Stevens Maria A, Melnick Edward R, Savitz Samuel T, Jeffery Molly Moore, Nath Bidisha, Janke Alexander T
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic Rochester Minnesota USA.
Division of Health Care Delivery Research Mayo Clinic Rochester Minnesota USA.
J Am Coll Emerg Physicians Open. 2023 Aug 12;4(4):e13023. doi: 10.1002/emp2.13023. eCollection 2023 Aug.
To evaluate trends in emergency care sensitive conditions (ECSCs) from pre-COVID (March 2018-February 2020) through Omicron (December 2021-February 2022).
This cross-sectional analysis evaluated trends in ECSCs using claims (OptumLabs Data Warehouse) from commercial and Medicare Advantage enrollees. Emergency department (ED) visits for ECSCs (acute appendicitis, aortic aneurysm/dissection, cardiac arrest/severe arrhythmia, cerebral infarction, myocardial infarction, pulmonary embolism, opioid overdose, pre-eclampsia) were reported per 100,000 person months from March 2018 to February 2022 by pandemic wave. We calculated the percent change for each pandemic wave compared to the pre-pandemic period.
There were 10,268,554 ED visits (March 2018-February 2022). The greatest increases in ECSCs were seen for pulmonary embolism, cardiac arrest/severe arrhythmia, myocardial infarction, and pre-eclampsia. For commercial enrollees, pulmonary embolism visit rates increased 22.7% (95% confidence interval [CI], 18.6%-26.9%) during Waves 2-3, 37.2% (95% CI, 29.1%-45.8%] during Delta, and 27.9% (95% CI, 20.3%-36.1%) during Omicron, relative to pre-pandemic rates. Cardiac arrest/severe arrhythmia visit rates increased 4.0% (95% CI, 0.2%-8.0%) during Waves 2-3; myocardial infarction rates increased 4.9% (95% CI, 2.1%-7.8%) during Waves 2-3. Similar patterns were seen in Medicare Advantage enrollees. Pre-eclampsia visit rates among reproductive-age female enrollees increased 31.1% (95% CI, 20.9%-42.2%), 23.7% (95% CI, 7.5%,-42.3%), and 34.7% (95% CI, 16.8%-55.2%) during Waves 2-3, Delta, and Omicron, respectively. ED visits for other ECSCs declined or exhibited smaller increases.
ED visit rates for acute cardiovascular conditions, pulmonary embolism and pre-eclampsia increased despite declines or stable rates for all-cause ED visits and ED visits for other conditions. Given the changing landscape of ECSCs, studies should identify drivers for these changes and interventions to mitigate them.
评估从新冠疫情前（2018年3月至2020年2月）到奥密克戎毒株流行期（2021年12月至2022年2月）期间急诊护理敏感疾病（ECSCs）的趋势。
本横断面分析利用商业保险和医疗保险优势计划参保者的理赔数据（OptumLabs数据仓库）评估ECSCs的趋势。按疫情阶段报告了2018年3月至2022年2月期间每10万人月因ECSCs（急性阑尾炎、主动脉瘤/夹层、心脏骤停/严重心律失常、脑梗死、心肌梗死、肺栓塞、阿片类药物过量、先兆子痫）而进行的急诊就诊情况。我们计算了每个疫情阶段相较于疫情前时期的变化百分比。
共有10268554次急诊就诊（2018年3月至2022年2月）。肺栓塞、心脏骤停/严重心律失常、心肌梗死和先兆子痫的ECSCs增加最为显著。对于商业保险参保者，与疫情前相比，在第2 - 3波期间肺栓塞就诊率增加了22.7%（95%置信区间[CI]，18.6% - 26.9%），在德尔塔毒株流行期增加了37.2%（95% CI，29.1% - 45.8%），在奥密克戎毒株流行期增加了27.9%（95% CI，20.3% - 36.1%）。心脏骤停/严重心律失常就诊率在第2 - 3波期间增加了4.0%（95% CI，0.2% - 8.0%）；心肌梗死就诊率在第2 - 3波期间增加了4.9%（95% CI，2.1% - 7.8%）。医疗保险优势计划参保者中也观察到类似模式。育龄期女性参保者中先兆子痫就诊率在第2 - 3波、德尔塔毒株流行期和奥密克戎毒株流行期分别增加了31.1%（95% CI，20.9% - 42.2%）、23.7%（95% CI，7.5% - 42.3%）和34.7%（95% CI，16.8% - 55.2%）。其他ECSCs的急诊就诊次数减少或增加幅度较小。
尽管全因急诊就诊次数以及其他疾病的急诊就诊次数有所下降或保持稳定，但急性心血管疾病、肺栓塞和先兆子痫的急诊就诊率仍有所上升。鉴于ECSCs情况的变化，研究应确定这些变化的驱动因素以及减轻这些变化的干预措施。
