Abstract
Simple SummaryWhether it is for COVID-19 primary vaccination or the administration of booster vaccines, prioritization criteria need to be established to optimize COVID-19 vaccination programs accounting for both clinical and social vulnerability risks for severe COVID-19 disease. We developed a dual socio-clinical risk model for severe COVID-19 disease in the Medicare population, which is comprised mostly of individuals aged 65 and over. Our model generated risk levels correlated with regionalized COVID-19 case hospitalization rates and mapped them at the county and zip code levels. The model and map can be used by health jurisdictions to reach out to unvaccinated individuals. Our model approach can also be applied to identify Medicare beneficiaries who were in early vaccination groups to be vaccinated to identify those who might maximally benefit from an additional dose of COVID-19 vaccine if and when vaccine immunity wanes.Recommendations for prioritizing COVID-19 vaccination have focused on the elderly at higher risk for severe disease. Existing models for identifying higher-risk individuals lack the needed integration of socio-demographic and clinical risk factors. Using multivariate logistic regression and random forest modeling, we developed a predictive model of severe COVID-19 using clinical data from Medicare claims for 16 million Medicare beneficiaries and socio-economic data from the CDC Social Vulnerability Index. Predicted individual probabilities of COVID-19 hospitalization were then calculated for population risk stratification and vaccine prioritization and mapping. The leading COVID-19 hospitalization risk factors were non-white ethnicity, end-stage renal disease, advanced age, prior hospitalization, leukemia, morbid obesity, chronic kidney disease, lung cancer, chronic liver disease, pulmonary fibrosis or pulmonary hypertension, and chemotherapy. However, previously reported risk factors such as chronic obstructive pulmonary disease and diabetes conferred modest hospitalization risk. Among all social vulnerability factors, residence in a low-income zip code was the only risk factor independently predicting hospitalization. This multifactor risk model and its population risk dashboard can be used to optimize COVID-19 vaccine allocation in the higher-risk Medicare population.
Highlights
The question of who should get COVID-19 vaccines was first debated by the National Academy of Medicine, the Centers for Disease Control and Prevention, and by epidemiologists and other disease experts worldwide
The National Academy of Medicine recommended simultaneously prioritizing individuals living in areas with socio-economic conditions associated with disproportionate vulnerability [3,4] by using the Centers for Disease Control and Prevention (CDC, Atlanta, GA, USA) Social Vulnerability Index (SVI) [5] or the COVID-19 Community Vulnerability Index (CCVI) [6]
We developed a model to predict COVID-19 hospitalization and death for Medicare beneficiaries using de-identified Medicare claims which are an important national data resource for studies of the COVID-19 pandemic [15,16,17,18] and CDC Social Vulnerability Index (SVI) data [5]
Summary
The question of who should get COVID-19 vaccines was first debated by the National Academy of Medicine, the Centers for Disease Control and Prevention, and by epidemiologists and other disease experts worldwide. The National Academy of Medicine recommended simultaneously prioritizing individuals living in areas with socio-economic conditions associated with disproportionate vulnerability [3,4] by using the Centers for Disease Control and Prevention (CDC, Atlanta, GA, USA) Social Vulnerability Index (SVI) [5] or the COVID-19 Community Vulnerability Index (CCVI) [6]. At a time when we have most recently observed a pandemic uptick due to the SARSCoV-2 delta variant and may see future pandemic waves due to new variants, this model can be applied to reach out to unvaccinated individuals at highest risk for severe disease to encourage them to get vaccinated This same modeling approach can be applied to identify vaccinated Medicare beneficiaries who were first prioritized for vaccination and who might most benefit from an additional dose of COVID-19 vaccine if their level of immunity declines over time
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