.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e888\u0026nbsp;(3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e659\u0026nbsp;(4.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e996\u0026nbsp;(6.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eNote: Readmissions are reported as a percentage of those who had the full amount of follow up time at each period of interest (30, 60, 90, and 180 days) and those who were readmitted within said period of interest. Rates at each time period are cumulative.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cspan\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e1. Any healthcare facility included: skilled nursing facilities, inpatient rehabilitation facilities, hospice, intermediate care facilities, long-term care hospitals, psychiatric inpatient unit, and other types of health care institutions.\u003c/p\u003e\n\u003cp\u003eReadmission rates for COVID-19 within six months post-discharge were also higher for patients who received IMV during the index hospitalization compared to those admitted to the general ward (4.4%) or the ICU (5.2%) on index hospitalization (Table 4). Among patients aged 65–74 years, 4.4% were readmitted for COVID-19 within 6 months post-discharge; a similar rate (4.6%) of those aged ≥ 75 years were readmitted. All-cause hospital readmissions are reported in Table S4 and Table S5.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 4\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eCOVID-19-related hospital readmissions at various time points stratified by COVID-19 hospitalization severity and age group\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eCOVID-19 Hospitalization Severity\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eAge Group\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOverall\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGeneral Ward\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eICU without IMV\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIMV with or without ICU\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAge 65–74\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAge 75+\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatient\u0026nbsp;count\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e67358 (100.0%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e60972 (90.5%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e2965 (4.4%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e3421 (5.1%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e16666 (24.7%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e50692 (75.3%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatients readmitted within 30 days or had at least 30 days follow-up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWas not readmitted within 30 days follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61248\u0026nbsp;(96.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55878\u0026nbsp;(96.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2553\u0026nbsp;(96.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2817\u0026nbsp;(96.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15509\u0026nbsp;(96.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45739\u0026nbsp;(96.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReadmitted between discharge and 30 days follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2025\u0026nbsp;(3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1814\u0026nbsp;(3.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95\u0026nbsp;(3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e116\u0026nbsp;(4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e532\u0026nbsp;(3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1493\u0026nbsp;(3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatients readmitted within 60 days or had at least 60 days follow-up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWas not readmitted within 60 days follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58832\u0026nbsp;(96.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53813\u0026nbsp;(96.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2405\u0026nbsp;(95.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2614\u0026nbsp;(95.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15054\u0026nbsp;(96.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43778\u0026nbsp;(96.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReadmitted between discharge and 60 days follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2262\u0026nbsp;(3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2020\u0026nbsp;(3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e103\u0026nbsp;(4.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e139\u0026nbsp;(5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e598\u0026nbsp;(3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1664\u0026nbsp;(3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatients readmitted within 90 days or had at least 90 days follow-up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWas not readmitted within 90 days follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57169\u0026nbsp;(96.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52346\u0026nbsp;(96.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2320\u0026nbsp;(95.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2503\u0026nbsp;(94.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14712\u0026nbsp;(95.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42457\u0026nbsp;(96.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReadmitted between discharge and 90 days follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2383\u0026nbsp;(4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2124\u0026nbsp;(3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e108\u0026nbsp;(4.