Changes in Emergency Department Visits, Diagnostic Groups, and 28-Day Mortality Associated With the COVID-19 Pandemic: A Territory-Wide, Retrospective, Cohort Study

Abraham K C Wai, Carlos K H Wong, Janet Y H Wong, Xi Xiong, Owen C K Chu, Man S Wong, Matthew S H Tsui, Timothy H Rainer, Abraham K C Wai, Carlos K H Wong, Janet Y H Wong, Xi Xiong, Owen C K Chu, Man S Wong, Matthew S H Tsui, Timothy H Rainer

Abstract

Study objective: We aimed to evaluate and characterize the scale and relationships of emergency department (ED) visits and excess mortality associated with the early phase of the COVID-19 pandemic in the territory of Hong Kong.

Methods: We conducted a territory-wide, retrospective cohort study to compare ED visits and the related impact of the COVID-19 pandemic on mortality. All ED visits at 18 public acute hospitals in Hong Kong between January 1 and August 31 of 2019 (n=1,426,259) and 2020 (n=1,035,562) were included. The primary outcome was all-cause mortality in the 28 days following an ED visit. The secondary outcomes were weekly number of ED visits and diagnosis-specific mortality.

Results: ED visits decreased by 27.4%, from 1,426,259 in 2019 to 1,035,562 in 2020. Overall period mortality increased from 28,686 (2.0%) in 2019 to 29,737 (2.9%) in 2020. The adjusted odds ratio for 28-day, all-cause mortality in the pandemic period of 2020 relative to 2019 was 1.26 (95% confidence interval 1.24 to 1.28). Both sexes, age more than 45 years, all triage categories, all social classes, all ED visit periods, epilepsy (odds ratio 1.58, 95% confidence interval 1.20 to 2.07), lower respiratory tract infection, and airway disease had higher adjusted ORs for all-cause mortality.

Conclusion: A significant reduction in ED visits in the first 8 months of the COVID-19 pandemic was associated with an increase in deaths certified in the ED. The government must make provisions to encourage patients with alarming symptoms, mental health conditions, and comorbidities to seek timely emergency care, regardless of the pandemic.

Copyright © 2021 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1
Figure 1
Natural cubic splines with 95% confidence intervals (CIs) and equally spaced knots were fitted through the weekly ED visits by disease subgroup. 2020 (red line) and the same period in 2019 (blue line). Three waves were shown in gray shading.
Figure 2
Figure 2
Natural cubic splines with 95% confidence intervals (CIs) and equally spaced knots were fitted through the weekly count of certified deaths in the EDs (red shading area for 2020 and blue shading area for 2019). Three waves were shown in gray shading.
Figure 3
Figure 3
The first confirmed COVID-19 case in Hong Kong has announced on 23 January 2020: the first wave from 23 January to 29 February; the second wave from 17 March to 21 April; the third wave from 5 July to 31 August 2020. We estimated adjusted odds ratios (ORs) of COVID-19 effects in 2020 on 28-day mortality by multivariable logistic regression models adjusted propensity score as covariate by week.
Figure 4
Figure 4
Subgroups analysis was conducted based on disease groups and different levels of covariates. Multivariable logistic regression models, adjusting propensity score as covariate, were performed to estimate adjusted odds ratios (ORs) of COVID-19 effects in 2020 on 28-day mortality. CSSA, comprehensive social security assistance; SDI, social deprivation index.

