BOSTON — An often repeated misconception during the COVID-19 pandemic is that the Sars-C0V-2 and influenza viruses are similarly fatal for older adults, although there have been limited data to support that observation.
A report in the Journal of the American Geriatric Society pointed out that both COVID-19 and influenza are important sources of morbidity and mortality among older adults. Researchers from the New England Geriatrics Research, Education, and Clinical Center at the VA Boston Health Care System and colleagues suggested that it is important to understand how outcomes differ for older adults hospitalized with either infection to improve care.1
To do that, the investigative team conducted a retrospective study of 30-day mortality among veterans 65 and older hospitalized with COVID-19 from March 1, 2020-Dec. 31, 2020 or with influenza A/B from Sept. 1, 2017 to Aug. 31, 2019 in the VA.
COVID-19 infection was determined by a positive PCR test and influenza by tests used in the VA system. Frailty was defined by the claims-based VA Frailty Index (VA-FI). Included int eh study were 15,474 veterans admitted with COVID-19 and 7867 with influenza. Mean (SD) ages were 76.1 (7.8) and 75.8 (8.3) years, 97.7% and 97.4% were male, and 66.9% and 76.4% were white in the COVID-19 and influenza cohorts respectively.
Results indicated that crude 30-day mortality (95% CI) was 18.9% (18.3%-19.5%) for COVID-19 and 4.3% (3.8%-4.7%) for influenza. “Combining cohorts, the odds ratio for 30-day mortality from COVID-19 (versus influenza) was 6.61 (5.74-7.65),” the researchers reported. “There was a statistically significant interaction between infection with COVID-19 and frailty, but there was no significant interaction between COVID-19 and age. Separating cohorts, greater 30-day mortality was significantly associated with older age (p: COVID-19: <0.001, Influenza: <0.001) and for frail compared with robust individuals (p for trend: COVID-19: <0.001, Influenza: <0.001).”
The authors concluded that mortality from COVID-19 exceeded that from influenza among hospitalized older adults. “However, odds of mortality were higher at every level of frailty among those admitted with influenza compared to COVID-19,” they added. “Prevention will remain key to reducing mortality from viral illnesses among older adults.”
The study team went on to point out that COVID‐19 has been compared to influenza, and public health measures to reduce transmission are being reversed despite high mortality. “We show that, accounting for patient characteristics including frailty, COVID‐19 has higher mortality than influenza among hospitalized older adults,” they wrote. “We also demonstrate that frailty is associated with higher mortality from COVID‐19 and influenza and may be a tool for prognostication or to prioritize individuals for vaccination/boosters or treatments.”
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Seligman B, Charest B, Ho YL, Gerlovin H, et. al. 30-day mortality following COVID-19 and influenza hospitalization among US veterans aged 65 and older. J Am Geriatr Soc. 2022 Apr 26:10.1111/jgs.17828. doi: 10.1111/jgs.17828. Epub ahead of print. PMID: 35474510; PMCID: PMC9115089.