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e151\u0026nbsp;(5.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e629\u0026nbsp;(4.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1754\u0026nbsp;(4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatients readmitted within 180 days or had at least 180 days follow-up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWas not readmitted within 180 days follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53434\u0026nbsp;(95.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49034\u0026nbsp;(95.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2153\u0026nbsp;(94.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2247\u0026nbsp;(93.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13982\u0026nbsp;(95.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39452\u0026nbsp;(95.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReadmitted between discharge and 180 days follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2543\u0026nbsp;(4.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2271\u0026nbsp;(4.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e117\u0026nbsp;(5.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e155\u0026nbsp;(6.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e650\u0026nbsp;(4.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1893 (4.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eICU: intensive care unit, IMV: invasive mechanical ventilation\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eNote: Readmissions are reported as a percentage of those who had the full amount of follow up time at each period of interest (30, 60, 90, and 180 days) and those were readmitted within said period of interest. Rates at each time period are cumulative.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eAll-Cause Mortality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 11,658 (17.4%) patients died within six months of hospital discharge; 6.6% of the deaths occurred within 30 days, 10.0% within 60 days, and 12.3% within 90 days post-hospitalization (Fig. 2; Table S6). Mortality rates varied by post-discharge care setting (Fig. 2). A total of 7.1% of patients discharged to home (self-care) died within six months of hospital discharge, whereas 13.0% of patients discharged to home (under care) and 31.8% discharged to any healthcare facility died within six months (Table S6).\u003c/p\u003e\n\u003cp\u003eOf those admitted to the general ward on index hospitalization, 16.4% died within six months of discharge, compared to 23.9% of those admitted to the ICU and 31.0% who received IMV (Table 5). Mortality rates within six months post-discharge were higher in patients aged ≥ 75 years than those aged 64–75 years (19.1% and 12.4%, respectively). This trend was similar regardless of post-discharge care location (Table 5).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 5\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eMortality at various time points stratified by COVID-19 hospitalization severity and age group\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCharacteristic\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eCOVID-19 Hospitalization Severity\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eAge Group\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOverall\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGeneral Ward\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eICU without IMV\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIMV with or without ICU\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAge 65–74\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAge 75+\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatient\u0026nbsp;count\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e67358 (100.0%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e60972 (90.5%%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e2965 (4.4%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e3421 (5.1%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e16666 (24.7%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e50692 (75.3%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatients who died within 30 days or had at least 30 days follow-up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDid not die within 30 days follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62877\u0026nbsp;(93.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57350\u0026nbsp;(94.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2627\u0026nbsp;(88.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2900\u0026nbsp;(84.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15964\u0026nbsp;(95.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46913\u0026nbsp;(92.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDied between discharge and 30 days follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4426\u0026nbsp;(6.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3572\u0026nbsp;(5.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e336\u0026nbsp;(11.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e518\u0026nbsp;(15.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e690\u0026nbsp;(4.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3736\u0026nbsp;(7.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatients who died within 60 days or had at least 60 days follow-up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDid not die within 60 days follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60533\u0026nbsp;(90.