New data published yesterday in Morbidity and Mortality Weekly Report (MMWR) show older adults continue to be hospitalized for COVID-19 at a much higher rate than other age groups.
The data analyzed by the COVID-Net Surveillance team, which includes researchers from the Centers for Disease Control and Prevention (CDC) and state public health departments, show that cumulative rates of COVID-19 hospitalization from October 2023 through April 2024 were the lowest for all adult age groups during the October-to-April surveillance period since the first year of the pandemic. An estimated 40,761 COVID-19–associated hospitalizations occurred during the surveillance period, 38,900 of them in adults ages 18 and older.
But adults ages 65 and older accounted for 70% of all adult COVID-associated hospitalizations, and hospitalization rates were highest among those ages 75 and older, with nearly one COVID-associated hospitalization for every 100 persons. Relative to adults ages 18 to 49 years, cumulative hospitalization rates among adults aged 65 to 74 and over 75 years during the surveillance period were 7.3 and 24.1 times as high, respectively.
“These findings suggest that COVID-19–associated hospitalization among adults aged ≥65 years remains a public health concern,” the study authors wrote.
Racial and ethnic disparities, low vaccination rates
The data, collected from 90 counties across 12 states, also showed that disparities in COVID-19 hospitalization by race and ethnicity have decreased but continue to persist.
During the surveillance period, hospitalization rates were highest among non-Hispanic American Indian or Alaska Native (AI/AN) and non-Hispanic black adults; rates among both groups were 1.4 and 1.3 times higher than those among Hispanic and non-Hispanic White adults, respectively. Data from the July 2021 to August 2022 surveillance period showed that age-adjusted COVID hospitalization rates were twice as high for AI/AN and Black adults compared with White adults.
These findings suggest that COVID-19–associated hospitalization among adults aged ≥65 years remains a public health concern.
Another significant finding from the report is that among a sample of 1,320 adults hospitalized for COVID-19, 88.1% had not received the 2023-24 COVID-19 vaccine and 57.7% had not received the 2022-23 vaccine.
“Receipt of COVID-19 vaccine has been demonstrated to reduce the risk for COVID-19–associated hospitalization,” the authors wrote.
Further analysis of that sample found that 80% had at least two underlying medical conditions and 16.6% were residents of long-term care facilities (LTCFs). Among all in-hospital deaths, 45% occurred in patients aged 75 and older.
The authors say that adults 65 and older can reduce their risk for COVID-19–associated hospitalization by receiving recommended COVID-19 vaccines, adopting measures to reduce their risk of infections, and seeking early outpatient COVID-19 antiviral treatment.
Antiviral treatments underused in older adults
But in another study published yesterday in MMWR, a team led by CDC researchers found that COVID-19 antiviral treatment remains underutilized in older adults.
The findings, based on electronic health record data on 393,390 patients aged 65 and older who received a COVID-19 diagnosis at 28 US healthcare systems, show that from April 2022 through September 2023, only 45.9% received recommended COVID-19 antivirals treatments (nirmatrelvir-ritonavir, molnupiravir, monoclonal antibody, or remdesivir). The percentages were even lower among those ages 75 to 89 (43.5%) and over 90 (35.2%).
Patients aged 75 to 89 and over 90 years had 1.17 (95% confidence interval [CI], 1.15 to 1.19) and 1.54 (95% CI, 1.49 to 1.61) times the adjusted odds of being untreated, respectively, compared with those aged 65 to 74 years.
Although the study did not investigate the reasons why older patients didn’t receive COVID-19 antiviral treatments, the researchers note that frequent self-reported reasons for nonuse of antivirals include the presence of mild signs and symptoms, lack of awareness of eligibility, and absence of a provider recommendation. Other reasons cited include delays in seeking treatment and missing the treatment window (5 to 7 days after symptom onset) and concerns about drug interactions.
Whatever the reason, the authors say improving COVID-19 antiviral use among older adults should be a public health priority, given that older age is a strong risk-factor for severe COVID-19–associated outcomes.
“In addition to vaccination and access to early sensitive diagnostics such as polymerase chain reaction testing, COVID-19 treatment should be routinely discussed with older adults with mild or moderate COVID-19,” they wrote. “Public health efforts to address provider hesitancy and patient knowledge of COVID-19 antivirals and to eliminate barriers to COVID-19 diagnostics and treatment are needed, especially among older adults.”
