Impact of COVID-19 infection rates on admissions for ambulatory care sensitive conditions: nationwide difference-in-difference design in Japan

Kaneko, Makoto; Shimizu, Sayuri; Oishi, Ai; Fushimi, Kiyohide

doi:10.1136/fmch-2022-001736

Cited by 5 publications

(10 citation statements)

References 25 publications

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“…Second, this study used the ACSC definition used in the UK National Health Service but has not yet been validated in Japan. Still, several previous studies in Japan have used it, 17,21 and thus the findings of the present study are comparable to the findings of the past reports. Third, patients with ACSC may have been admitted with COVID-19 (ICD-10 code U07.1).…”

Section: Limitationssupporting

confidence: 91%

“…In this study, we used the definition of ACSC from the UK National Health Service 12 because previous studies in Japan have used it and because Japan has not yet established its own ACSC definition. 17,21 The ACSCs were categorized as acute, including 9 conditions (eg, dehydration and gastroenteritis); chronic, including 8 conditions (eg, asthma and congestive heart failure); or vaccine-preventable, including 2 conditions (eg, pneumococcal pneumonia). Disease definitions and their corresponding ICD-10 codes are provided in eTable 1 in Supplement 1.…”

Section: Definition Of Acscmentioning

confidence: 99%

“…A decrease in the number of hospitalizations and emergency department visits for ACSC during the early stages of the COVID-19 pandemic was also reported in previous studies conducted in Canada, Japan, and the US, despite variation in COVID-19 rates. 14,15,17 While some previous studies conducted regression analysis based on a before-vs-after comparison, adjusted for covariates, the present analysis adopted a DID design to address possible unmeasured confounders such as socioeconomic status. A new finding in this study was that, despite the decrease in the number of hospitalizations, the number of deaths and in-hospital mortality rates increased during the pandemic, especially for patients with acute ACSC.…”

Section: Jama Network Open | Health Policymentioning

confidence: 99%

“…15 Even in Japan, where the number of patients with COVID-19 was lower than in Canada and the US, 16 a decrease in the number of ACSC-related hospitalizations has been reported. 17 However, it can be difficult to interpret these findings based on indicators alone, such as the number of hospital admissions. 15 For example, it is not clear whether the decrease in ACSC-related hospitalizations during the pandemic was a good outcome, as it is possible that patients who needed to be admitted likely simply could not gain entry into hospitals.…”

Section: Introductionmentioning

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: Limitationssupporting

confidence: 91%

Section: Definition Of Acscmentioning

confidence: 99%

Section: Jama Network Open | Health Policymentioning

confidence: 99%

Section: Introductionmentioning

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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“…Another quasi-experimental design, the difference-in-difference, has been implemented in Japan RWD. A COVID-19 study assessed the difference-in-difference for the change in admissions for ambulatory care sensitive conditions before and during the pandemic by comparing prefectures enforcing a state of emergency with those that did not [ 68 ].…”

Section: Challenges and Solutions Relating To The Methodologymentioning

confidence: 99%

Strategies to Address Current Challenges in Real-World Evidence Generation in Japan

Laurent

Lambrelli

Wakabayashi

et al. 2023

Drugs - Real World Outcomes

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Risk of Potentially Preventable Hospitalizations After SARS-CoV-2 Infection

Govier,

Niederhausen,

Takata

et al. 2024

JAMA Netw Open

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ImportanceResearch demonstrates that SARS-CoV-2 infection is associated with increased risk of all-cause hospitalization. However, no prior studies have assessed the association between SARS-CoV-2 and potentially preventable hospitalizations—that is, hospitalizations for conditions that can usually be effectively managed in ambulatory care settings.ObjectiveTo examine whether SARS-CoV-2 is associated with potentially preventable hospitalization in a nationwide cohort of US veterans.Design, Setting, and ParticipantsThis cohort study used an emulated target randomized trial design with monthly sequential trials to compare risk of a potentially preventable hospitalization among veterans with SARS-CoV-2 and matched comparators without SARS-CoV-2. A total of 189 136 US veterans enrolled in the Veterans Health Administration (VHA) who were diagnosed with SARS-CoV-2 between March 1, 2020, and April 30, 2021, and 943 084 matched comparators were included in the analysis. Data were analyzed from May 10, 2023, to January 26, 2024.ExposureSARS-CoV-2 infection.Main Outcomes and MeasuresThe primary outcome was a first potentially preventable hospitalization in VHA facilities, VHA-purchased community care, or Medicare fee-for-service care. Extended Cox models were used to examine adjusted hazard ratios (AHRs) of potentially preventable hospitalization among veterans with SARS-CoV-2 and comparators during follow-up periods of 0 to 30, 0 to 90, 0 to 180, and 0 to 365 days. The start of follow-up was defined as the date of each veteran’s first positive SARS-CoV-2 diagnosis, with the same index date applied to their matched comparators.ResultsThe 1 132 220 participants were predominantly men (89.06%), with a mean (SD) age of 60.3 (16.4) years. Most veterans were of Black (23.44%) or White (69.37%) race. Veterans with SARS-CoV-2 and comparators were well-balanced (standardized mean differences, all &lt;0.100) on observable baseline clinical and sociodemographic characteristics. Overall, 3.10% of veterans (3.81% of those with SARS-CoV-2 and 2.96% of comparators) had a potentially preventable hospitalization during 1-year follow-up. Risk of a potentially preventable hospitalization was greater among veterans with SARS-CoV-2 than comparators in 4 follow-up periods: 0- to 30-day AHR of 3.26 (95% CI, 3.06-3.46); 0- to 90-day AHR of 2.12 (95% CI, 2.03-2.21); 0- to 180-day AHR of 1.69 (95% CI, 1.63-1.75); and 0- to 365-day AHR of 1.44 (95% CI, 1.40-1.48).Conclusions and RelevanceIn this cohort study, an increased risk of preventable hospitalization in veterans with SARS-CoV-2, which persisted for at least 1 year after initial infection, highlights the need for research on ways in which SARS-CoV-2 shapes postinfection care needs and engagement with the health system. Solutions are needed to mitigate preventable hospitalization after SARS-CoV-2.

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Impact of COVID-19 infection rates on admissions for ambulatory care sensitive conditions: nationwide difference-in-difference design in Japan

Cited by 5 publications

References 25 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

Strategies to Address Current Challenges in Real-World Evidence Generation in Japan

Risk of Potentially Preventable Hospitalizations After SARS-CoV-2 Infection

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