John D. Birkmeyer (
Amber Barnato is a professor at the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth.
Health Aff (Millwood). 2020 Nov;39(11):2010-2017. doi: 10.1377/hlthaff.2020.00980. Epub 2020 Sep 24.
Hospital admissions in the US fell dramatically with the onset of the coronavirus disease 2019 (COVID-19) pandemic. However, little is known about differences in admissions patterns among patient groups or the extent of the rebound. In this study of approximately one million medical admissions from a large, nationally representative hospitalist group, we found that declines in non-COVID-19 admissions from February to April 2020 were generally similar across patient demographic subgroups and exceeded 20 percent for all primary admission diagnoses. By late June/early July 2020, overall non-COVID-19 admissions had rebounded to 16 percent below prepandemic baseline volume (8 percent including COVID-19 admissions). Non-COVID-19 admissions were substantially lower for patients residing in majority-Hispanic neighborhoods (32 percent below baseline) and remained well below baseline for patients with pneumonia (-44 percent), chronic obstructive pulmonary disease/asthma (-40 percent), sepsis (-25 percent), urinary tract infection (-24 percent), and acute ST-elevation myocardial infarction (-22 percent). Health system leaders and public health authorities should focus on efforts to ensure that patients with acute medical illnesses can obtain hospital care as needed during the pandemic to avoid adverse outcomes.
美国的医院入院人数随着 2019 年冠状病毒病(COVID-19)大流行的爆发而急剧下降。然而,人们对患者群体中入院模式的差异以及反弹的程度知之甚少。在这项对来自一个大型、全国代表性的住院医师组的大约 100 万例医疗入院的研究中,我们发现,2020 年 2 月至 4 月期间,非 COVID-19 入院人数的下降在患者人口统计学亚组中基本相似,所有主要入院诊断的下降均超过 20%。到 2020 年 6 月底/7 月初,非 COVID-19 入院人数已反弹至比大流行前基线水平低 16%(包括 COVID-19 入院人数为 8%)。居住在以西班牙裔为主的社区的患者的非 COVID-19 入院人数大幅下降(比基线低 32%),肺炎患者(-44%)、慢性阻塞性肺疾病/哮喘(-40%)、脓毒症(-25%)、尿路感染(-24%)和急性 ST 段抬高型心肌梗死(-22%)患者的入院人数仍远低于基线。医疗系统领导人和公共卫生当局应重点努力确保患有急性疾病的患者在大流行期间能够按需获得医院护理,以避免不良后果。