Direct and Indirect Effects of the Coronavirus Disease 2019 Pandemic on Private Healthcare Utilization in South Africa, March 2020-September 2021.
Direct and Indirect Effects of the Coronavirus Disease 2019 Pandemic on Private Healthcare Utilization in South Africa, March 2020-September 2021.
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DOI：
10.1093/cid/ciac055
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发表时间：
2022-08-24
期刊：
影响因子：
--
通讯作者：
Cohen C
中科院分区：
文献类型：
--
作者：
Perofsky AC;Tempia S;Bingham J;Maslo C;Toubkin M;Laubscher A;Walaza S;Pulliam JRC;Viboud C;Cohen C
2019冠状病毒病（COVID-19）大流行对世界许多地区的医疗保健造成严重干扰，但撒哈拉以南非洲的数据仍然稀缺。我们评估了2016 - 2021年期间南非最大的私人医疗保健系统的入院率和门诊急诊部（艾德）和全科医生（GP）的趋势。我们将时间序列模型拟合到历史数据中，并在2020年3月至2021年9月期间量化了相对于基线的遭遇变化。于二零二零年三月二十七日的全国封城令求医行为大幅减少，并在最初下降后持续18个月。例如，在家庭隔离期间，总入院人数下降了59. 6%（95%置信区间[CI]，52. 4 - 66. 8），并在2021年9月低于基线33. 2%（95% CI，29 - 37. 4）。我们确定了3波与COVID-19活动一致的全因呼吸道接触。肠道感染和非COVID-19呼吸道疾病的下降最为明显，即使非药物干预措施（NPI）放松，一些诊断也减少了80%。在整个大流行期间，非呼吸系统住院（包括受伤和急性疾病）比基线低20%-60%，并与NPI和流动性表现出强烈的时间相关性。艾德就诊率呈现出与住院相似的趋势，而全科医生就诊率受影响较小，已恢复到大流行前的水平。我们发现，在疫情期间，与COVID-19无关的一系列疾病的医疗服务使用大幅减少。住院率和艾德就诊率持续下降表明，高危患者仍在延迟就医，这可能导致未来发病率或死亡率增加。我们发现，在南非最大的私人医疗保健系统中，所有临床严重程度的寻求护理都大幅下降。非COVID-19呼吸道疾病和肠道感染，其次是受伤，经历了最急剧的下降，并在整个研究期间保持在基线以下。
The coronavirus disease 2019 (COVID-19) pandemic caused severe disruptions to healthcare in many areas of the world, but data remain scarce for sub-Saharan Africa. We evaluated trends in hospital admissions and outpatient emergency department (ED) and general practitioner (GP) visits to South Africa’s largest private healthcare system during 2016–2021. We fit time series models to historical data and, for March 2020–September 2021, quantified changes in encounters relative to baseline. The nationwide lockdown on 27 March 2020 led to sharp reductions in care-seeking behavior that persisted for 18 months after initial declines. For example, total admissions dropped 59.6% (95% confidence interval [CI], 52.4–66.8) during home confinement and were 33.2% (95% CI, 29–37.4) below baseline in September 2021. We identified 3 waves of all-cause respiratory encounters consistent with COVID-19 activity. Intestinal infections and non–COVID-19 respiratory illnesses experienced the most pronounced declines, with some diagnoses reduced 80%, even as nonpharmaceutical interventions (NPIs) relaxed. Non-respiratory hospitalizations, including injuries and acute illnesses, were 20%–60% below baseline throughout the pandemic and exhibited strong temporal associations with NPIs and mobility. ED attendances exhibited trends similar to those for hospitalizations, while GP visits were less impacted and have returned to pre-pandemic levels. We found substantially reduced use of health services during the pandemic for a range of conditions unrelated to COVID-19. Persistent declines in hospitalizations and ED visits indicate that high-risk patients are still delaying seeking care, which could lead to morbidity or mortality increases in the future. We found substantial declines in care seeking at all levels of clinical severity in South Africa’s largest private healthcare system. Non-COVID-19 respiratory illnesses and intestinal infections, followed by injuries, experienced the sharpest reductions and remained below baseline throughout the study.
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影响因子：
13.8
作者：
Pelletier JH;Rakkar J;Au AK;Fuhrman D;Clark RSB;Horvat CM
通讯作者：
Horvat CM
影响因子：
9.8
作者：
Hasell J;Mathieu E;Beltekian D;Macdonald B;Giattino C;Ortiz-Ospina E;Roser M;Ritchie H
通讯作者：
Ritchie H
DOI：
10.1016/s2214-109x(21)00289-8
发表时间：
2021-09
期刊：
The Lancet. Global health
影响因子：
--
作者：
Jassat W;Mudara C;Ozougwu L;Tempia S;Blumberg L;Davies MA;Pillay Y;Carter T;Morewane R;Wolmarans M;von Gottberg A;Bhiman JN;Walaza S;Cohen C;DATCOV author group
通讯作者：
DATCOV author group
DOI：
10.1016/s2352-3018(20)30359-3
发表时间：
2021-03
期刊：
The lancet. HIV
影响因子：
--
作者：
Dorward J;Khubone T;Gate K;Ngobese H;Sookrajh Y;Mkhize S;Jeewa A;Bottomley C;Lewis L;Baisley K;Butler CC;Gxagxisa N;Garrett N
通讯作者：
Garrett N
影响因子：
3.2
作者：
Shapira, Gil;Ahmed, Tashrik;Friedman, Jed
通讯作者：
Friedman, Jed