Non-COVID-19 patients in times of pandemic: decreased emergency department visits and increased out-of-hospital mortality in Northern Italy

Abstract

ObjectiveThe aim of this was to assess the short-term impact of the pandemic on non-COVID-19 patients living in a one-million inhabitants area in Northern Italy (Bologna Metropolitan Area-BMA), analyzing time trends of Emergency Department (ED) visits, hospitalizations and mortality.MethodsWe conducted a retrospective observational study using data extracted from BMA healthcare informative systems. Weekly trends of ED visits, hospitalizations, in- and out-of-hospital, all-cause and cause-specific mortality between December 1st, 2019 to May 31st, 2020, were compared with those of the same period of the previous year, using Joinpoint regression models and incidence rate ratios.ResultsNon-COVID-19 ED visits and hospitalizations showed a stable trend until the first Italian case of COVID-19 has been recorded, on February 19th, 2020, when they dropped simultaneously. The reduction of ED visits was observed in all age groups and across all severity and diagnosis groups. In the lockdown period a significant increase was found in overall out-of-hospital mortality (43.2%) and cause-specific out-of-hospital mortality related to neoplasms (76.7%), endocrine, nutritional and metabolic (79.5%) as well as cardiovascular (32.7%) diseases.ConclusionsThe pandemic caused a sudden drop of ED visits and hospitalizations of non-COVID-19 patients during the lockdown period, and a concurrent increase in out-of-hospital mortality mainly driven by deaths for neoplasms, cardiovascular and endocrine diseases. The findings of this study might be useful to understand both the population reaction and the healthcare system response at the early phases of the pandemic in terms of reduced demand of care and systems capability in intercepting it.

COVID-19 and regional differences in the timeliness of hip-fracture surgery: an interrupted time-series analysis

“…Due to the uncontrolled spread of the epidemic across the regions of northern Italy, the central government declared the national lockdown on March 9, 2020. Lifestyle changes, fear of the contagion and sense of civic responsibility (Rosenbaum, 2020) may have determined an overall reduction in the number of patients accessing emergency departments (EDs) and hospitals, as confirmed by previous research conducted in Italy and other countries (Jeffery et al, 2020;Santi et al, 2020). Moreover, by confining people at home, interrupting work activities and reducing road traffic, the frequency of traveland work-related injuries dropped (Dolci et al, 2020); as a consequence, ED visits and hospitalizations for trauma have decreased.…”

COVID-19 and regional differences in the timeliness of hip-fracture surgery: an interrupted time-series analysis

“…Due to the uncontrolled spread of the epidemic across the regions of northern Italy, the central government declared the national lockdown on March 9, 2020. Lifestyle changes, fear of the contagion and sense of civic responsibility [31] may have determined an overall reduction in the number of patients accessing emergency departments (EDs) and hospitals, as confirmed by previous research conducted in Italy and other countries [32,33]. Moreover, by confining people at home, interrupting work activities and reducing road traffic, the frequency of travel-and workrelated injuries dropped [34]; as a consequence, ED visits and hospitalizations for trauma have decreased.…”