The Hospital for Sick Children, Toronto, Ontario, Canada.
Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada.
JAMA Netw Open. 2023 Nov 1;6(11):e2343318. doi: 10.1001/jamanetworkopen.2023.43318.
Severe respiratory disease declined during the COVID-19 pandemic, partially due to decreased circulation of respiratory pathogens. However, the outcomes of children with higher risk have not been described using population-based data.
To compare respiratory-related hospitalizations, intensive care unit (ICU) admissions, and mortality during the pandemic vs prepandemic, among children with medical complexity (CMC) and without medical complexity (non-CMC).
DESIGN, SETTING, AND PARTICIPANTS: This population-based repeated cross-sectional study used Canadian health administrative data of children aged younger than 18 years in community and pediatric hospitals during a pandemic period (April 1, 2020, to February 28, 2022) compared with a 3-year prepandemic period (April 1, 2017, to March 31, 2020). The pandemic period was analyzed separately for year 1 (April 1, 2020, to March 31, 2021) and year 2 (April 1, 2021, to February 28, 2022). Statistical analysis was performed from October 2022 to April 2023.
Respiratory-related hospitalizations, ICU admissions, and mortality before and during the pandemic among CMC and non-CMC.
A total of 139 078 respiratory hospitalizations (29 461 respiratory hospitalizations for CMC and 109 617 for non-CMC) occurred during the study period. Among CMC, there were fewer respiratory hospitalizations in both 2020 (rate ratio [RR], 0.44 [95% CI, 0.42-0.46]) and 2021 (RR, 0.55 [95% CI, 0.51-0.62]) compared with the prepandemic period. Among non-CMC, there was an even larger relative reduction in respiratory hospitalizations in 2020 (RR, 0.18 [95% CI, 0.17-0.19]) and a similar reduction in 2021 (RR, 0.55 [95% CI, 0.54-0.56]), compared with the prepandemic period. Reductions in ICU admissions for respiratory illness followed a similar pattern for CMC (2020: RR, 0.56 [95% CI, 0.53-0.59]; 2021: RR, 0.66 [95% CI, 0.63-0.70]) and non-CMC (2020: RR, 0.22 [95% CI, 0.20-0.24]; RR, 0.65 [95% CI, 0.61-0.69]). In-hospital mortality for these conditions decreased among CMC in both 2020 (RR, 0.63 [95% CI, 0.51-0.77]) and 2021 (RR, 0.72 [95% CI, 0.59-0.87]).
This cross-sectional study found a substantial decrease in severe respiratory disease resulting in hospitalizations, ICU admissions, and mortality during the first 2 years of the pandemic compared with the 3 prepandemic years. These findings suggest that future evaluations of the effect of public health interventions aimed at reducing circulating respiratory pathogens during nonpandemic periods of increased respiratory illness may be warranted.
在 COVID-19 大流行期间，严重呼吸道疾病有所减少，部分原因是呼吸道病原体的循环减少。然而，使用基于人群的数据尚未描述具有更高风险的儿童的结果。
比较在大流行期间和大流行前，患有医疗复杂性 (CMC) 和无医疗复杂性 (非 CMC) 的儿童的与呼吸相关的住院、重症监护病房 (ICU) 入院和死亡率。
设计、地点和参与者：这项基于人群的重复横断面研究使用了加拿大社区和儿科医院的 18 岁以下儿童的加拿大卫生行政数据，在大流行期间（2020 年 4 月 1 日至 2022 年 2 月 28 日）与大流行前的 3 年（2017 年 4 月 1 日至 2020 年 3 月 31 日）进行比较。大流行期间分别分析了第 1 年（2020 年 4 月 1 日至 2021 年 3 月 31 日）和第 2 年（2021 年 4 月 1 日至 2022 年 2 月 28 日）。统计分析于 2023 年 10 月至 2023 年 4 月进行。
在大流行期间和大流行前，CMC 和非 CMC 儿童的与呼吸相关的住院、ICU 入院和死亡率。
研究期间共发生 139078 例呼吸住院治疗（29461 例 CMC 呼吸住院治疗和 109617 例非 CMC 呼吸住院治疗）。在 CMC 中，2020 年（RR，0.44 [95%CI，0.42-0.46]）和 2021 年（RR，0.55 [95%CI，0.51-0.62]）的呼吸住院治疗均明显减少。在非 CMC 中，2020 年的呼吸住院治疗相对减少幅度更大（RR，0.18 [95%CI，0.17-0.19]），2021 年的呼吸住院治疗减少幅度相似（RR，0.55 [95%CI，0.54-0.56]），与大流行前相比。呼吸疾病 ICU 入院减少的模式与 CMC 相似（2020 年：RR，0.56 [95%CI，0.53-0.59]；2021 年：RR，0.66 [95%CI，0.63-0.70]）和非 CMC（2020 年：RR，0.22 [95%CI，0.20-0.24]；RR，0.65 [95%CI，0.61-0.69]）。这些疾病的住院死亡率在 CMC 中均有所下降，2020 年（RR，0.63 [95%CI，0.51-0.77]）和 2021 年（RR，0.72 [95%CI，0.59-0.87]）。
这项横断面研究发现，与大流行前的 3 年相比，大流行的头 2 年严重呼吸道疾病导致住院、ICU 入院和死亡率大幅下降。这些发现表明，在呼吸道疾病增多的非大流行期间，评估旨在减少呼吸道病原体循环的公共卫生干预措施的效果可能是合理的。
