National Trends In ED Visits, Hospital Admissions, And Mortality For Medicare Patients During The COVID-19 Pandemic

UMMS Affiliation

Department of Emergency Medicine

Publication Date


Document Type



Emergency Medicine | Epidemiology | Infectious Disease | Virus Diseases


Concerns about avoidance or delays in seeking emergency care during the COVID-19 pandemic are widespread, but national data on emergency department (ED) visits and subsequent rates of hospitalization and outcomes are lacking. Using data on all traditional Medicare beneficiaries in the US from October 1, 2018, to September 30, 2020, we examined trends in ED visits and rates of hospitalization and thirty-day mortality conditional on an ED visit for non-COVID-19 conditions during several stages of the pandemic and for areas that were considered COVID-19 hot spots versus those that were not. We found reductions in ED visits that were largest by the first week of April 2020 (52 percent relative decrease), with volume recovering somewhat by mid-June (25 percent relative decrease). These reductions were of similar magnitude in counties that were and were not designated as COVID-19 hot spots. There was an early increase in hospitalizations and in the relative risk for thirty-day mortality, starting with the first surge of the pandemic, peaking at just over a 2-percentage-point increase. These results suggest that patients were presenting with more serious illness, perhaps related to delays in seeking care.


Emergency departments, COVID-19, Hospitals, Mortality, Medicare, Traditional Medicare, Diseases, Myocardial infarction, Chronic disease, Pandemics, Coronavirus

DOI of Published Version



Smulowitz PB, O'Malley AJ, Khidir H, Zaborski L, McWilliams JM, Landon BE. National Trends In ED Visits, Hospital Admissions, And Mortality For Medicare Patients During The COVID-19 Pandemic. Health Aff (Millwood). 2021 Sep;40(9):1457-1464. doi: 10.1377/hlthaff.2021.00561. PMID: 34495730. Link to article on publisher's site

Journal/Book/Conference Title

Health affairs (Project Hope)

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Link to Article in PubMed

PubMed ID