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55349\u0026nbsp;(90.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2478\u0026nbsp;(83.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2706\u0026nbsp;(79.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15532\u0026nbsp;(93.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45001\u0026nbsp;(88.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDied between discharge and 60 days follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6711\u0026nbsp;(10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5522\u0026nbsp;(9.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e480\u0026nbsp;(16.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e709\u0026nbsp;(20.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1108\u0026nbsp;(6.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5603\u0026nbsp;(11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatients who died within 90 days or had at least 90 days follow-up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDid not die within 90 days follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58893\u0026nbsp;(87.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53897\u0026nbsp;(88.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2397\u0026nbsp;(81.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2599\u0026nbsp;(76.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15197\u0026nbsp;(91.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43696\u0026nbsp;(86.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDied between discharge and 90 days follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8279\u0026nbsp;(12.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6906\u0026nbsp;(11.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e559\u0026nbsp;(18.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e814\u0026nbsp;(23.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1423\u0026nbsp;(8.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6856\u0026nbsp;(13.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatients who died within 180 days or had at least 180 days follow-up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDid not die within 180 days follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55154\u0026nbsp;(82.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50589\u0026nbsp;(83.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2235\u0026nbsp;(76.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2330\u0026nbsp;(69.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14463\u0026nbsp;(87.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40691\u0026nbsp;(80.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDied between discharge and 180 days follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11658\u0026nbsp;(17.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9912\u0026nbsp;(16.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e701\u0026nbsp;(23.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1045\u0026nbsp;(31.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2049\u0026nbsp;(12.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9609 (19.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eICU: intensive care unit, IMV: invasive mechanical ventilation\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eNote: Mortality is reported as a percentage of those who had the full amount of follow up time at each period of interest (30, 60, 90, and 180 days) and those that died within said period of interest. Rates at each time period are cumulative.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this analysis of older patients with a high prevalence (96.4%) of high-risk comorbidities, COVID-19 hospitalization served as a catalyst for requiring increased levels of care and a loss of independence, as exhibited by less than half of patients who resided in their home under self-care prior to being hospitalized with COVID-19 returning to their home without care post-discharge. Patients with more severe COVID-19 during the index hospitalization and who were older (aged\u0026thinsp;\u0026ge;\u0026thinsp;75 years) experienced increased care requirements upon discharge. Individuals in this study spent several days (5.8 on average) in the hospital despite most being admitted to the general ward and considered to have low-severity COVID-19. Increased readmission rates were observed for those who transitioned to a healthcare facility and those who were admitted to the ICU or required IMV during the index hospitalization. The mortality rate within six months of hospital discharge was 17.4%. This increased for those of advanced age, with more severe COVID-19, and for those who required increased care upon discharge.\u003c/p\u003e\u003cp\u003eData are limited regarding the patient journey following a COVID-19 hospitalization, especially for elderly patients in more recent years. Our findings align with a previous study by Yehoshua et al., which demonstrated that more severe COVID-19 (as measured by ICU admission and IMV usage) and advanced age were associated with worse outcomes (increased LOS, higher inpatient mortality and hospitalization cost).(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) Our findings also align with a recently published study by Roberts et al., which reported that approximately 50% of high-risk Medicare patients hospitalized with COVID-19 were discharged home under self-care in early 2022.