Reductions in hospital care among clinically vulnerable children aged 0-4 years during the COVID-19 pandemic.
Reductions in hospital care among clinically vulnerable children aged 0-4 years during the COVID-19 pandemic.
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DOI：
10.1136/archdischild-2021-323681
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发表时间：
2022-09-20
影响因子：
5.2
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中科院分区：
文献类型：
--
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量化2019冠状病毒病大流行期间临床脆弱儿童的住院护理减少情况。出生队列。英国的国民健康服务医院。所有在医院行政数据中记录的5岁以下儿童（2010年1月至2021年3月）。临床脆弱性定义为慢性健康状况、早产（妊娠期<37周）或出生体重低（<2500 g）。护理减少的定义为2015年至2019年的预计医院接触率减去大流行第一年（2020年3月至2021年）每1000名儿童年的观察率。在3 813 465名儿童中，17.7%（六分之一）在临床上易受伤害（9.5%早产或出生体重不足，10.3%患有慢性病）。在大流行期间，临床脆弱儿童的住院治疗减少率远远高于同龄儿童：分别是门诊就诊率（每1000儿童年314对73）、计划内住院率（每1000儿童年55对10）和计划外住院率（每1000儿童年105对79）。临床弱势儿童占门诊就诊减少的50.1%，占计划内住院减少的55.0%，占计划外住院减少的32.8%。在大流行期间，患有慢性病的婴儿每周计划护理率恢复到大流行前的水平，但年龄较大的儿童则没有。减少照料的情况因族裔群体和贫困程度而异。疫情期间，虚拟门诊就诊率由3. 2%上升至24. 8%。六分之一的临床脆弱儿童占大流行期间医院护理减少的三分之一到一半。虽然患有慢性病、早产或出生时体重不足的儿童占英格兰0-4岁儿童的六分之一，但他们占COVID-21大流行相关医院接触减少的一半（从2020年1月至2021年3月）。
To quantify reductions in hospital care for clinically vulnerable children during the COVID-19 pandemic. Birth cohort. National Health Service hospitals in England. All children aged <5 years with a birth recorded in hospital administrative data (January 2010–March 2021). Clinical vulnerability defined by a chronic health condition, preterm birth (<37 weeks’ gestation) or low birth weight (<2500 g). Reductions in care defined by predicted hospital contact rates for 2020, estimated from 2015 to 2019, minus observed rates per 1000 child years during the first year of the pandemic (March 2020–2021). Of 3 813 465 children, 17.7% (one in six) were clinically vulnerable (9.5% born preterm or low birth weight, 10.3% had a chronic condition). Reductions in hospital care during the pandemic were much higher for clinically vulnerable children than peers: respectively, outpatient attendances (314 vs 73 per 1000 child years), planned admissions (55 vs 10) and unplanned admissions (105 vs 79). Clinically vulnerable children accounted for 50.1% of the reduction in outpatient attendances, 55.0% in planned admissions and 32.8% in unplanned hospital admissions. During the pandemic, weekly rates of planned care returned to prepandemic levels for infants with chronic conditions but not older children. Reductions in care differed by ethnic group and level of deprivation. Virtual outpatient attendances increased from 3.2% to 24.8% during the pandemic. One in six clinically vulnerable children accounted for one-third to one half of the reduction in hospital care during the pandemic. While children with chronic conditions, prematurity or were born with low birthweight make up a sixth of children aged 0-4 years in England, they account of up to half of COVID-21 pandemic-related reductions in hospital contact (from Jan 2020 to March 2021).
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