Mulholland Rachel H, Wood Rachael, Stagg Helen R, Fischbacher Colin, Villacampa Jaime, Simpson Colin R, Vasileiou Eleftheria, McCowan Colin, Stock Sarah J, Docherty Annemarie B, Ritchie Lewis D, Agrawal Utkarsh, Robertson Chris, Murray Josephine Lk, MacKenzie Fiona, Sheikh Aziz
Usher Institute, University of Edinburgh, Edinburgh EH8 9YL, UK.
National Health Service Scotland, Public Health Scotland, Glasgow G2 6QE and Edinburgh EH12 9EB, UK.
J R Soc Med. 2020 Nov;113(11):444-453. doi: 10.1177/0141076820962447. Epub 2020 Oct 4.
Following the outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus and the subsequent global spread of the 2019 novel coronavirus disease (COVID-19), health systems and the populations who use them have faced unprecedented challenges. We aimed to measure the impact of COVID-19 on the uptake of hospital-based care at a national level.
The study period (weeks ending 5 January to 28 June 2020) encompassed the pandemic announcement by the World Health Organization and the initiation of the UK lockdown. We undertook an interrupted time-series analysis to evaluate the impact of these events on hospital services at a national level and across demographics, clinical specialties and National Health Service Health Boards.
Scotland, UK.
Patients receiving hospital care from National Health Service Scotland.
Accident and emergency (A&E) attendances, and emergency and planned hospital admissions measured using the relative change of weekly counts in 2020 to the averaged counts for equivalent weeks in 2018 and 2019.
Before the pandemic announcement, the uptake of hospital care was largely consistent with historical levels. This was followed by sharp drops in all outcomes until UK lockdown, where activity began to steadily increase. This time-period saw an average reduction of -40.7% (95% confidence interval [CI]: -47.7 to -33.7) in A&E attendances, -25.8% (95% CI: -31.1 to -20.4) in emergency hospital admissions and -60.9% (95% CI: -66.1 to -55.7) in planned hospital admissions, in comparison to the 2018-2019 averages. All subgroup trends were broadly consistent within outcomes, but with notable variations across age groups, specialties and geography.
COVID-19 has had a profoundly disruptive impact on hospital-based care across National Health Service Scotland. This has likely led to an adverse effect on non-COVID-19-related illnesses, increasing the possibility of potentially avoidable morbidity and mortality. Further research is required to elucidate these impacts.
在严重急性呼吸综合征冠状病毒2（SARS-CoV-2）病毒爆发以及随后2019年新型冠状病毒病（COVID-19）在全球传播之后，卫生系统及其使用者面临了前所未有的挑战。我们旨在衡量COVID-19在国家层面上对医院医疗服务利用情况的影响。
研究期间（截至2020年1月5日至6月28日的各周）涵盖了世界卫生组织宣布大流行以及英国开始实施封锁的时间段。我们进行了中断时间序列分析，以评估这些事件对国家层面以及不同人口统计学特征、临床专科和国民保健服务健康委员会的医院服务的影响。
英国苏格兰。
接受苏格兰国民保健服务医院护理的患者。
使用2020年每周就诊次数相对于2018年和2019年同期平均就诊次数的相对变化来衡量的急诊（A&E）就诊人数、急诊和计划性住院人数。
在宣布大流行之前，医院医疗服务的利用情况与历史水平基本一致。随后，在所有指标上都急剧下降，直到英国实施封锁，此时活动开始稳步增加。与2018 - 2019年的平均水平相比，在此期间急诊就诊人数平均减少了-40.7%（95%置信区间[CI]：-47.7至-33.7），急诊住院人数减少了-25.8%（95%CI：-31.1至-20.4），计划性住院人数减少了-60.9%（95%CI：-66.1至-55.7）。所有亚组趋势在各指标内大致一致，但在年龄组、专科和地理区域之间存在显著差异。
COVID-19对苏格兰国民保健服务体系内的医院医疗服务产生了极其严重的破坏性影响。这可能对非COVID-19相关疾病产生了不利影响，增加了潜在可避免的发病和死亡的可能性。需要进一步研究以阐明这些影响。
