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

Abstract

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.

The Influence of the COVID-19 Pandemic on Hospitalizations for Ambulatory Care-Sensitive Conditions in Split-Dalmatia County, Croatia

“…This is especially evident in vaccine-preventable ACSC hospitalizations. Increased in-hospital mortality rates of ACSC-related hospitalizations during the COVID-19 pandemic have also been reported by other authors [38]. On the one hand, this could suggest that patients, for some reason, did not seek help on time, as was already shown for acute coronary syndrome [39,40].…”

Trends in inequalities in avoidable hospitalisations across the COVID-19 pandemic: a cohort study of 23.5 million people in England

“…These findings follow similar trends observed in other countries despite their differences in health systems, sociocultural contexts and experiences of COVID-19. [15][16][17][18] We extend this work through analysing a longer time period and through detailed disaggregated by markers of socioeconomic inequality. Our results also follow observations for other metrics including falls in non-COVID-19 mortality.…”

“…10 Research has shown that avoidable hospitalisations in many countries fell in 2020 during the first COVID-19 waves and did not return to pre-pandemic levels thereafter. [15][16][17][18] Most of this research, however, stops at the end of 2020 and there is less understanding of how trends have continued since. This ignores a critical period in the response and recovery from the pandemic.…”