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Health Services Research & Development

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2023 HSR&D/QUERI National Conference Abstract

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1143 — Demographic Characteristics of Veterans with COVID-19 by Wave

Lead/Presenter: Wathsala Widanagamaachchi,  Clinical Systems Development & Evaluation (CSDE)
All Authors: Widanagamaachchi WN (Clinical Systems Development & Evaluation - CSDE, Department of Veterans Affairs), Callahan AR (Clinical Systems Development & Evaluation - CSDE, Department of Veterans Affairs) Dalton CD (Clinical Systems Development & Evaluation - CSDE, Department of Veterans Affairs) Willson TM (Clinical Systems Development & Evaluation - CSDE, Department of Veterans Affairs) Jones MM (Clinical Systems Development & Evaluation - CSDE, Department of Veterans Affairs) Plomondon M (Clinical Systems Development & Evaluation - CSDE, Department of Veterans Affairs) Box T (Analytics and Performance Integration - API, Department of Veterans Affairs) Francis J (Analytics and Performance Integration - API, Department of Veterans Affairs)

Objectives:
To better understand cases, hospitalizations, and deaths stratified by different demographic groups during different waves of the COVID-19 pandemic in the Veteran population.

Methods:
A retrospective analysis was conducted on a cohort of 6,284,830 Veterans who received care at least once at a VA facility between December 2020 and March 2022. The VA COVID-19 Shared Data Resource was used to identify the COVID-19 infections, hospitalizations, and deaths among Veterans. The pandemic was divided into four waves - Wave 1: January 21 to September 08, 2020, Wave 2: September 09, 2020, to June 19, 2021, Wave 3 (Delta): June 20 to November 26, 2021, and Wave 4 (Omicron): November 27, 2021, to March 21, 2022. Four demographic factors (race, ethnicity, age, and gender) were considered.

Results:
The majority of COVID-19 cases were amongst White (70.54%) or Black or African American (17.43%) Veterans; Hispanic or Latino Veterans made up only 6.72%. The majority of these Veterans were male (90%) and 13.88% were aged 80+ years. In the first wave, Black or African Americans had the highest percent of the population with documented cases (1.52%, White = 0.7%), hospitalizations (0.26%, White = 0.09%), and mortality (0.09%, White = 0.05%). In later waves, other racial groups take prominence. For example, the groups with highest mortality rates in other waves were American Indian and Alaskan Natives (wave 2: 0.22%, wave 3: 0.09%, wave 4: 0.09%), Native Hawaiian and other Pacific Islanders (wave 2: 0.16%, wave 3: 0.082%, wave 4: 0.065%), and Whites (wave 2: 0.16%, wave 3: 0.077%, wave 4: 0.072%). When looking at associations in ethnicity, Hispanic or Latinos had the highest case (wave 1: 1.55%, wave 2: 4.18%, wave 3: 6.12%, wave 4: 4.29%) and hospitalization (wave 1: 0.18%, wave 2: 0.57%, wave 3: 0.85%, wave 4: 0.36%) rates across all waves. They also had the highest mortality rate (0.07%) but only in the first wave. As for age, across all waves, 80+ age group had the highest mortality rate (wave 1: 0.16%, wave 2: 0.42%, wave 3: 0.13%, wave 4: 0.17%). The case rates (wave 1: 0.91%, wave 2: 3.36%, wave 3: 5.39%, wave 4: 4.28%) were higher in female Veterans across all waves, but males showed higher hospitalization (wave 1: 0.13%, wave 2: 0.5%, wave 3: 0.76%, wave 4: 0.35%) and mortality (wave 1: 0.06%, wave 2: 0.16%, wave 3: 0.07%, wave 4: 0.07%) rates.

Implications:
The COVID-19 pandemic did not impact all demographic groups equally. Further, differences in outcomes by wave within group could be related to a combination of pandemic evolution, cumulative immunity, or public health response.

Impacts:
The COVID-19 pandemic had a differential impact on different demographic groups in a changing way over time. Analyses of disparity that examine long periods of time without factoring non-linear time effects may measure different levels of association and miss important effects. Groups impacted early during the pandemic deserve consideration because less is known about treatment and pandemic management.