Poucineau Jonas, Delory Tristan, Lapidus Nathanaël, Hejblum Gilles, Chouaïd Christos, Le Cœur Sophie, Khlat Myriam
French Institute for Demographic Studies (INED), Mortality, Health and Epidemiology Unit, Aubervilliers, France.
Institute for Research and Information in Health Economics (IRDES), Paris, France.
Front Med (Lausanne). 2022 Sep 16;9:995016. doi: 10.3389/fmed.2022.995016. eCollection 2022.
A global reduction in hospital admissions for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) was observed during the first months of the COVID-19 pandemic. Large-scale studies covering the entire pandemic period are lacking. We investigated hospitalizations for AECOPD and the associated in-hospital mortality at the national level in France during the first 2 years of the pandemic.
We used the French National Hospital Database to analyse the time trends in (1) monthly incidences of hospitalizations for AECOPD, considering intensive care unit (ICU) admission and COVID-19 diagnoses, and (2) the related in-hospital mortality, from January 2016 to November 2021. Pandemic years were compared with the pre-pandemic years using Poisson regressions.
The database included 565,890 hospitalizations for AECOPD during the study period. The median age at admission was 74 years (interquartile range 65-83), and 37% of the stays concerned women. We found: (1) a dramatic and sustainable decline in hospitalizations for AECOPD over the pandemic period (from 8,899 to 6,032 monthly admissions, relative risk (RR) 0.65, 95% confidence interval (CI) 0.65-0.66), and (2) a concomitant increase in in-hospital mortality for AECOPD stays (from 6.2 to 7.6% per month, RR 1.24, 95% CI 1.21-1.27). The proportion of stays yielding ICU admission was similar in the pre-pandemic and pandemic years, 21.5 and 21.3%, respectively. In-hospital mortality increased to a greater extent for stays without ICU admission (RR 1.39, 95% CI 1.35-1.43) than for those with ICU admission (RR 1.09, 95% CI 1.05-1.13). Since January 2020, only 1.5% of stays were associated with a diagnosis of COVID-19, and their mortality rate was nearly three-times higher than those without COVID-19 (RR 2.66, 95% CI 2.41-2.93).
The decline in admissions for AECOPD during the pandemic could be attributed to a decrease in the incidence of exacerbations for COPD patients and/or to a possible shift from hospital to community care. The rise in in-hospital mortality is partially explained by COVID-19, and could be related to restricted access to ICUs for some patients and/or to greater proportions of severe cases among the patients hospitalized during the pandemic.
在2019年冠状病毒病（COVID-19）大流行的最初几个月，观察到慢性阻塞性肺疾病急性加重（AECOPD）的住院人数在全球范围内有所减少。缺乏涵盖整个大流行时期的大规模研究。我们调查了大流行的头两年法国全国范围内AECOPD的住院情况及其相关的院内死亡率。
我们使用法国国家医院数据库分析了2016年1月至2021年11月期间（1）考虑重症监护病房（ICU）入院和COVID-19诊断的AECOPD住院月发病率的时间趋势，以及（2）相关的院内死亡率。使用泊松回归将大流行年份与大流行前年份进行比较。
在研究期间，该数据库包括565,890例AECOPD住院病例。入院时的中位年龄为74岁（四分位间距65 - 83岁），37%的住院病例为女性。我们发现：（1）在大流行期间AECOPD的住院人数急剧且持续下降（从每月8899例降至6032例，相对风险（RR）0.65，95%置信区间（CI）0.65 - 0.66），以及（2）AECOPD住院的院内死亡率随之增加（从每月6.2%升至7.6%，RR 1.24，95% CI 1.21 - 1.27）。大流行前和大流行年份入住ICU的住院病例比例相似，分别为21.5%和21.3%。未入住ICU的住院病例的院内死亡率上升幅度（RR 1.39，95% CI 1.35 - 1.43）大于入住ICU的病例（RR 1.09，95% CI 1.05 - 1.13）。自2020年1月以来，只有1.5%的住院病例与COVID-19诊断相关，其死亡率几乎是未感染COVID-19病例的三倍（RR 2.66，95% CI 2.41 - 2.93）。
大流行期间AECOPD住院人数的下降可能归因于COPD患者急性加重发生率的降低和/或从医院护理向社区护理的可能转变。院内死亡率的上升部分可由COVID-19解释，并且可能与一些患者进入ICU的机会受限和/或大流行期间住院患者中重症病例比例较高有关。
Zotero 插件