References

    1. Azhar E.I., Hui D.S.C., Memish Z.A., et al. The Middle East respiratory syndrome (MERS) Infect Dis Clin North Am. 2019;33:891–905.
    1. Hui D.S.C., Zumla A. Severe acute respiratory syndrome: historical, epidemiologic, and clinical features. Infect Dis Clin North Am. 2019;33:869–889.
    1. Dong E., Du H., Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis. 2020;20:533–534.
    1. Peeri N.C., Shrestha N., Rahman M.S., et al. The SARS, MERS and novel coronavirus (COVID-19) epidemics, the newest and biggest global health threats: what lessons have we learned? Int J Epidemiol. 2020;49:717–726.
    1. Ritchie H., Beltekian D., Mathieu E., et al. Coronavirus Pandemic (COVID-19). Vol 2020. Our World in Data. Accessed 1 July, 2021.
    1. Tam C.F., Cheung K.S., Lam S., et al. Impact of Coronavirus Disease 2019 (COVID-19) outbreak on ST-segment-elevation myocardial infarction care in Hong Kong, China. Circ Cardiovasc Qual Outcomes. 2020;13
    1. Lazzerini M., Barbi E., Apicella A., et al. Delayed access or provision of care in Italy resulting from fear of COVID-19. Lancet Child Adolesc Health. 2020;4:e10–e11.
    1. Nuñez J.H., Sallent A., Lakhani K., et al. Impact of the COVID-19 pandemic on an emergency traumatology service: experience at a tertiary trauma centre in Spain. Injury. 2020;51:1414–1418.
    1. Hartnett K.P., Kite-Powell A., DeVies J., et al. Impact of the COVID-19 pandemic on emergency department visits—United States, January 1, 2019-May 30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:699–704.
    1. Vollmer M.A.C., Radhakrishnan S., Kont M.D., et al. The impact of the COVID-19 pandemic on patterns of attendance at emergency departments in two large London hospitals: an observational study. BMC Health Serv Res. 2021;21:1008.
    1. Jeffery M.M., D’Onofrio G., Paek H., et al. Trends in emergency department visits and hospital admissions in health care systems in 5 states in the first months of the COVID-19 pandemic in the US. JAMA Intern Med. 2020;180:1328–1333.
    1. Prime Minister's Office Prime Minister's statement on coronavirus (COVID-19): 25 March 2020. Vol 2020. Accessed 1 July, 2021.
    1. Lange S.J., Ritchey M.D., Goodman A.B., et al. Potential indirect effects of the COVID-19 pandemic on use of emergency departments for acute life-threatening conditions—United States, January-May 2020. MMWR Morb Mortal Wkly Rep. 2020;69:795–800.
    1. Wu J., Mamas M., Rashid M., et al. Patient response, treatments, and mortality for acute myocardial infarction during the COVID-19 pandemic. Eur Heart J Qual Care Clin Outcomes. 2021;7:238–246.
    1. de Havenon A., Ney J.P., Callaghan B., et al. Excess neurological death in New York City after the emergence of COVID-19. J Neurol. 2021;268:2026–2028.
    1. Mannucci E., Nreu B., Monami M. Factors associated with increased all-cause mortality during the COVID-19 pandemic in Italy. Int J Infect Dis. 2020;98:121–124.
    1. Sjödin H., Johansson A.F., Brännström Å., et al. COVID-19 healthcare demand and mortality in Sweden in response to non-pharmaceutical mitigation and suppression scenarios. Int J Epidemiol. 2020;49:1443–1453.
    1. Solano-López J., Zamorano J.L., Pardo Sanz A., et al. Risk factors for in-hospital mortality in patients with acute myocardial infarction during the COVID-19 outbreak. Article in Spanish. Rev Esp Cardiol. 2020;73:985–993.
    1. Vieira A., Peixoto V.R., Aguiar P., et al. Rapid estimation of excess mortality during the COVID-19 pandemic in Portugal -beyond reported deaths. J Epidemiol Glob Health. 2020;10:209–213.
    1. Woolf S.H., Chapman D.A., Sabo R.T., et al. Excess deaths from COVID-19 and other causes, March-July 2020. JAMA. 2020;324:1562–1564.
    1. Kwok K.O., Li K.K., Chan H.H.H., et al. Community responses during early phase of COVID-19 epidemic, Hong Kong. Emerg Infect Dis. 2020;26:1575–1579.
    1. Cheng M., Tong Y., Kwok T., et al. Development journey of clinical data analysis and reporting system (CDARS) in hospital authority of Hong Kong. MedInfo. 2010:1468.
    1. Hong Kong Hospital Authority Introduction: Caring for our community's health. Vol 2020. Accessed 1 July, 2021.
    1. Wong A.Y., Wong I.C., Chui C.S., et al. Association between acute neuropsychiatric events and Helicobacter pylori therapy containing clarithromycin. JAMA Intern Med. 2016;176:828–834.
    1. Controlling Officer . The Government of the Hong Kong Special Administrative Region; 2020. Government Secretariat: Food & Health Bureau Controlling Officer (Health Branch): Controlling Officer’s Report 2019-20. Accessed 1 July, 2021.
    1. von Elm E., Altman D.G., Egger M., et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147:573–577.
    1. Heyworth J. Academic Emergency Medicine; 2011. Emergency medicine-quality indicators: the United Kingdom perspective; pp. 1239–1241.
    1. Wong C.M., Ou C.Q., Chan K.P., et al. The effects of air pollution on mortality in socially deprived urban areas in Hong Kong, China. Environ Health Perspect. 2008;116:1189–1194.
    1. Kitagawa E.M. Standardized comparisons in population research. Demography. 1964;1:296–315.
    1. Lucero A.D., Lee A., Hyun J., et al. Underutilization of the emergency department during the COVID-19 pandemic. West J Emerg Med. 2020;21:15–23.
    1. Wongtanasarasin W., Srisawang T., Yothiya W., et al. Impact of national lockdown towards emergency department visits and admission rates during the COVID-19 pandemic in Thailand: a hospital-based study. Emerg Med Australas. 2021;33:316–323.
    1. Hung KK, Walline JH, Chan EYY, et al. Health service utilization in Hong Kong during the COVID-19 pandemic—a cross-sectional public survey. Int J Health Policy Manag. Published online October 19, 2020.
    1. Lam H.Y., Lam T.S., Wong C.H., et al. The epidemiology of COVID-19 cases and the successful containment strategy in Hong Kong–January to May 2020. Int J Infect Dis. 2020;98:51–58.
    1. Teo K.C., Leung W.C.Y., Wong Y.K., et al. Delays in stroke onset to hospital arrival time during COVID-19. Stroke. 2020;51:2228–2231.
    1. Al-Jaghbeer M.J., Justo J.A., Owens W., et al. Risk factors for pneumonia due to beta-lactam-susceptible and beta-lactam-resistant Pseudomonas aeruginosa: a case–case–control study. Infection. 2018;46:487–494.

Source: PubMed

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