When DVA reports next week we should hear that mortality was more like 3Q 2021 than 4Q 2021. Although 1Q 2022 data is incomplete, deaths from Renal Failure and Covid where Renal Failure was secondary cause, remain elevated. According to the Supplemental Covid-19 report from the United States Renal Data System, deaths per thousand patients hovered around 2.75-3.00/per 1000 patients in pre-Covid period. It rises to about 4.00/per 1000 patients during peak Covid spread.
However, in 4Q, DVA disclosed about 1000 deaths or about 4.11 per 1000 patients. In 3Q they disclosed 1600 deaths on census or about 6.6 deaths per 1000 patients. Given the elevated mortality, overall, that is forming up for 1Q 2022 and DVA's apparent lack of success in fending it off, we should see an increase in deaths on census on 1Q 2022.
More mortality, of course, means slower growth in the dialysis population of which DVA has claimed about 43% the last few quarters. Pre-COVID the dialysis population grew about 0.60-0.90% QoQ. After a period of contraction during 2020 and early 2021, growth resumed but at a lower rate of around 0.40%. Using a 0.30% QoQ growth rate, the dialysis population probably will not exceed pre-COVID population until sometime mid- to-late 2022. If mortality is a bigger factor than expected, it could be later in the year.
Trends in initiation of dialysis are not particularly encouraging either to the extent we have data. The excess mortality among diabetes patients throughout 2020, 21 and 22 are likely to keep the growth of new patients at their current levels - or worse. About 60% of patients initiated dialysis have diabetes. As health has generally declined during COVID and access is becoming an issue due to labor constraints, mortality will continue to play a role long after Covid fades away.
Let me know what you think.
Emily Evans
Managing Director – Health Policy
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