Contributor: Links Between COVID-19 Comorbidities, Mortality Detailed in FAIR Health Study

November 11, 2020
Robin Gelburd, JD
Robin Gelburd, JD

Robin Gelburd, JD, is the President of FAIR Health, a national, independent nonprofit organization with the mission of bringing transparency to healthcare costs and health insurance information. FAIR Health possesses the nation’s largest collection of private healthcare claims data, which includes over 31 billion claim records contributed by payers and administrators who insure or process claims for private insurance plans covering more than 150 million individuals. Certified by CMS as a national Qualified Entity, FAIR Health also receives data representing the experience of all individuals enrolled in traditional Medicare Parts A, B and D; FAIR Health houses data on Medicare Advantage enrollees in its private claims data repository. Gelburd is a nationally recognized expert on healthcare policy, data and transparency.

In patients under age 70, lung cancer conferred the highest risk of death from coronavirus disease 2019 (COVID-19).

A new study from FAIR Health, in collaboration with the West Health Institute and Marty Makary, MD, MPH, from Johns Hopkins University School of Medicine, shows the relationship between preexisting comorbidities of COVID-19 and mortality in privately insured patients. The study has been released as a white paper entitled Risk Factors for COVID-19 Mortality among Privately Insured Patients: A Claims Data Analysis.

Across all age groups, the top 3 comorbidity risk factors for death from COVID-19 were, in order from highest to lowest risk, developmental disorders (eg, developmental disorders of speech and language, developmental disorders of scholastic skills, central auditory processing disorders); lung cancer; and intellectual disabilities and related conditions (eg, Down syndrome and other chromosomal anomalies; mild, moderate, severe and profound intellectual disabilities; and congenital malformations, such as certain disorders that cause microcephaly). As detailed in the white paper, these findings are supported by recent scientific literature.

There are several possible reasons for the high COVID-19 mortality risk in people with developmental disorders and intellectual disabilities. These include greater prevalence of comorbid chronic conditions, disproportionate representation as workers in essential services, and increased COVID-19 transmission in group residential settings.

In patients under age 70, lung cancer conferred the highest risk of COVID-19 mortality. In that age cohort, patients with COVID-19 and lung cancer were nearly 7 times more likely to die than patients who had COVID-19 but not lung cancer.

The findings were based on an analysis of data from the nation’s largest private healthcare claims database, the FAIR Health National Private Insurance Claims (FH NPIC) repository. Evaluating all patients in FH NPIC’s longitudinal dataset, FAIR Health identified 467,773 patients diagnosed with COVID-19 from April 1, 2020, through August 31, 2020. Relationships were examined between the outcomeof mortality(dependent variable) and the following independent variables:age, gender and preexisting comorbidities. The results of this analysis could help inform protocols for vaccine distribution as well as prevention and treatment protocols.

Among the other study findings:

Chronic kidney disease (CKD) and heart failure. Across all age groups, patients with COVID-19 and CKD were nearly twice as likely to die as patients who had COVID-19 but not CKD. Patients with COVID-19 and heart failure were more than one and a half times as likely to die as patients who had COVID-19 but not heart failure.

All age groups versus patients under age 70.The risk of COVID-19 mortality was generally higher for a comorbidity for patients under age 70 than it was for the same comorbidity for patients of all age groups.

Lack of comorbidities. Lack of comorbidities was partially protective against COVID-19 mortality, but not completely. Of COVID-19 patients who died, 83.29% had a preexisting comorbidity, while 16.71% did not, per the medical claims data (Exhibit 1).

Exhibit 1. Distribution of Patients with and without a Comorbidity among All Patients Diagnosed with COVID-19 (left) and All Deceased COVID-19 Patients (right), April-August 2020

(Source: FAIR Health)

Multiple comorbidities. As a patient’s number of comorbidities increased, so did the odds of dying from COVID-19.

Gender. Males accounted for 60.07% of total COVID-19 deaths, females for 39.93%.


Age. Patients over age 69 accounted for 4.82% of COVID-19 diagnoses but 42.43% of total deaths from COVID-19 (Exhibit 2).

Exhibit 2. Distribution of COVID-19 Diagnoses (left) and Deaths (right) by Age, April-August 2020

Mortality rate. Of patients diagnosed with COVID-19, 0.59% died.

By delving into our unparalleled repository of private healthcare claims, FAIR Health has been able to produce actionable findings that can inform public health recommendations and policies, particularly those related to protocols for vaccine distribution, as well as prevention and treatment protocols. We thank our collaborators in this work, the West Health Institute and Dr. Marty Makary.

For the complete white paper, click here.

About Robin Gelburd, JD, president of FAIR Health

Robin Gelburd, JD, is the president of FAIR Health, a national, independent nonprofit organization with the mission of bringing transparency to healthcare costs and health insurance information. FAIR Health possesses the nation’s largest collection of private healthcare claims data, which includes over 32 billion claim records and is growing at a rate of over 2 billion claim records a year. Certified by the Centers for Medicare & Medicaid Services (CMS) as a national Qualified Entity, FAIR Health also receives data representing the experience of all individuals enrolled in traditional Medicare Parts A, B and D; FAIR Health includes among the private claims data in its database, data on Medicare Advantage enrollees.