In JAMA Network Open, researchers report increased excess mortality during the first year of the pandemic among Veteran Affairs patients, similar to what was seen across the country.
To conduct the study, researchers used data from the National Center for Health Statistics (NCHS) and the VA health system to code deaths occurring between January 1, 2014, and December 31, 2020, among adults over age 25 in three groups: VA enrollees, VA active users, and the general US population.
VA enrollees included approximately 10.9 million Americans, including 9.2 military veterans and 1.7 million family members. VA active users were defined as individuals with at least one diagnosis in their VA health system electronic health record in the 2 years prior to each time point, the authors said.
The goal was to create a model of deaths predicted for each quarter of 2020 based on deaths recorded in the previous 6 years.
The VA population was mostly men (more than 85%, compared to 49% of the general US population), with an average age of 61. Notably, VA users were mostly White (73%, compared to 61% of general population.)
Expected death rates were generally higher among the VA enrollees than the general US population (2,520 per 100,000 [95% prediction interval, 2,360 to 2,670] vs 930 deaths per 100,000 [95% prediction interval, 910 to 960]) and higher still among active users of VA healthcare (2,910 deaths per 100,000 [95% prediction interval, 2,770 to 3,050]).
VA mimicked general US population
Overall, prepandemic, the expected death rate among active users of VA healthcare was approximately 26% higher than in the general US population.
Across all of 2020, the relative increase in death rates was similar in the general US population (risk ratio [RR], 1.20; 95% confidence interval [CI], 1.17 to 1.22]), among VA enrollees (RR, 1.20; 95% CI, 1.14 to 1.29), and among VA active users (RR, 1.19; 95% CI, 1.14 to 1.26).
This finding suggests that approximately 85% of the increase in the death rate was directly associated with COVID-19.
The authors calculated 200 excess deaths per 100,000 people in 2020, and during the same period, 170 deaths per 100,000 were related to COVID-19.
"This finding suggests that approximately 85% of the increase in the death rate was directly associated with COVID-19 (170 COVID-19 deaths/200 total excess deaths)," the authors said.
After adjusting for age, race, ethnicity, and geographic reason, the relative increase in rates of death were similar among VA active users and enrollees.
The authors said this finding shows the pandemic acted as "a multiplier on the baseline death rates," because the VA population was more at risk for COVID-related mortality, as VA users are more likely to be men, older, and report comorbid conditions.
"The baseline death rate was higher in the VA populations, but the relative increase during the pandemic was not notably different," the authors said.