(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eReadmission rates from our study align with findings from other research in older patients with COVID-19. For example, the Agency for Healthcare Research and Quality reported that the rate of 30-day all-cause readmissions for Medicare patients aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years was 15.9% on average during the pre-pandemic stage (2016\u0026ndash;2019)(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) and Oseran et al. reported a 30-day all-cause readmission for Medicare patients admitted to the hospital with COVID-19 (2020\u0026ndash;2022) of 16.0%.(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) The 30-day all-cause readmission rate from our study was 17.6% (Table S4). Both all-cause and COVID-19-related readmissions increased with higher post-discharge care requirements and COVID-19 hospitalization severity. Readmissions increased slightly in the \u0026ge;\u0026thinsp;75 years age group. Notably, COVID-19 readmissions represented approximately 10% of all-cause readmissions 180 days post-discharge.\u003c/p\u003e\u003cp\u003eOur study found that a total of 11,780 (17.4%) patients died within 180 days of being discharged from a COVID-19 hospitalization, with most deaths occurring within 30 days, suggesting that the immediate period post-hospital discharge represents a particularly vulnerable time for older patients. Mortality was highest in patients requiring increased levels of care post-discharge, those with higher COVID-19 severity (i.e., required ICU stay or IMV), and those aged\u0026thinsp;\u0026ge;\u0026thinsp;75 years.\u003c/p\u003e\u003cp\u003eOur findings align with other studies that have reported increased mortality in older patients after a COVID-19 hospitalization.(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) A study of US veterans hospitalized with COVID-19 in 2020 found a three-fold increased risk for death in the first year post-hospitalization compared to controls.(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) Oseran et al. examined all-cause mortality rates in Medicare patients post-COVID-19 hospitalization compared to historical control patients with influenza. The average 30-day all-cause mortality was 10.9% and 3.9%, respectively, and the 180-day mortality rate was 19.1% versus 10.5%-- nearly double for the COVID-19 cohort compared to the influenza cohort.(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) Roberts et al. reported a 30-day all-cause mortality rate for high-risk Medicare patients hospitalized for COVID-19 in December 2022 of 6.25%.(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) This estimate aligns closely with the 30-day all-cause mortality rate reported in our study (6.6%).\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study has a number of limitations. First, the mortality data reported in this study are for all causes as the specific cause of death is not reported in the data source. Further investigation is warranted to determine mortality rates due to COVID-19 in the post-hospitalization setting. The CDC suggests that mortality due to COVID-19 is often underreported and only counting deaths in which COVID-19 was recorded on the death certificate would substantially understate the true impact.(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) As such, adjustments are made in burden estimates by the CDC to account for underreporting, with preliminary estimates in the 2024\u0026ndash;2025 season of 29,000\u0026ndash;47,000 COVID-19 deaths (data as of April 26, 2025).(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eSecond, it is possible that patients transitioned to higher levels of care for reasons unrelated to COVID-19. Despite this potential limitation, the comparison to pre-hospitalization locations in our analysis indicates that a COVID-19 hospitalization serves as a catalyst for requiring higher levels of care for many patients. Third, pre-hospital and post-discharge settings were identified using claims data. The care setting identified in claims closest to admission/discharge and discharge status was used if no claims within the period in question were available. If there were no claims within seven days and no care setting was identified on discharge status, the care setting was assumed to be home (self-care), but this assumption may not be accurate. Fourth, all healthcare facilities were grouped into a single, broad category to help with interpretation of results, but we acknowledge that there are inherent differences in various healthcare settings. A more granular look at post-discharge care locations by type of care facility can be found in Table S7. Finally, vaccination data in the baseline period are likely underreported in this study due to the possibly that patients may have received a vaccine prior to the six-month baseline period as well as the potential to receive vaccination through sources not identified in claims.(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study showed that hospitalization for COVID-19 in the \u0026ge;\u0026thinsp;65-year-old population is associated with poor outcomes including loss of independence, increased care requirements, increased mortality, and high rate of readmission to the hospital, even in recent seasons. The post-hospitalization period represents a particularly vulnerable time for elderly patients; particular attention during this transitional period is warranted to ensure that these patients receive required care. Lapo et al. reported that the loss of functionality experienced by elderly patients after a COVID-19 hospitalization can be improved with inpatient rehabilitation.(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eBeyond the loss of independence experienced by many older patients who transition to higher levels of care, there are substantial cost implications. Further research is warranted to determine the economic impact of increased healthcare utilization required post-COVID-19 hospitalization. This highlights the potential benefit of preventative measures in avoiding severe disease leading to hospitalization, including vaccination and antiviral use. Such practices may further improve public health and avoid costly, lesser-known downstream effects of infection.