Impact of COVID-19 on the Volume of Acute Stroke Admissions: A Nationwide Survey in Japan

Abstract

This study aimed to measure the impact of the COVID-19 pandemic on the volumes of annual stroke admissions compared with those before the pandemic in Japan. We conducted an observational, retrospective nationwide survey across 542 primary stroke centers in Japan. The annual admission volumes for acute stroke within 7 days from onset between 2019 as the pre-pandemic period and 2020 as the pandemic period were compared as a whole and separately by months during which the epidemic was serious and prefectures of high numbers of infected persons. The number of stroke patients declined from 182,660 in 2019 to 178,083 in 2020, with a reduction rate of 2.51% (95% confidence interval [CI], 2.58%-2.44%). The reduction rates were 1.92% (95% CI, 1.85%-2.00%; 127,979-125,522) for ischemic stroke, 3.88% (95% CI, 3.70%-4.07%, 41,906-40,278) for intracerebral hemorrhage, and 4.58% (95% CI, 4.23%-4.95%; 13,020-12,424) for subarachnoid hemorrhage. The admission volume declined by 5.60% (95% CI, 5.46%-5.74%) during the 7 months of 2020 when the epidemic was serious, whereas it increased in the remaining 5 months (2.01%; 95% CI, 1.91%-2.11%). The annual decline in the admission volume was predominant in the five prefectures with the largest numbers of infected people per million population (4.72%; 95% CI, 4.53%-4.92%). In conclusion, the acute stroke admission volume declined by 2.51% in 2020 relative to 2019 in Japan, especially during the months of high infection, and in highly infected prefectures. Overwhelmed healthcare systems and infection control practices may have been associated with the decline in the stroke admission volume during the COVID-19 pandemic.

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“…This decline was more evident in hospitals that received a high number of patients infected with COVID-19. [ 4 , 13 , 28 ] These findings coincide with what we observed at our hospital, which during the 1 st months of the pandemic was oversaturated by the high demand created by critical patients with this disease. Despite the possible association between COVID-19 infection and acute cerebrovascular complications,[ 24 ] in addition to psychological stress and the risk of aneurysmal rupture,[ 17 ] the admissions decline of patients with SAH is probably also related to the fact that those patients with moderate neurological symptoms did not seek medical care due to fear of infection,[ 5 ] resulting in misdiagnosis or unknown deaths during lockdown.…”

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

“…The number of patients with stroke declined from 2019 to 2020, with a reduction of 2.51% (95% CI, −2.58% to −2.44%). 275 The reductions were 1.92% (95% CI, −2.00% to −1.85%; 127 979 to 125 522) for ischemic stroke, 3.88% (95% CI, −4.07% to −3.70%; 41 906 to 40 278) for ICH, and 4.58% (95% CI, −4.95% to −4.23%; 13 020 to 12 424) for SAH. The annual decline in the admission volume was mainly in the 5 areas with the largest number of infected people per million population (4.72% [95% CI, −4.92% to −4.53%]).…”

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“…Second, this study did not consider the impact of COVID-19. COVID-19 caused the number of hospitalizations for stroke to decrease during its spread ( 58 ), and there is a likelihood of a disparity in the spread effect on our results. The incidence of acute IS by region was also unknown.…”