Risk factors for mechanical ventilation and mortality among hospitalized Medicaid patients with COVID-19 in Kentucky, 2020–2021

This retrospective cohort study examined patient characteristics and comorbidities associated with mechanical ventilation and mortality among 28,128 hospitalized Kentucky Medicaid patients aged 18-64 years with COVID-19 in 2020-2021. Logistic regression estimated adjusted odds ratios (aORs) for mechanical ventilation and Cox regression estimated adjusted hazard ratios (aHRs) for mortality, controlling for demographics, rurality, and comorbidities. Mechanical ventilation was required in 18.8% of patients, and 8.4% died. Older age (45-54: aOR = 1.25; aHR = 1.28; 55-64: aOR = 1.35; aHR = 1.61), male sex (aOR = 1.30; aHR = 1.10), rural residence (aOR = 1.18; aHR = 1.15), chronic obstructive pulmonary disease (aOR = 1.66; aHR = 1.12), chronic kidney disease (aOR = 1.16; aHR = 1.22), and atrial fibrillation (aOR = 1.75; aHR = 1.21) were associated with higher risk of both ventilation and mortality. Each one-unit increase in a ventilation duration severity score corresponded to a 64% higher mortality risk (aHR 1.64). Findings highlight increased risk among adults aged 45-64 years, men, rural residents, and patients with pulmonary, renal, and cardiac conditions. Tailored primary care management for identified high-risk patients may help reduce the risk of severe outcomes and inform future preparedness efforts.