County-level impact of the COVID-19 Pandemic on excess mortality among U.S. veterans: A population-based study
Summary: Background: As the novel coronavirus (COVID-19) continues to impact the world at large, Veterans of the US Armed Forces are experiencing increases in both COVID-19 and non-COVID-19 mortality. Veterans may be more susceptible to the pandemic than the general population due to their higher c...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-01-01
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| Series: | The Lancet Regional Health. Americas |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2667193X21000892 |
| _version_ | 1798016367242248192 |
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| author | Yevgeniy Feyman Samantha G. Auty Kertu Tenso Kiersten L. Strombotne Aaron Legler Kevin N. Griffith |
| author_facet | Yevgeniy Feyman Samantha G. Auty Kertu Tenso Kiersten L. Strombotne Aaron Legler Kevin N. Griffith |
| author_sort | Yevgeniy Feyman |
| collection | DOAJ |
| description | Summary: Background: As the novel coronavirus (COVID-19) continues to impact the world at large, Veterans of the US Armed Forces are experiencing increases in both COVID-19 and non-COVID-19 mortality. Veterans may be more susceptible to the pandemic than the general population due to their higher comorbidity burdens and older age, but no research has examined if trends in excess mortality differ between these groups. Additionally, individual-level data on demographics, comorbidities, and deaths are provided in near-real time for all enrolees of the Veterans Health Administration (VHA). These data provide a unique opportunity to identify excess mortality throughout 2020 at a subnational level, and to validate these estimates against local COVID-19 burden. Methods: We queried VHA administrative data on demographics and comorbidities for 11.4 million enrolees during 2016-2020. Pre-pandemic data was used to develop and cross-validate eight mortality prediction models at the county-level including Poisson, Poisson quasi-likelihood, negative binomial, and generalized estimating equations. We then estimated county-level excess Veteran mortality during 2020 and correlated these estimates with local rates of COVID-19 confirmed cases and deaths. Findings: All models demonstrated excellent agreement between observed and predicted mortality during 2016-2019; a Poisson quasi-likelihood with county fixed effects minimized median squared error with a calibration slope of 1.00. Veterans of the U.S. Armed Forces faced an excess mortality rate of 13% in 2020, which corresponds to 50,299 excess deaths. County-level estimates of excess mortality were correlated with both COVID-19 cases (R2=0.77) and deaths per 1,000 population (R2=0.59). Interpretation: We developed sub-national estimates of excess mortality associated with the pandemic and shared our data as a resource for researchers and data journalists. Despite Veterans’ greater likelihood of risk factors associated with severe COVID-19 illness, their excess mortality rate was slightly lower than the general population. Consistent access to health care and the rapid expansion of VHA telemedicine during the pandemic may explain this divergence. Funding: This work was supported by grants from the Department of Veterans Affairs Quality Enhancement Research Initiative [PEC 16-001]. Dr. Griffith's effort was supported in part by the Agency for Healthcare Research & Quality [K12 HS026395]. |
| first_indexed | 2024-04-11T15:49:32Z |
| format | Article |
| id | doaj.art-cffd11874ea14623bd0a603a4c9d208b |
| institution | Directory Open Access Journal |
| issn | 2667-193X |
| language | English |
| last_indexed | 2024-04-11T15:49:32Z |
| publishDate | 2022-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Americas |
| spelling | doaj.art-cffd11874ea14623bd0a603a4c9d208b2022-12-22T04:15:26ZengElsevierThe Lancet Regional Health. Americas2667-193X2022-01-015100093County-level impact of the COVID-19 Pandemic on excess mortality among U.S. veterans: A population-based studyYevgeniy Feyman0Samantha G. Auty1Kertu Tenso2Kiersten L. Strombotne3Aaron Legler4Kevin N. Griffith5Boston University School of Public Health, Boston MA, USA; VA Boston Healthcare System, Boston MA, USABoston University School of Public Health, Boston MA, USABoston University School of Public Health, Boston MA, USA; VA Boston Healthcare System, Boston MA, USABoston University School of Public Health, Boston MA, USA; VA Boston Healthcare System, Boston MA, USAVA Boston Healthcare System, Boston MA, USAVA Boston Healthcare System, Boston MA, USA; Vanderbilt University Medical Center, Nashville TN, USA; Corresponding Author: Dr. Kevin N. Griffith, 2525 West End Avenue, Suite 1200, Nashville, Tennessee 37203Summary: Background: As the novel coronavirus (COVID-19) continues to impact the world at large, Veterans of the US Armed Forces are experiencing increases in both COVID-19 and non-COVID-19 mortality. Veterans may be more susceptible to the pandemic than the general population due to their higher comorbidity burdens and older age, but no research has examined if trends in excess mortality differ between these groups. Additionally, individual-level data on demographics, comorbidities, and deaths are provided in near-real time for all enrolees of the Veterans Health Administration (VHA). These data provide a unique opportunity to identify excess mortality throughout 2020 at a subnational level, and to validate these estimates against local COVID-19 burden. Methods: We queried VHA administrative data on demographics and comorbidities for 11.4 million enrolees during 2016-2020. Pre-pandemic data was used to develop and cross-validate eight mortality prediction models at the county-level including Poisson, Poisson quasi-likelihood, negative binomial, and generalized estimating equations. We then estimated county-level excess Veteran mortality during 2020 and correlated these estimates with local rates of COVID-19 confirmed cases and deaths. Findings: All models demonstrated excellent agreement between observed and predicted mortality during 2016-2019; a Poisson quasi-likelihood with county fixed effects minimized median squared error with a calibration slope of 1.00. Veterans of the U.S. Armed Forces faced an excess mortality rate of 13% in 2020, which corresponds to 50,299 excess deaths. County-level estimates of excess mortality were correlated with both COVID-19 cases (R2=0.77) and deaths per 1,000 population (R2=0.59). Interpretation: We developed sub-national estimates of excess mortality associated with the pandemic and shared our data as a resource for researchers and data journalists. Despite Veterans’ greater likelihood of risk factors associated with severe COVID-19 illness, their excess mortality rate was slightly lower than the general population. Consistent access to health care and the rapid expansion of VHA telemedicine during the pandemic may explain this divergence. Funding: This work was supported by grants from the Department of Veterans Affairs Quality Enhancement Research Initiative [PEC 16-001]. Dr. Griffith's effort was supported in part by the Agency for Healthcare Research & Quality [K12 HS026395].http://www.sciencedirect.com/science/article/pii/S2667193X21000892 |
| spellingShingle | Yevgeniy Feyman Samantha G. Auty Kertu Tenso Kiersten L. Strombotne Aaron Legler Kevin N. Griffith County-level impact of the COVID-19 Pandemic on excess mortality among U.S. veterans: A population-based study The Lancet Regional Health. Americas |
| title | County-level impact of the COVID-19 Pandemic on excess mortality among U.S. veterans: A population-based study |
| title_full | County-level impact of the COVID-19 Pandemic on excess mortality among U.S. veterans: A population-based study |
| title_fullStr | County-level impact of the COVID-19 Pandemic on excess mortality among U.S. veterans: A population-based study |
| title_full_unstemmed | County-level impact of the COVID-19 Pandemic on excess mortality among U.S. veterans: A population-based study |
| title_short | County-level impact of the COVID-19 Pandemic on excess mortality among U.S. veterans: A population-based study |
| title_sort | county level impact of the covid 19 pandemic on excess mortality among u s veterans a population based study |
| url | http://www.sciencedirect.com/science/article/pii/S2667193X21000892 |
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