Emergency hospitalization caused by non-COVID-19 respiratory diseases before and during the COVID-19 pandemic: A retrospective observational cohort study

Abstract

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic as well as the subsequent prevention and control measures is like a quasi-experiment intervention that might have changed the features of emergency hospitalizations. Mortality is high in patient hospitalization due to emergency respiratory diseases (ERD). Therefore, we compared the characteristics of these patients before and during the pandemic. Exploring this issue might contribute to decision-making of emergency management when most of the resources and attention has been devoted to combat COVID-19.MethodsThis study was a retrospective observational cohort study. All emergency hospitalizations due to ERD from January 1, 2019 to December 31, 2020 in a tertiary hospital in China were included. Data including patients’ age, sex, and clinical outcomes were extracted. Air quality was collected from the official online platform. Clinical characteristics were compared and odds ratios were calculated.ResultsThe ERD hospitalization rate was lower in 2020 than in 2019 (6.4 vs. 4.3%, χ2 = 55.449, P = 0.000) with a 50.65% reduction; however, the patients were older in 2020 than in 2019 (P = 0.000) with a higher proportion of admission to the intensive care unit (ICU) (46 vs. 33.5%, χ2 = 20.423, P = 0.000) and a longer ICU stay (P = 0.000). The overall intubation rate, hospital mortality, and rate of discharge due to ineffective treatment in 2020 were higher than those in 2019 (15.6 vs. 8%, χ2 = 18.578, P = 0.000; 4.2 vs. 1.1%, χ2 = 4.122, P = 0.000; 5.5 vs. 2.4%, χ2 = 8.93, P = 0.000, respectively). The logistic regression analysis indicated hospitalizations due to ERD were mainly associated with PM2.5 and sulfur dioxide on the day, and on the 4th and 5th days before admission (P = 0.034 and 0.020, 0.021 and 0.000, 0.028, and 0.027, respectively) in 2019. However, in 2020, the relationship between parameters of air quality and hospitalization changed.ConclusionThe COVID-19 pandemic has changed the characteristics of emergency hospitalization due to ERD with a larger proportion of severe patients and poorer prognosis. The effect of air quality on emergencies were weakened. During the COVID-19 pandemic, it is necessary to pay more attention to the non-COVID-19 emergency patients.

Trend in the admissions of patients with non-COVID-19 respiratory symptoms during COVID-19 pandemic and its impact on hospital finances in Surabaya, Indonesia

“…Other [ 44 ] equal to the result in our research, there is a decrease in the number of deaths due to respiratory disorders unrelated to COVID-19 during the COVID-19 pandemic, like asthma, COPD, pneumonia, acute bronchitis, seasonal influenza, and pneumococcal infections invasive. Previous studies [ 45 ] report that respiratory problems unrelated to COVID-19 in adult patients increased mortality. A previous study reported that readmission <30 days during the COVID-19 pandemic is not different from before the COVID-19 pandemic [ 46 ].…”

“…Previous literature has also discussed the impact of the COVID-19 pandemic. Still, the literature does not have estimates of the magnitude of the COVID-19 pandemic “effect size” on clinical and financial outcomes in a structural model [ 9 , 30 , 41 , 45 , 56 , 60 , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] ]. Previous publications have also not provided information on the relationship between the COVID-19 pandemic, patient condition, cost risk, and clinical and financial outcomes, as well as the effect of the season as a confounder in two structural models, the child model and the adult model.…”

Impact of COVID-19 on risks and deaths of non-communicable diseases in the Western Pacific region

“…Of a total of 10 included studies, eight studies reported on cardiovascular mortality, 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 one on cancer mortality 20 and one on mental health mortality. 21 Six studies reported increased mortality, 12 , 13 , 16 , 19 , 20 , 21 whereas four studies reported decreased in-hospital or after-hospital mortality. 14 , 15 , 17 , 18 …”

“…Among six studies that reported increased NCDs mortality, four were conducted in China, with the range of increase between 6.6 and 26% 12 , 16 , 19 , 21 ; one study reported in Philippines that increased by 6% compared to pre-COVID period 13 ; one study reported in Japan that increased by 27% compared to pre-COVID period. 20 Among four studies that reported decreased mortality, with the range of decrease between 1.6% and 11.9% 14 , 15 , 17 , 18 ; two studies reported in China, 17 , 18 one study reported in Japan 15 and one was in Singapore.…”