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eAV:\u0026nbsp;\u003c/strong\u003eAntiviral\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCCI:\u003c/strong\u003e Charlson Comorbidity Index\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCDC:\u003c/strong\u003e Centers for Disease Control and Prevention\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCOVID-19:\u003c/strong\u003e Coronavirus disease 2019\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCPT-4:\u003c/strong\u003e Current Procedural Terminology, 4th edition\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFFS:\u003c/strong\u003e Fee-for-service\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHCPCS:\u003c/strong\u003e Healthcare Common Procedure Coding System\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eICF:\u003c/strong\u003e Intermediate care facility\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eICU:\u003c/strong\u003e Intensive care unit\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIMV:\u003c/strong\u003e Invasive mechanical ventilation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIQR:\u003c/strong\u003e Interquartile range\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIRF:\u003c/strong\u003e Inpatient rehabilitation facility\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLOS:\u003c/strong\u003e Length of stay\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLTCH:\u003c/strong\u003e Long-term care facility\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSNF:\u003c/strong\u003e Skilled nursing facility\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSD:\u003c/strong\u003e Standard deviation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUS:\u0026nbsp;\u003c/strong\u003eUnited States\u003cstrong\u003e\u003c/strong\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from The Centers for Medicare and Medicaid Services (CMS) and were obtained through a restricted data use agreement for the current study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors AY, SMCL, MDF, RMN, MMF, MAC, TA are employed by Pfizer Inc. and may hold stock or stock options of Pfizer. \u0026nbsp;Author RMB is employed by AESARA Inc. Authors AZ, MAS, and YH are employed by Genesis Research Group. Author BY is employed by Evidera Inc. AESARA, Inc. and Genesis Research Group received funding from Pfizer in connection with the study and the development of this manuscript. All authors declare no other competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was sponsored by Pfizer.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article. All authors contributed to study conceptualization and design, analysis and interpretation of data, draft of the paper and revision of manuscript, and final approval of the version to be published. All authors agree to be accountable for all aspects of work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePreliminary Estimates of COVID-19 Burden for 2024-2025 [Internet]. 2024 [cited 2025 May 5]. Available from: https://www.cdc.gov/covid/php/surveillance/burden-estimates.html.\u003c/li\u003e\n\u003cli\u003eCOVID-NET: Coronavirus Disease 2019 (COVID-19) Hospitalization Surveillance Network [Internet]. 2024 [cited 2025 April 10]. Available from: https://covid.cdc.gov/covid-data-tracker/#covidnet-hospitalization-network.\u003c/li\u003e\n\u003cli\u003ePanagiotakopoulos L. Use of 2025\u0026ndash;2026 COVID-19 Vaccines: Work Group Considerations. Advisory Committee on Immunization Practices (ACIP); 2025 April 15; Atlanta, Georgia\u003c/li\u003e\n\u003cli\u003eTarazi WW, Finegold K, Sheingold SH, Wong Samson L, Zuckerman R, Bosworth A. COVID-19-Related Deaths And Excess Deaths Among Medicare Fee-For-Service Beneficiaries. Health Affairs. 2021;40(6):879-85.\u003c/li\u003e\n\u003cli\u003eGreenwald SD, Chamoun NG, Manberg PJ, Gray J, Clain D, Maheshwari K, et al. Covid-19 and excess mortality in medicare beneficiaries. PLOS ONE. 2022;17(2):e0262264.\u003c/li\u003e\n\u003cli\u003eGeriatric Medicine Research Collaborative, Covid Collaborative, Welch C. Age and frailty are independently associated with increased COVID-19 mortality and increased care needs in survivors: results of an international multi-centre study. Age Ageing. 2021;50(3):617-30.\u003c/li\u003e\n\u003cli\u003eAhmad FB, Cisewski JA, Xu J, Anderson RN. COVID-19 Mortality Update \u0026mdash; United States, 2022. MMWR Morb Mortal Wkly Rep. 2023.\u003c/li\u003e\n\u003cli\u003eUnderlying Medical Conditions Associated with Higher Risk for Severe COVID-19: Information for Healthcare Professionals [Internet]. 2023 [cited 2025 May 7]. Available from: https://archive.cdc.gov/www_cdc_gov/coronavirus/2019-ncov/hcp/clinical-care/underlyingconditions.html.\u003c/li\u003e\n\u003cli\u003eUnderlying Conditions and the Higher Risk for Severe COVID-19 [Internet]. [cited 2023 November 1]. Available from: https://www.cdc.gov/covid/hcp/clinical-care/underlying-conditions.html.\u003c/li\u003e\n\u003cli\u003eYehoshua A, D. CA, Manuela DF, E. RA, Elizabeth T, C. LSM, et al. Health outcomes and economic burden among patients with a COVID-19-associated hospitalization in the United States during the predominance of the XBB and JN.1 omicron lineages. Journal of Medical Economics. 2024;27(1):1372-8.\u003c/li\u003e\n\u003cli\u003eRoberts AI, Santostefano CM, Chen Z, McGarry BE, White EM, Resnik LJ, et al. Trends in hospital discharge outcomes among high-risk Medicare beneficiaries before and during the COVID-19 pandemic. Health Affairs Scholar. 