Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh (K Schweiberger and KN Ray), Pittsburgh, Pa.
Department of Health Care Policy, Harvard Medical School (SY Patel and A Mehrotra), Boston, Mass.
Acad Pediatr. 2021 Nov-Dec;21(8):1426-1433. doi: 10.1016/j.acap.2021.04.031. Epub 2021 May 11.
Months after the declaration of the coronavirus disease of 2019 (COVID-19) national emergency, visits among children remained suppressed for unclear reasons, which we sought to understand by examining child visit rates.
Using de-identified claims data for children <18 years old from OptumLabs® Data Warehouse, a large commercial claims database, we compared monthly primary care visit and vaccination rates from January-October 2020 to January-October 2018 and 2019. Visit rates were analyzed by visit reason and by the month after (eg, month +1) the COVID-19 public health emergency declaration using a series of child-level Poisson regression models.
There were 3.4, 3.4, and 3.1 million children in 2018, 2019, and 2020 cohorts, respectively. Compared to the same months in prior years, primary care visits in 2020 were 60% lower in month +1 (incidence rate ratio [IRR] 0.40, 99% confidence interval [CI] 0.40-0.40) and 17% lower in month +7 (IRR 0.83, 99% CI 0.83-0.83). Preventive visit rates were 53% lower in month +1 (IRR 0.47, 99% CI 0.47-0.47), but 8% higher than prior years in month +7 (IRR 1.08, 99% CI 1.08-1.08). Monthly rates of vaccine administration followed a similar pattern. Problem-focused visits remained 31% lower in month +7 (IRR 0.69, 99% CI 0.68-0.69), with notably fewer infection-related visits (acute respiratory tract infections IRR 0.37, 99% CI 0.36-0.37; gastroenteritis IRR 0.20, 99% CI 0.20-0.20).
Seven months after the COVID-19 emergency declaration, receipt of pediatric care remained suppressed due to fewer problem-focused visits, with notably fewer infection-related visits. By October 2020, rates of preventive visits and vaccination exceeded rates in prior years.
在宣布 2019 年冠状病毒病（COVID-19）国家紧急状态数月后，儿童就诊率仍不明原因下降，我们试图通过检查儿童就诊率来了解这一情况。
我们使用来自 OptumLabs® Data Warehouse 的匿名索赔数据，该数据库是一个大型商业索赔数据库，对 2020 年 1 月至 10 月和 2018 年、2019 年 18 岁以下儿童的每月初级保健就诊和疫苗接种率进行了比较。使用一系列儿童水平泊松回归模型，根据就诊原因和 COVID-19 公共卫生紧急状态声明后的月份（例如，第 1 个月后）分析就诊率。
2018 年、2019 年和 2020 年队列中分别有 340 万、340 万和 310 万儿童。与前几年同期相比，2020 年第 1 个月的初级保健就诊率下降了 60%（发病率比 [IRR]0.40，99%置信区间 [CI]0.40-0.40），第 7 个月下降了 17%（IRR 0.83，99%CI 0.83-0.83）。预防就诊率在第 1 个月下降了 53%（IRR 0.47，99%CI 0.47-0.47），但在第 7 个月比前几年高 8%（IRR 1.08，99%CI 1.08-1.08）。疫苗接种的月度接种率也呈现出类似的模式。第 7 个月问题导向就诊率仍下降 31%（IRR 0.69，99%CI 0.68-0.69），感染相关就诊明显减少（急性呼吸道感染 IRR 0.37，99%CI 0.36-0.37；胃肠炎 IRR 0.20，99%CI 0.20-0.20）。
在 COVID-19 紧急状态声明后 7 个月，由于问题导向就诊减少，儿童医疗服务的获得率仍受到抑制，且感染相关就诊明显减少。到 2020 年 10 月，预防就诊和疫苗接种率已超过前几年的水平。
