Nationwide study on trends in unplanned hospital attendance and deaths during the 7 weeks after the onset of the COVID-19 pandemic in Denmark
Nationwide study on trends in unplanned hospital attendance and deaths during the 7 weeks after the onset of the COVID-19 pandemic in Denmark
复制标题
DOI：
10.1136/bmjqs-2020-012144
复制
发表时间：
2021-12-01
影响因子：
5.4
通讯作者：
Brabrand, Mikkel
中科院分区：
文献类型：
--
作者：
Bogh, Soren Bie;Flojstrup, Marianne;Brabrand, Mikkel
背景 大流行对计划外就诊的影响尚未得到广泛研究。本研究的目的是报告在丹麦发布“居家避难”令后 7 周内，COVID-19 大流行对丹麦计划外就诊造成的全国性影响。方法 我们合并了来自国家登记处（民事登记系统和患者登记处）的数据，对所有丹麦人的计划外（不包括门诊就诊和择期手术）医院医疗保健和死亡率进行了研究。使用“居家避难”命令后 7 周的数据，将 2020 年每周计划外就诊的发生率与 2017-2019 年相应周进行比较。主要结果是每周住院就诊率作为发病率比率。次要结局是一般人群死亡率和院内死亡风险，以每周死亡率比（MRR）报告。结果 研究期间的出勤人数为 2 438 286 人次，总体计划外出勤率下降了 21%；不包括 COVID-19 的出席人数减少了 31%；非精神病患者占 31%，精神病患者占 30%。在预计保持稳定的五种最常见诊断中，只有精神分裂症和心肌梗塞保持稳定，而慢性阻塞性肺疾病恶化、髋部骨折和尿路感染则显着下降。全国普通人群 MRR 在有记录的六周内上升，而排除 COVID-19 阳性患者的 MRR 仅在两周内上升。结论 尽管排除了 COVID-19 患者，但 COVID-19 大流行和政府的全国“居家避难”令与计划外住院人数显着减少有关，并且普通人群在 7 周中的两周内 MRR 增加。在规划公共信息活动时应考虑这些调查结果。
Background The impact of a pandemic on unplanned hospital attendance has not been extensively examined. The aim of this study is to report the nationwide consequences of the COVID-19 pandemic on unplanned hospital attendances in Denmark for 7 weeks after a 'shelter at home' order was issued. Methods We merged data from national registries (Civil Registration System and Patient Registry) to conduct a study of unplanned (excluding outpatient visits and elective surgery) hospital-based healthcare and mortality of all Danes. Using data for 7 weeks after the 'shelter at home' order, the incidence rate of unplanned hospital attendances per week in 2020 was compared with corresponding weeks in 2017-2019. The main outcome was hospital attendances per week as incidence rate ratios. Secondary outcomes were general population mortality and risk of death in-hospital, reported as weekly mortality rate ratios (MRRs). Results From 2 438 286 attendances in the study period, overall unplanned attendances decreased by up to 21%; attendances excluding COVID-19 were reduced by 31%; non-psychiatric by 31% and psychiatric by 30%. Out of the five most common diagnoses expected to remain stable, only schizophrenia and myocardial infarction remained stable, while chronic obstructive pulmonary disease exacerbation, hip fracture and urinary tract infection fell significantly. The nationwide general population MRR rose in six of the recorded weeks, while MRR excluding patients who were COVID-19 positive only increased in two. Conclusion The COVID-19 pandemic and a governmental national 'shelter at home' order was associated with a marked reduction in unplanned hospital attendances with an increase in MRR for the general population in two of 7 weeks, despite exclusion of patients with COVID-19. The findings should be taken into consideration when planning for public information campaigns.