2025;3(4).\u003c/li\u003e\n\u003cli\u003eKR Fingar MB, HJ Jiang. Characteristics Of 30-Day All-Cause Hospital Readmissions, 2016-2020 [Internet]. Rockville, MD: Agency for Healthcare Research and Quality; 2023. (HCUP Statistical Brief #304). Available from: www.hcup-us.ahrq.gov/reports/statbriefs/sb304-readmissions-2016-2020.pdf\u003c/li\u003e\n\u003cli\u003eOseran AS, Song Y, Xu J, Dahabreh IJ, Wadhera RK, de Lemos JA, et al. Long term risk of death and readmission after hospital admission with covid-19 among older adults: retrospective cohort study. BMJ. 2023;382:e076222.\u003c/li\u003e\n\u003cli\u003eCai M, Xie Y, Topol EJ, Al-Aly Z. Three-year outcomes of post-acute sequelae of COVID-19. Nature Medicine. 2024;30(6):1564-73.\u003c/li\u003e\n\u003cli\u003eHow CDC Estimates the Burden of COVID-19 in the US [Internet]. 2024 [cited 2025 April 14]. Available from: https://www.cdc.gov/covid/php/surveillance/about-burden-estimates.html.\u003c/li\u003e\n\u003cli\u003eMedicare COVID-19 Vaccine Analysis [Internet]. 2024 [cited 2025 May 6]. Available from: https://www.cms.gov/data-research/cms-covid-19-data-products/medicare-covid-19-vaccine-analysis.\u003c/li\u003e\n\u003cli\u003eLapo HM, Sardeli AV, Mariano LO, Howroyd FJ, Sokoll PR, Sapey E, et al. Functionality loss due to COVID-19 hospitalisation in older adults recovers with inpatient rehabilitation: A systematic review and meta-analysis. Experimental Gerontology. 2024;198:112617.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"COVID-19, older adults, post-hospitalization, mortality, transitions-of-care","lastPublishedDoi":"10.21203/rs.3.rs-7085733/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7085733/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThe patient burden from COVID-19 extends beyond acute hospitalization, especially for older adults. The objective of this study was to describe post-discharge care settings and mortality rates after a COVID-19 hospitalization among adults aged ≥65 years in the United States.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis retrospective observational study used the Medicare fee-for-service dataset. \u0026nbsp;We identified Medicare patients hospitalized with COVID-19 from September 2023–February 2024. The date of discharge was the index date. Patients were followed until death, end of enrollment, or six months post-index. Pre- and post- hospitalization care settings, all-cause mortality, and readmission rates were analyzed. Patients were stratified by COVID-19 severity (general ward, intensive care unit [ICU], invasive mechanical ventilation [IMV]) and age (65-74, ≥75 years old).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eA total of 67,358 patients were included; most were female (55.6%), white (84.9%), and on average 80.8 years (standard deviation: 8.1). The majority (96.4%) had ≥1 high-risk condition as defined by the Centers for Disease Control and Prevention (CDC). The median (interquartile range) length of stay was 5.0 (3.0–7.0) days. During index hospitalization, 4.4% of patients were admitted to the ICU and 5.1% required IMV. \u0026nbsp;Post-discharge, 50.5% of patients who resided at home pre-hospitalization (self-care or under care) required increased care. \u0026nbsp;Less than half (47.8%) of patients who were home (self-care) pre-hospitalization returned home (self-care) upon discharge.\u003c/p\u003e\n\u003cp\u003eA total of 11,658 (17.4%) patients died within 6-months of hospital discharge. Mortality rates increased for patients requiring higher levels of care: 7.1% of patients discharged home (self-care), 13.0% of patients discharged home (under care), and 31.8% discharged to any healthcare facility died within six months. Mortality was higher in those with more severe COVID-19 and those aged ≥75 years. The COVID-19-related readmission rate was 4.5% within six months of discharge, and 3.2% occurred within 30 days.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe proportion of older adults who lost independence and required care (under care at home or at a healthcare facility) more than doubled after COVID-19 hospitalization, making the post-discharge period a particularly vulnerable time for patients, who are at risk for death and hospital readmission.\u003c/p\u003e","manuscriptTitle":"Mortality and Transitions-Of-Care After COVID-19 Hospitalization Among US Medicare Patients: A Retrospective Claims Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-17 08:40:17","doi":"10.21203/rs.3.rs-7085733/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-15T06:54:13+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-29T01:19:44+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-23T21:12:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"122480116813180644994649929882282231829","date":"2025-09-18T12:34:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"183744424497707946062330108972178990113","date":"2025-09-18T12:31:01+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-09T12:34:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-26T04:10:51+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-01T10:55:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-31T17:52:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2025-07-31T17:49:19+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cd3a44fb-76f5-48a0-9c8c-6e6fe4c7d43a","owner":[],"postedDate":"September 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-20T10:26:17+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-17 08:40:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7085733","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7085733","identity":"rs-7085733","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}