Hospitalization, Mechanical Ventilation, and Case-Fatality Outcomes in US Veterans with COVID-19 Disease During 2020

Abstract

Purpose: Although veterans represent a significant proportion (7%) of the USA population, the COVID-19 disease impact within this group has been under-reported. To bridge this gap, we report the patient demographics and relative incidences of hospitalization, mechanical ventilation, and case-fatality amongst veterans who tested positive for COVID-19.Method: A total of 105,664 veterans who tested positive for COVID-19 disease in the Veterans Affairs hospital system from March 1st to December 31st, 2020 was included in this descriptive, cross-sectional, retrospective review. Primary outcome measures included patient demographics (age, race, and gender), and age-adjusted incidences and relative incidences of COVID-19 hospitalization, mechanical ventilation, and case-fatality outcomes.Results: Of this veteran cohort with COVID-19 disease, predominately 80.5% were male, 49.4% White, 29.0% ages 50-64, and 36.8% obese. Over 30% relative higher hospitalization incidence was observed within the Black race (RR=1.54, 95%CI 1.50–1.58; p 65 (p 65 years old and those > 85 years old had a five-fold higher incidence of death. The monthly outcomes for hospitalization, ventilation, and case-fatality data showed decreasing trends during the pandemic onset, which plateaued by the summer of 2020.Conclusion & Relevance: An increased incidence of death was associated with age > 65 years and underweight veterans compared to the referent group. Age-adjusted data, however, did not show any increased incidence of death in Black compared to White veterans. Clinical management of COVID-19 disease within the Veterans Affairs hospital system appeared to have improved by the summer of 2020.