(B-200) Assessing the Potential Differential Impact of the COVID-19 Pandemic on Cardiovascular Incidence Rates in United States Claims Data

Background: Cardiovascular adverse event incidence is likely to be underestimated in data that were routinely collected during the COVID-19 pandemic due to underdiagnosis that occurred because of healthcare disruptions and community lockdowns. Differential changes to healthcare-seeking behaviors across patient groups compared to the general population could contribute to biased incidence rate ratios (IRRs). Here, we provide an example of estimated incidence of two cardiovascular outcomes with different etiologies (myocardial infarction [MI] and heart failure [HF]) throughout the COVID-19 era in a diseased population compared to a general population.

Objectives: To assess the impact of the COVID-19 pandemic on recorded incidence of MI and HF in US claims data among individuals with asthma compared to a general population.

Methods: Optum’s de-identified Clinformatics® Data Mart Database was used to create a cohort of adults (18+ years) with asthma (ICD-10 J45) and referents without asthma who were 1:1 matched on age, sex, and calendar month/year. We estimated incidence rates (IRs) of MI (ICD-10 I21, I22) and HF (ICD-10 I50) during three periods: (1) pre-pandemic (Jan 2016–Mar 2020); (2) early pandemic (Apr 2020–May 2020); (3) later pandemic (Jun 2020–May 2023). IRRs compared asthma patients to referents.

Results: The study cohorts included ~1 million asthma patients who were 1:1 matched to non-asthma referents. For MI analyses, pre-pandemic incidence was marginally higher for asthma (430/100,000 PY) vs referents (402/100,000 PY) (IRR 1.07, 95% CI 1.02 to 1.12). During the early pandemic, MI IRs dropped by 37% for asthma (271/100,000 PY) and 31% for referents (278/100,000 PY), which resulted in similar IRs (IRR 0.97, 95% CI 0.79 to 1.20). Later pandemic MI IRs remained ~10% lower than pre-pandemic, but the increased MI risk in asthma vs referents was restored (IRR 1.14, 95% CI 1.09 to 1.19). For HF analyses, pre-pandemic incidence was 33% increased for asthma (124/100,000 PY) vs referents (93/100,000 PY) (IRR 1.33, 95% CI 1.21 to 1.46). During the early pandemic, HF IRs declined by ~55% for both asthma (56/100,000 PY) and referents (43/100,000 PY); the IRR was unaffected (IRR 1.30, 95% CI 0.77 to 2.19). Compared to pre-pandemic, IRs in the later pandemic remained 13% decreased for asthma (108/100,000 PY) but 25% decreased for controls (69/100,000), resulting in a greater magnitude of increased HF risk in asthma vs referents (IRR 1.55, 95% CI 1.42 to 1.70).

Conclusions: Future research should consider how claims-based time trend or comparative studies of cardiovascular incidence could be biased in different directions depending on the indicated population and etiology of the outcome of interest.