Claims-Recorded Comorbidities, Healthcare Utilization, Costs, and Mortality: A Retrospective Analysis of the 2025 Edition of the Indonesian National Health Insurance Contextual COVID-19 Dataset

Background: Evidence remains limited on relationships between comorbidities, healthcare utilization, costs, and mortality among Indonesian recipients of coronavirus disease 2019-related services. Aim: To examine factors associated with healthcare utilization, annualized high costs, and recorded mortality in the Indonesian National Health Insurance Contextual COVID-19 Sample. Methods: This retrospective study linked five membership and claims sources covering 2015–2024. The cohort comprised recipients of coronavirus disease 2019-related services during 2020–2023. Analyses were performed in Python 3.13 and included normalized probability-weighted logistic regression, negative-binomial regression with an observation-time offset, a two-part annual cost model, sensitivity analyses, and five-fold cross-validation. Results: The analysis included 32,243 participants; 53.3% had claims-recorded comorbidities and 19.0% had recorded deaths. Chronic kidney disease was associated with recorded mortality (adjusted odds ratio 2.56; 95% confidence interval 2.31–2.84), annualized high cost (adjusted odds ratio 6.36; 95% confidence interval 5.70–7.09), and visit rate (adjusted incidence rate ratio 2.15; 95% confidence interval 2.05–2.26). Malignancy and human immunodeficiency virus were also strongly associated with mortality and costs. The cross-validated area under the curve for mortality was 0.795. Conclusions: Claims-recorded comorbidities identified groups with substantially different healthcare utilization, annual costs, and recorded mortality. Chronic kidney disease, malignancy, and human immunodeficiency virus showed the largest adjusted associations. These findings support risk-stratified service planning but remain non-causal because diagnoses and outcomes were retrospectively accumulated.