In-Hospital Deaths From Ambulatory Care-Sensitive Conditions Before and During the COVID-19 Pandemic in Japan.
In-Hospital Deaths From Ambulatory Care-Sensitive Conditions Before and During the COVID-19 Pandemic in Japan.
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DOI：
10.1001/jamanetworkopen.2023.19583
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发表时间：
2023-06-01
影响因子：
13.8
通讯作者：
Miyawaki, Atsushi
中科院分区：
文献类型：
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作者：
Abe, Kazuhiro;Kawachi, Ichiro;Iba, Arisa;Miyawaki, Atsushi
这项队列研究比较了流行期前期与大流行的死亡率和门诊护理敏感型患者的住院数据。在日本新冠肺炎大流行期间，患有门诊护理敏感症(ACSC)的患者是否在医院经历了更糟糕的结局？在这项对28例 321ACSC相关住院的队列研究中，急性ACSC(如脱水和胃肠炎)以及疫苗可预防的疾病(如细菌性肺炎)的住院死亡率总体上增加了。死亡率的增加不仅与住院人数的减少有关，而且与住院死亡人数的增加有关。这项研究的结果表明，ACSC患者在大流行期间经历了更糟糕的结果，这表明获得高质量初级保健和住院护理的机会可能已经受到影响。新冠肺炎大流行可能在门诊护理敏感疾病(ACSC)获得医疗服务的机会恶化中发挥了作用。目的：确定在日本宣布新冠肺炎国家紧急状态后，与ACSC相关的住院死亡人数和住院死亡率是否发生了变化。这项队列研究使用差异性设计来比较在日本宣布新冠肺炎大流行进入全国紧急状态之前(2015年1月1日至2019年12月31日)与之后(2020年1月1日至2020年12月31日)ACSC的结果。分析使用了日本242家急性护理医院的出院摘要数据。样本包括研究期间(2015年1月1日至2020年12月31日)ACSC患者的计划外住院情况。数据分析是在2022年8月16日至12月7日之间进行的。2020年4月，日本政府宣布新冠肺炎国家进入紧急状态，被认为是一次外生冲击。主要结果是与ACSC相关的住院死亡人数、住院人数和住院死亡率。共观察到28例与 相关的住院治疗，涉及15318名男性(54.1%)，年龄中位数为76岁(58-85岁)。住院死亡2117例(7.5%)。住院人数总体上减少了(发病率比[IRR]，0.84；95%CI，0.75-0.94)，慢性病(IRR，0.84；95%CI，0.77-0.92)，疫苗可预防疾病(IRR，0.58；95%CI，0.44-0.76)。然而，住院死亡(IRR1.66；95%CI，1.15-2.39)和到达医院24小时内的住院死亡(IRR7.27 × 106；95%CI，1.83 × 106to 2.89 × 107)因急性情况而增加。急性疾病(IRR，1.87；95%CI，1.19-2.96)、急性疾病(IRR，2.15 × 106；95%CI，5.25 × 105至8.79 × 106)和疫苗可预防疾病(IRR，4.64；95%CI，1.28-16.77)的24小时住院死亡率总体上也有所上升。这项队列研究发现，在日本，2020年《新冠肺炎》国家紧急状态宣布后，住院死亡人数有所增加，尤其是急性非典和住院24小时内死亡。这一发现表明，在大流行期间，急性ACSC患者获得高质量初级保健和住院护理的机会可能受到了影响。
This cohort study compares prepandemic with pandemic mortality and hospitalization data among patients with ambulatory care–sensitive conditions. Did patients with ambulatory care–sensitive conditions (ACSCs) experience worse outcomes in hospitals during the COVID-19 pandemic in Japan? In this cohort study of 28 321 ACSC-associated hospitalizations, in-hospital mortality rates within 24 hours of hospital arrival increased overall, for acute ACSC (eg, dehydration and gastroenteritis), and for vaccine-preventable conditions (eg, bacterial pneumonia). The increased mortality was associated with not only a decrease in the number of hospitalizations but also an increase in in-hospital deaths. Findings of this study suggest that patients with ACSC experienced worse outcomes during the pandemic, suggesting that access to good-quality primary care and inpatient care could have been compromised. The COVID-19 pandemic may have played a role in the deterioration of access to medical care for ambulatory care–sensitive conditions (ACSCs). To ascertain whether the number of in-hospital deaths and in-hospital mortality rate associated with ACSC changed after the declaration of the COVID-19 national state of emergency in Japan. This cohort study used a difference-in-differences design to compare outcomes for ACSC in the period before (January 1, 2015, to December 31, 2019) vs the period after (January 1, 2020, to December 31, 2020) Japan declared a national state of emergency for the COVID-19 pandemic. Analyses used discharge summary data from 242 acute care hospitals across Japan. The sample comprised unscheduled hospitalizations of patients with ACSC during the study period (January 1, 2015, to December 31, 2020). Data analyses were performed between August 16 and December 7, 2022. The declaration of the COVID-19 national state of emergency announced by the Japanese government in April 2020 was considered to be an exogenous shock. Primary outcomes were the ACSC-associated number of in-hospital deaths, number of hospitalizations, and in-hospital mortality rate. A total of 28 321 ACSC-related hospitalizations were observed involving 15 318 males (54.1%), with a median (IQR) age of 76 (58-85) years. The number of in-hospital deaths was 2117 (7.5%). The number of hospitalizations decreased overall (incidence rate ratio [IRR], 0.84; 95% CI, 0.75-0.94), for chronic conditions (IRR, 0.84; 95% CI, 0.77-0.92), and for vaccine-preventable conditions (IRR, 0.58; 95% CI, 0.44-0.76). However, in-hospital deaths (IRR, 1.66; 95% CI, 1.15-2.39) and in-hospital deaths within 24 hours of hospital arrival (IRR, 7.27 × 106; 95% CI, 1.83 × 106 to 2.89 × 107) increased for acute conditions. The in-hospital mortality rate increased for acute conditions (IRR, 1.71; 95% CI, 1.16-2.54), and the 24-hour in-hospital mortality rates also increased overall (IRR, 1.87; 95% CI, 1.19-2.96), for acute conditions (IRR, 2.15 × 106; 95% CI, 5.25 × 105 to 8.79 × 106), and for vaccine-preventable conditions (IRR, 4.64; 95% CI, 1.28-16.77). This cohort study found that in Japan, the number of in-hospital deaths increased after the declaration of the COVID-19 national state of emergency in 2020, particularly for acute ACSC and deaths within 24 hours of hospital admission. This finding suggests that access to good-quality primary care and inpatient care for patients with acute ACSC may have been compromised during the pandemic.
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影响因子：
2.9
作者：
Hao, Kiyotaka;Takahashi, Jun;Sato, Koichi;Suda, Akira;Sindo, Tomohiko;Godo, Shigeo;Nishimiya, Kensuke;Kikuchi, Yoku;Shiroto, Takashi;Yasuda, Satoshi
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影响因子：
6.1
作者：
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影响因子：
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作者：
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影响因子：
3
作者：
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通讯作者：
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Covid-19期间医疗保健访问的变化：2020年6月至1月的日本数据估计，2021年10月。
DOI：
10.3390/ijerph19148810
发表时间：
2022-07-20
影响因子：
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作者：
Tanoue, Yuta;Ghaznavi, Cyrus;Kawashima, Takayuki;Eguchi, Akifumi;Yoneoka, Daisuke;Nomura, Shuhei
通讯作者：
Nomura, Shuhei