Hospital admission rates for non-COVID-19 diseases have decreased since start of pandemic in Denmark

1. Retrospective analysis of hospital records showed decreased hospital admission rates for non-COVID-19 diseases in Denmark since the first lockdown.

2. Mortality rates were also shown to be higher for non-COVID-19 diseases, including respiratory diseases, cancer, pneumonia, and sepsis.

Evidence Rating Level: 2 (Good)

Study Rundown: The COVID-19 pandemic has put a major strain on all hospitals across the globe, limiting capacity and access for non-COVID diseases. This Denmark retrospective study quantified the change in hospital admissions and mortality from non-COVID diseases by analyzing their national healthcare registries. Large-scale, population-based data was collected and separated by first or second lockdown and compared to pre-pandemic baseline. Non-covid hospital admission was shown to have decreased to 70% of baseline numbers. Inversely, 30-day mortality rates for these same diseases were shown to have increased by approximately 25%. Between the two lockdowns, the data was seen to be trending back to baseline values. Limitations of this study include its non-prospective nature, which leave the results prone to confounding variables, such as pre-existing conditions before the pandemic. Additionally, while Danish healthcare registries are considered high quality, the lack of information on case severity is also a significant constraint. Is the higher mortality of these diseases due to an increased neglect from the healthcare system or because only the most severe cases were allowed hospital admission? These unanswered questions limit the study’s ability to inform healthcare decisions. Nonetheless, the results of this study paint a preliminary picture of the limited usage of hospital services by these non-covid diseases, whether it be due to patient fear, hospital overcapacity or another factor altogether.

Click to read the study in the BMJ

Click to read the accompanying editorial in the BMJ

Relevant Reading: Hospitalizations for Chronic Disease and Acute Conditions in the Time of COVID-19

In-Depth [retrospective cohort]: Using the national healthcare registry between 11 March 2020 to 27 January 2021, hospital admission was collected for 675 447 unique patients with a total of 1 113 705 hospital admissions. Follow-up was until migration, death, or end of the study period. Disease diagnosis was done by ICD-10 codes given. Admission rates were found to have decreased from 204.1 (pre-pandemic baseline) to 142.8 (first lockdown) and 158.3 (second lockdown) per 100 000 patients/week. For example, when compared to pre-pandemic baseline rates, rate ratios [RR] during the first regional lockdown were significantly lower for bone, muscle, and connective tissue diseases (RR 0.34, 95% CI 0.25-0.46), diseases of the nervous system (0.54, 95% CI 0.46-0.64), hematological disorders (0.65, 95% CI 0.59-0.71), respiratory diseases (0.70, 95% CI 0.62-0.79), and circulatory diseases (0.76, 95% CI 0.71-0.82). This was the case for all major ICD-10 disease classifications. Compared to pre-pandemic baselines, 30-day mortality rates were higher in the first lockdown (RR 1.28, 95% CI 1.23-1.32) and second lockdown (1.20, 1.16 to 1.24). Notably, when compared to baseline, 30-day mortality during the first regional lockdown was increased for pneumonia (RR 1.40, 95% CI 1.27-1.55), sepsis (1.39, 95% CI 1.23-1.57), and urinary tract infections (1.23, 95% CI 1.01-1.50).

Image: PD

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