Hospital admission and mortality rates for non-covid diseases in Denmark during covid-19 pandemic: nationwide population based cohort study

Abstract

Objective To determine the incidence of hospital admissions and associated mortality rates for non-covid medical conditions during the covid-19 pandemic. Design Nationwide, population based cohort study. Setting Denmark from 13 March 2019 to 27 January 2021. Participants All Danish residents >1 year of age. Main outcomes measures Population based healthcare registries that encompass the entire Danish population were used to compare hospital admission and mortality rates during the covid-19 pandemic (from 11 March 2020 to 27 January 2021) with the prepandemic baseline data (from 13 March 2019 to 10 March 2020). Hospital admissions were categorised as covid-19 when patients were assigned a diagnosis code for covid-19 within five days of admission. All patients were followed until migration, death, or end of follow-up, whichever came first. Rate ratios for hospital admissions were computed using Poisson regression and were directly standardised using the Danish population on 1 January 2019 as reference. 30 day mortality rate ratios were examined by Cox regression, adjusted for age and sex, and covid-19 diagnosis was used as a competing risk. Results 5 753 179 residents were identified during 567.8 million person weeks of observation, with 1 113 705 hospital admissions among 675 447 people. Compared with the prepandemic baseline period (mean hospital admission rate 204.1 per 100 000/week), the overall hospital admission rate for non-covid-19 conditions decreased to 142.8 per 100 000/week (rate ratio 0.70, 95% confidence interval 0.66 to 0.74) after the first national lockdown, followed by a gradual return to baseline levels until the second national lockdown when it decreased to 158.3 per 100 000/week (0.78, 0.73 to 0.82). This pattern was mirrored for most major diagnosis groups except for non-covid-19 respiratory diseases, nervous system diseases, cancer, heart failure, sepsis, and non-covid-19 respiratory infections, which remained lower throughout the study period. Overall 30 day mortality rates were higher during the first national lockdown (mortality rate ratio 1.28, 95% confidence interval 1.23 to 1.32) and the second national lockdown (1.20, 1.16 to 1.24), and these results were similar across most major diagnosis groups. For non-covid-19 respiratory diseases, cancer, pneumonia, and sepsis, the 30 day mortality rate ratios were also higher between lockdown periods. Conclusions Hospital admissions for all major non-covid-19 disease groups decreased during national lockdowns compared with the prepandemic baseline period. Additionally, mortality rates were higher overall and for patients admitted to hospital with conditions such as respiratory diseases, cancer, pneumonia, and sepsis. Increased attention towards management of serious non-covid-19 medical conditions is warranted.

Non-COVID-19 In-Hospital Admission in a Large Academic Center in Belgium During the First Two Waves of the COVID-19 Pandemic

“…15 Recently, Bodilsen et al in a Danish nationwide cohort study involving more than 1 million of hospital admissions, found that compared with the pre-COVID baseline period (mean hospital admission rate 204.1 per 100,000/week), the overall hospital admission rate for non COVID-19 conditions was reduced to 142.8 per 100,000/week after the first national lockdown, followed by a gradual return to baseline state until the second lockdown when it decreased to 158.3 per 100,000/week. 16 The second most interesting findings of our study is that the decrease of admissions (non-COVID) was statistically significant during the peak-COVID and late-COVID periods but not the early-COVID period during the two waves compare to pre-COVID period. The decrease was in most of the type of admissions but some were significantly affected by the crisis depending on restrictive measures undertaken at the country and hospital levels.…”

“…Our results on non-COVID in-hospital admissions are in line with those published in the literature. [9][10][11][12][13][14][15][16] Birkmeyer et al found in a large study of approximately one million medical admissions in the US that declines in non-COVID admissions from the first two months of COVID crisis exceeded 20% for all primary admission diagnoses. 9 Kapsner et al found that overall in-patient hospital admissions in Germany decreased by 35% in the first month and by 30.3% in the second month after the lockdown announcement during the first wave compared to 2018.…”

The association of the COVID-19 pandemic and short-term outcomes of non-COVID-19 critically ill patients: an observational cohort study in Brazilian ICUs

“…Despite many studies assessing the effect of COVID-19 on the presentation of other conditions [23][24][25], there are few reports on the effect of COVID-19 on the outcomes of non-COVID critically ill patients or assessing the impact on ICU performance. A recent nationwide study in Denmark reported that outcomes of several acute conditions on hospitalized patients, including those with sepsis and cancer, were worst during COVID-19 pandemic [26]. Although not focused specifically on critically ill patients, conditions whose outcomes were more impaired during COVID-19 were unsurprisingly those requiring more urgent care.…”

Experience of Healthcare Access in Australia during the First Year of the COVID-19 Pandemic

“…Elderly people and individuals with pre-existing chronic medical conditions are at increased risk of morbidity and mortality due to COVID-19 [23,24]. However, excess deaths, including out-of-hospital deaths, from non-COVID conditions such as cancer, diabetes, dementia, hypertension and heart disease have occurred during the pandemic [25][26][27][28]. Thus, COVID-19 has particular implications for the ability of vulnerable populations to access healthcare, as they will need to balance specific care needs against a heightened risk of contracting the disease.…”