Simply missing one outpatient medical appointment could increase a typical client's relative risk of dying in the next 12 months by more than 10 percentage points.
A team of researchers led by Engy Ziedan, an economist at Tulane University, has published data supporting that estimate in a new working paper based on patient record data gathered before and after the March 13, 2020, start of the COVID-19 pandemic emergency period.
Patients and care providers canceled many appointments because of the effects of the pandemic on the health care system and concerns about contagion.
Overall, the cancellations led to 22.8 extra deaths per 10,000 among people under age 65, and 48.5 extra deaths per 10,000 people ages 65 and older, the researchers found.
That means the patients under age 65 suffered one extra death, over the expected baseline level, per 438 canceled appointments, and patients ages 65 and older suffered one extra death per 206 canceled appointments.
What It Means
For insurance advisors helping clients with mortality-based products such as life insurance, one implication is that clients who report missing their most recent scheduled medical appointments might need more life insurance than other information about the clients would suggest.
Similarly, for insurance and retirement advisors helping clients with income planning arrangements, such as annuities, tontines, cash-value life insurance and asset withdrawal strategies, reports that clients were able to get their most recent schedule imply that those clients might outlive the standard life expectancy forecasts. Those clients might need more longevity protection than other clients.
The Research
A working paper is a research paper that has not yet been through a full peer review process. The authors might change and expand the paper to include new data and new ideas.
Ziedan wrote the paper together with Kosali Simon and Coady Wing, two researchers at Indiana University. They published their paper on the website of the National Bureau of Economic Research.
The researchers conducted the research by analyzing about 70 million patient records from the Healthjump electronic medical records database. The database includes data on physician practices, stand-alone clinics and hospital outpatient clinics that offer scheduled appointments, but not urgent care clinics or hospital emergency rooms.
To study the effects of appointment cancellations, the researchers compared records for the 30-day period before March 13, 2020, and the 30-day after.
The researchers contend that the cancellation effects they detected were not driven by COVID-19 deaths, because the 12-month COVID-19 death totals were similar for patients who had appointments in the 30-day period before March 13 and the 30-day period that started March 13.
The patient and appointment mix appear to be similar for both groups, but the post-emergency appointments had 1,469 more cancellations per 10,000 appointments.
