Hospitalization of mild cases of community-acquired pneumonia decreased more than severe cases during the COVID-19 pandemic

Abstract

Objective The epidemic of the coronavirus disease 2019 (COVID-19) has affected the entire health care systems. Our aim was to assess the impact of the COVID-19 epidemic on the number and severity of cases for community-acquired pneumonia (CAP) in Japan. Methods Using claims data from the Quality Indicator/Improvement Project (QIP) database, we included urgent cases of inpatients for CAP from August 1, 2018, to July 30, 2020. We compared the monthly ratio of inpatient cases from August 2018 to July 2019 and August 2019 to July 2020 as a year-over-year comparison. We also compared this ratio according to the severity score “A-DROP” and performed an interrupted time series (ITS) analysis to evaluate the impact of the COVID-19 epidemic on the monthly number of inpatient cases. Results A total of 67,900 inpatient cases for CAP in 262 hospitals were included. During the COVID-19 epidemic (defined as the period between March and July 2020), the number of inpatient cases for CAP drastically decreased during the epidemic compared with the same period in the past year (-48.1%), despite only a temporary reduction in the number of other urgent admissions. The number of inpatient cases decreased according to the severity of pneumonia. Milder cases showed a greater decrease in the year-over-year ratio than severe ones (mild -55.2%, moderate -45.8%, severe -39.4%, and extremely severe -33.2%). The ITS analysis showed that the COVID-19 epidemic reduced the monthly number of inpatient cases for CAP significantly (estimated decrease: -1233 cases; 95% CI, -521 to -1955). Conclusions Our study showed a significant reduction in the number of inpatient cases for CAP during the COVID-19 epidemic in Japan. The milder cases showed a greater decrease in the year-over-year ratio of the number of inpatient cases.

Incidence, Outcomes and Sex-Related Disparities in Pneumonia: A Matched-Pair Analysis with Data from Spanish Hospitals (2016–2019)

“…However, the COVID-19 pandemic onset will probably represent an inflection point for the incidence of CAP cases unrelated to SARS-CoV-2. Indeed, during the first waves of the COVID-19 pandemic, lower rates of admission for CAP have been reported, mainly in milder cases [ 22 ].…”

Medium-term impacts of the waves of the COVID-19 epidemic on treatments for non-COVID-19 patients in intensive care units: a retrospective cohort study in Japan

“…A previous study [6] suggested that the reduced volume of ICU patients was due to patients’ hesitancy to visit hospitals. In fact, a reduction in case volumes has been observed in many areas, including acute coronary syndrome[22], pneumonia[23], and surgeries[24]. However, the reasons behind the reduction in admissions have not been clarified.…”

“…Since the treatment of COVID-19 patients is considered to exhaust the capacity to undertake MV[4], MVs are supposed to have been suppressed more than other treatments. However, changes in patient volumes have been reported in various areas, including acute coronary syndrome[22], pneumonia[23], and surgeries[24]; the influence of these changes cannot be denied. In addition, volumes themselves of respiratory infection diseases were suggested to decrease due to infection prevention measures employed by residents during the epidemic of the COVID-19[23, 29].…”

Effects of the COVID‐19 pandemic on heart failure hospitalizations in Japan: interrupted time series analysis

“…In Japan, there was a marked reduction in the number of inpatients with non‐COVID‐19 acute respiratory infections during the COVID‐19 pandemic. 32 , 33 Therefore, this factor could be a contributor to reducing infection‐related hospital admissions of HF patients. Furthermore, because medical resources were transferred to prioritize COVID‐19 patients, there may have been delays in the treatment of less urgent HF patients.…”