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新冠疫情后状况对伦巴第大区首次疫情浪潮后医疗保健的影响。

Impact of the post-COVID-19 condition on health care after the first disease wave in Lombardy.

机构信息

Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and University of Milan, Milan, Italy.

Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.

出版信息

J Intern Med. 2022 Sep;292(3):450-462. doi: 10.1111/joim.13493. Epub 2022 Apr 22.

Abstract

BACKGROUND

Lombardy was affected in the early months of 2020 by the SARS-CoV-2 pandemic with very high morbidity and mortality. The post-COVID-19 condition and related public health burden are scarcely known.

SETTING AND DESIGN

Using the regional population administrative database including all the 48,932 individuals who survived COVID-19 and became polymerase-chain-reaction negative for SARS-CoV-2 by 31 May 2020, incident mortality, rehospitalizations, attendances to hospital emergency room, and outpatient medical visits were evaluated over a mid-term period of 6 months in 20,521 individuals managed at home, 26,016 hospitalized in medical wards, and 1611 in intensive care units (ICUs). These data were also evaluated in the corresponding period of 2019, when the region was not yet affected by the pandemic. Other indicators and proxies of the health-care burden related to the post-COVID condition were also evaluated.

MAIN RESULTS

In individuals previously admitted to the ICU and medical wards, rehospitalizations, attendances to hospital emergency rooms, and out-patient medical visits were much more frequent in the 6-month period after SARS-CoV-2 negativization than in the same prepandemic period. Performances of spirometry increased more than 50-fold, chest CT scans 32-fold in ICU-admitted cases and 5.5-fold in non-ICU cases, and electrocardiography 5.6-fold in ICU cases and twofold in non-ICU cases. Use of drugs and biochemical tests increased in all cases.

CONCLUSIONS

These results provide a real-life picture of the post-COVID condition and of its effects on the increased consumption of health-care resources, considered proxies of comorbidities.

摘要

背景

2020 年初,伦巴第大区受到 SARS-CoV-2 大流行的影响,发病率和死亡率非常高。COVID-19 后状况及其相关的公共卫生负担知之甚少。

设置和设计

使用包括所有 48932 名在 2020 年 5 月 31 日之前因 SARS-CoV-2 聚合酶链反应转为阴性而幸存 COVID-19 的个体的区域人口行政数据库,评估了在 6 个月的中期内,20521 名在家中接受管理、26016 名在病房住院和 1611 名在重症监护病房(ICU)住院的个体的死亡率、再次住院、到医院急诊室就诊和门诊就诊情况。这些数据还评估了该地区尚未受到大流行影响的 2019 年同期的数据。还评估了与 COVID-19 后状况相关的其他卫生保健负担指标和替代指标。

主要结果

在先前入住 ICU 和病房的个体中,在 SARS-CoV-2 转阴后的 6 个月内,再次住院、到医院急诊室就诊和门诊就诊的频率比大流行前同期高得多。在 ICU 住院的患者中,肺活量测定的表现增加了 50 多倍,胸部 CT 扫描增加了 32 倍,非 ICU 患者增加了 5.5 倍,心电图检查在 ICU 患者中增加了 5.6 倍,在非 ICU 患者中增加了 2 倍。所有患者的药物和生化检查使用均增加。

结论

这些结果提供了 COVID-19 后状况及其对增加卫生保健资源消耗的影响的真实写照,被认为是合并症的替代指标。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fd0/9115275/79a8d11fc219/JOIM-9999-0-g002.jpg

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