Trends in all‐cause mortality and inpatient and outpatient visits for ambulatory care sensitive conditions during the first year of the COVID‐19 pandemic: A population‐based study

Abstract

Background The impact of the COVID‐19 pandemic on the management of ambulatory care sensitive conditions (ACSCs) remains unknown. Objectives To compare observed and expected (projected based on previous years) trends in all‐cause mortality and healthcare use for ACSCs in the first year of the pandemic (March 2020 to March 2021). Design, Setting and Participants We conducted a population‐based study using provincial health administrative data on general adul population (Ontario, Canada). Outcomes and Measures Monthly all‐cause mortality, and hospitalizations, emergency department (ED) and outpatient visit rates (per 100,000 people at‐risk) for seven combined ACSCs (asthma, chronic obstructive pulmonary disease, angina, congestive heart failure, hypertension, diabetes, and epilepsy) during the first year were compared with similar periods in previous years (2016–2019) by fitting monthly time series autoregressive integrated moving‐average models. Results Compared to previous years, all‐cause mortality rates increased at the beginning of the pandemic (observed rate in March to May 2020 of 79.98 vs. projected of 71.24 [66.35–76.50]) and then returned to expected in June 2020—except among immigrants and people with mental health conditions where they remained elevated. Hospitalization and ED visit rates for ACSCs remained lower than projected throughout the first year: observed hospitalization rate of 37.29 versus projected of 52.07 (47.84–56.68); observed ED visit rate of 92.55 versus projected of 134.72 (124.89–145.33). ACSC outpatient visit rates decreased initially (observed rate of 4299.57 vs. projected of 5060.23 [4712.64–5433.46]) and then returned to expected in June 2020.

Association of clinically significant obstructive sleep apnoea with risks of contracting COVID-19 and serious COVID-19 complications: a retrospective population-based study of health administrative data

“…We tried to minimise referral bias by incorporating a comprehensive definition of the non-OSA group; however, we still missed individuals with undiagnosed OSA 50. The aforementioned biases differentially impact financially and socially disadvantaged populations who tend to be under-represented and, at the same time, are at the highest risk from COVID-19-related outcomes 51. This bias is mitigated by social assistance support for PAP and the location of sleep clinics in lower-income areas in Ontario, and the ATE weighting approach used in a sensitivity analysis.…”

“…50 The aforementioned biases differentially impact financially and socially disadvantaged populations who tend to be under-represented and, at the same time, are at the highest risk from COVID-19-related outcomes. 51 This bias is mitigated by social assistance support for PAP and the location of sleep clinics in lower-income areas in Ontario, and the ATE weighting approach used in a sensitivity analysis. In addition, we calculated the E-value to adjust for unmeasured confounders (online supplemental table E9).…”

Lulled into a false sense of security: Mortality for vulnerable populations may remain elevated even during the lull between COVID‐19 waves

“…The authors declare no conflict of interest. Suchita S. Sata MD 1,2 S. Ryan Greysen MD, MHS Email: Suchita.shah.sata@duke.edu; Twitter: @SuchitaSata ORCID Suchita S. Sata http://orcid.org/0000-0002-9773-6174…”

“…In this issue of Journal of Hospital Medicine , Kendzerska et al 2 suggest that the period between peaks in the pandemic waves is only an intermission for the privileged when it comes to health care. The investigators conducted a population‐level study in Ontario, Canada, comparing observed versus expected mortality as well as emergency department (ED) and hospital visits for several ACSCs.…”

“… 3 This burden has been borne disproportionately by historically marginalized groups due to losses of community health networks and the social safety net. 4 Kendzerska et al 2 provide unfortunate evidence that, even in a population with universal health insurance, inequities in health outcomes reach our most vulnerable neighbors. This study raises many important questions for future research.…”