AHRQ Data Underscore Uneven Impact of COVID-19

At the core of the Agency for Healthcare Research and Quality’s (AHRQ’s) vision is the idea that we must learn from how healthcare is delivered today to improve how healthcare is delivered tomorrow. One way in which we achieve this vision is by using data and analytics to provide health system leaders, clinicians, and policymakers with information to drive healthcare improvement. Consistent with our mission to improve the safety, quality, and equity of care, AHRQ’s rich data resources and analytical capabilities have played a pivotal role in helping to address the ongoing challenges presented by COVID-19.

Since the onset of COVID-19, it’s been clear that the pandemic has resulted in inequities in infection rates and outcomes. In recent weeks, data analyses by AHRQ’s Healthcare Cost and Utilization Project (HCUP) have confirmed those observations by providing important information about the COVID-19 pandemic’s dimensions, its uneven trajectory, and the ways that certain groups of patients have been more adversely impacted than others. For example:

• During the early months of the pandemic (April to September 2020), there was a 17 percent decline in the number of hospitalizations overall for non-Hispanic White patients and a 12 percent decline for non-Hispanic Black patients compared to earlier years. Hospitalizations for Hispanics were relatively unchanged.
• During the same period, hospital deaths for any condition increased 15 percent for non-Hispanic White patients, 60 percent for non-Hispanic Black patients, and 135 percent for Hispanic patients compared to earlier years.
• Hospital patients from large metro areas were more likely to die in the hospital from COVID-19 than patients from rural areas, after adjusting for age, in the pandemic’s early months (April and May 2020). But by June 2020, the trend reversed, and patients from rural areas were more likely to die in the hospital from COVID-19 than patients from urban areas.
• The arrival of COVID-19 was associated with a large reduction in the number of hospitalizations related to mental health and substance use disorders. These reductions varied dramatically between States—and some States have not returned to pre-pandemic levels.

These findings and others are highlighted in an evolving set of resources from AHRQ. The Agency has produced a series of nine Statistical Briefs, each applying a unique lens to hospitalizations during the pandemic’s first year (2020). These briefs offer data insights according to patients’ age, income, race and ethnicity, geographic location, and expected insurance payer, as well as standards for inclusion of data (PDF, 3.6 MB). As more and newer data become available, additional briefs will be released.

AHRQ also provides monthly estimates of hospital admissions related to COVID-19 and other priority conditions. These Summary Trend Tables quantify hospital discharges, percent of hospital discharges, average length of stay, intensive care and mechanical ventilator use, and patient characteristics between 2017 and 2021. To make these data more accessible, AHRQ created and continuously updates an interactive tool that allows users to visually explore State-specific trends in hospitalizations, lengths of stay, and mortality rates for COVID-19, surgeries, influenza, injuries, and other conditions.

Given AHRQ’s longstanding role in generating evidence, we are reluctant to draw conclusions from incomplete data, and we acknowledge that this information does not fully capture COVID-19’s impacts. But when combined with additional information related to COVID-19, socioeconomic factors, and healthcare services in communities, these data have potential to help tackle urgent questions such as:

• What is the capacity of the healthcare delivery system to adequately respond to demands before, during, and after a public health emergency?
• In an emergency, which communities will have the most urgent needs, and when, for general medical and surgical care, behavioral health services, treatment for injuries, and maternal and neonatal care? 
• Which underserved populations are disproportionately impacted during a pandemic? Which groups have limited access to care due to income or geographic location or an individual’s race/ethnicity? What steps must be taken to address those inequities?
• What preparations must be in place before an emergency to protect the well-being of people who need continuing care for heart, mental health, neurologic, or other pre-existing conditions? 
• What is the impact of a healthcare crisis on the structure and financing of the supply side of the healthcare delivery system?

The final assessment of the healthcare system’s response to the pandemic remains to be seen. But our data, along with data from other HHS agencies, already confirm that more remains to be done to achieve our goals for health and healthcare outcomes and equity. AHRQ is committed to compiling a fuller data picture and conducting the needed analysis to understand what happened, and work with our partners to advance a high-quality healthcare system for every American.

Pamela Owens is a senior research scientist in AHRQ’s Center for Financing, Access, and Cost Trends. David Meyers is acting director of AHRQ.

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