A real world analysis of COVID-19 impact on hospitalizations in older adults with chronic conditions from an Italian region

Abstract

Healthcare delivery reorganization during the COVID-19 emergency may have had a significant impact on access to care for older adults with chronic conditions. We investigated such impact among all adults with chronic conditions aged ≥ 65 years, identified through the electronic health databases of two local health agencies—ATS Brianza and ATS Bergamo—from the Lombardy region, Italy. We considered hospitalizations for 2020 compared to the average 2017–2019 and quantified differences using rate ratios (RRs). Overall, in 2017–2019 there were a mean of 374,855 older adults with ≥ 1 chronic condition per year in the two ATS and 405,371 in 2020. Hospitalizations significantly decreased from 84,624 (225.8/1000) in 2017–2019 to 78,345 (193.3/1000) in 2020 (RR 0.86). Declines were reported in individuals with many chronic conditions and for most Major Diagnostic Categories, except for diseases of the respiratory system. The strongest reductions were observed in hospitalizations for individuals with active tumours, particularly for surgical ones. Hospitalization rates increased in individuals with diabetes, likely due to COVID-19-related diseases. Although determinants of the decrease in demand and supply for care among chronic older adults are to be further explored, this raises awareness on their impacts on chronic patients’ health in the medium and long run.

COVID-19 long-term sequelae: Omicron versus Alpha and Delta variants

“…Obesity was categorized using BMI and standard references as non-obese, overweight, obesity, and severe obesity [12] . The following chronic comorbidities were assessed: diabetes, hypertension, cardiovascular diseases (ischemic cardiopathy, valvular cardiopathy, arrhythmia, myocardiopathy, heart failure, other), chronic liver disease (hepatic cirrhosis, chronic hepatitis), chronic respiratory diseases (chronic obstructive pulmonary disease, asthma, other lung conditions), chronic kidney disease, chronic neurological/neuromuscular disorders (epilepsy, Alzheimer’s disease, other dementias, cerebrovascular diseases, migraine and other neurological disorders, multiple sclerosis, Parkinson's disease, neuroinfections), immunodeficiency (primary immunodeficiency, hematologic malignancy, solid-organ transplantation, people living with HIV, asplenia, biologics and targeted disease-modifying drugs), cancer, and osteoarthritis/arthritis [13] , [14] .…”

Older Adults’ Access to Care during the COVID-19 Pandemic: Results from the LOckdown and LifeSTyles (LOST) in Lombardia Project

“…With the general aim of contributing to fill these gaps in knowledge, we described the impact of the COVID-19 pandemic on older adults' access to care −from primary care to self-pay consultations− and investigated associated factors, including sociodemographic characteristics, comorbidities, and mental health indicators, using data from a large crosssectional study conducted in northern Italy [18][19][20][21][22][23].…”

Mortality and healthcare assessment among patients with chronic disease over 2 years of COVID-19: a population-based study in a large hard-hit Italian region

“…Indeed, the pandemic has presented a unique challenge for end-of-life healthcare providers, forced to ration services in favour of patients who had the best chance of survival 46 47. A recent study in a large region of northern Italy provided evidence for a significantly reduced hospital care of older chronic disease patients; however, this reduction was greater for non-chronic disease patients, suggesting that there has been some attempt to scale up healthcare of more vulnerable patients 28. Our findings are consistent with this observation, as the dramatic decline in hospitalisations, as well as ER visits and major procedures for patients with chronic disease during the first outbreak, markedly recovered over the course of 2020.…”