Changes in Health Care Access during the COVID-19 Pandemic: Estimates of National Japanese Data, June 2020–October 2021

Tanoue, Yuta; Ghaznavi, Cyrus; Kawashima, Takayuki; Eguchi, Akifumi; Yoneoka, Daisuke; Nomura, Shuhei

doi:10.3390/ijerph19148810

Cited by 7 publications

(6 citation statements)

References 30 publications

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“…In addition, many patients may have been reluctant to seek care in hospitals for fear of contracting COVID-19 infection . As a result, a prior study reported a decrease in the number of outpatient visits after the declaration of the national state of emergency . Thus, many patients with COVID-19-like symptoms stayed home without undergoing PCR testing or accessing primary care.…”

Section: Discussionmentioning

confidence: 99%

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In-Hospital Deaths From Ambulatory Care–Sensitive Conditions Before and During the COVID-19 Pandemic in Japan

et al. 2023

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ImportanceThe COVID-19 pandemic may have played a role in the deterioration of access to medical care for ambulatory care–sensitive conditions (ACSCs).ObjectiveTo 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.Design, Setting, and ParticipantsThis 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.ExposureThe declaration of the COVID-19 national state of emergency announced by the Japanese government in April 2020 was considered to be an exogenous shock.Main Outcomes and MeasuresPrimary outcomes were the ACSC-associated number of in-hospital deaths, number of hospitalizations, and in-hospital mortality rate.ResultsA 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).Conclusions and RelevanceThis 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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Section: Discussionmentioning

confidence: 99%

“…1,2 As a result, a prior study reported a decrease in the number of outpatient visits after the declaration of the national state of emergency. 29 Thus, many patients with COVID-19-like symptoms stayed home without undergoing PCR testing or accessing primary care.…”

Section: Jama Network Open | Health Policymentioning

confidence: 99%

In-Hospital Deaths From Ambulatory Care–Sensitive Conditions Before and During the COVID-19 Pandemic in Japan

et al. 2023

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“…particularly in the early stages of the pandemic. (Makiyama et al, 2021;Tanoue et al, 2022) Although telemedicine was temporarily permitted, reduced opportunities for face-to-face medical care triggered reduced opportunities for both verbal and nonverbal medical communication.…”

Section: Discussionmentioning

confidence: 99%

The COVID-19 pandemic immediately increased the suicide rate in Kobe, Japan, especially among populations without psychiatry and primary care physician visits: Interrupted time-series analysis using a population-based database

Miyamori,

Nagasaki,

Yoshida

et al. 2024

Preprint

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Background Japan has one of the lowest numbers of deaths due to coronavirus disease (COVID-19). However, the annual number of suicides increased for the first time in 2020, after a downward trend since 2007. Objective This study aimed to identify high-risk populations and assess the impact of medical visits on suicide trends in Japan following the COVID-19 pandemic. Method This quasi-experimental study used a population-based database from Hyogo Prefecture between 2012 and 2022. Interrupted time-series analyses were used to identify immediate and slope changes in the monthly number of suicides during the exposure period (2020-2022) compared with the control (2012-2019). The analysis was stratified according to the status of psychiatric department and primary care physician visits. Results: A totalof 2181 cases were included. Two-thirds of the cases were male, with a median age of 54. Primary care physicians and psychiatric history were present in 69% and 40% of the patients, respectively. The level change was 4.46 (95%CI; 1.83, 7.09), 3.04 (95%CI; 1.45, 4.64), and 3.07 (95%CI; 0.60, 5.53), in the overall, no primary care physician visit, and no psychiatric visits groups, respectively, which were significant. The level change was not significant in the groups with primary care and psychiatric department visits, at 1.07 (95%CI; -0.84, 2.98) and 0.64 (95%CI; -1.05, 2.33), respectively. The slope changes were not significant in any group. Conclusion: This study suggests that visits to a medical institution may have helped prevent the rapid increase in suicides during the early stages of the COVID-19 pandemic.

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“…Japan was no exception, with the number of non-COVID-19-infected patients visiting hospitals decreasing significantly because of the state of emergency declared and outdoor restrictions imposed as soon as the wave of infection began in March 2020. 2 Because of postponing or canceling of scheduled surgeries, most of the oncological surgeries, including low anterior resection (LAR) for rectal cancer, temporarily decreased. 3 The impact of COVID-19 was not only a change in the number of surgeries.…”

Section: Introductionmentioning

confidence: 99%

“…Policies were made and strongly implemented in each country to prevent contagion, resulting in a significant impact on overall health care. Japan was no exception, with the number of non–COVID‐19‐infected patients visiting hospitals decreasing significantly because of the state of emergency declared and outdoor restrictions imposed as soon as the wave of infection began in March 2020 2 . Because of postponing or canceling of scheduled surgeries, most of the oncological surgeries, including low anterior resection (LAR) for rectal cancer, temporarily decreased 3 …”

Section: Introductionmentioning

confidence: 99%

Impact of COVID‐19 pandemic on short‐term outcomes after low anterior resection in patients with rectal cancer: Analysis of data from the Japanese National Clinical Database

Seishima,

Endo,

Hibi

et al. 2023

Annals of Gastroent Surgery

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AimThe Coronavirus Disease 2019 (COVID‐19) pandemic affected the allocation of various medical resources to several areas, including intensive care units (ICUs). However, currently, its impact on the short‐term postoperative outcomes of gastrointestinal cancer surgeries remains unclear. We aimed to evaluate the impact of the pandemic on the incidence of complications occurring after low anterior resection in patients with rectal cancer in Japan.MethodsData from the Japanese National Clinical Database between 2018 and 2021 were retrospectively examined. The primary outcome of the study was the postoperative morbidity and mortality rates before and after COVID‐19 pandemic. Moreover, the postoperative ICU admission rate was assessed. Morbidity and mortality rates were also assessed using a standardized morbidity/mortality ratio (SMR, the ratio of the actual number of incidences to the expected number of incidences calculated by the risk calculator).ResultsThis study included 74 181 patients, including 43 663 (58.9%) from COVID‐19 epidemic areas. The mean actual incidences of anastomotic leakage (AL) and pneumonia during the study period were 9.2% and 0.9%, respectively. The SMRs of these complications did not increase during the pandemic but those of AL declined gradually. The mean 30‐day mortality and operative mortality rates were 0.3% and 0.5%, respectively. Moreover, SMRs did not change significantly in the pandemic or regional epidemic status. The ICU admission rate temporarily decreased, especially in the epidemic areas.ConclusionAlthough the pandemic temporarily decreased the ICU admission rate, its impact on short‐term outcomes following low anterior resection in patients with rectal cancer was insignificant in Japan.

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Changes in Health Care Access during the COVID-19 Pandemic: Estimates of National Japanese Data, June 2020–October 2021

Cited by 7 publications

References 30 publications

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

The COVID-19 pandemic immediately increased the suicide rate in Kobe, Japan, especially among populations without psychiatry and primary care physician visits: Interrupted time-series analysis using a population-based database

Impact of COVID‐19 pandemic on short‐term outcomes after low anterior resection in patients with rectal cancer: Analysis of data from the Japanese National Clinical Database

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