Vargas Maria Espinoza, Gershon Andrea S, Pugliese Michael, Gotfrit Ryan Jason, Manuel Douglas, Sadatsafavi Mohsen, Stukel Therese A, To Teresa, Kendall Claire E, Thavorn Kednapa, Robillard Rebecca, Kendzerska Tetyana
The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
ICES, Ottawa, Toronto, ON, Canada.
Can J Neurol Sci. 2024 Sep;51(5):616-626. doi: 10.1017/cjn.2023.316. Epub 2023 Dec 20.
We conducted a population-based study using Ontario health administrative data to describe trends in healthcare utilization and mortality in adults with epilepsy during the first pandemic year (March 2020-March 2021) compared to historical data (2016-2019). We also investigated if changes in outpatient visits and diagnostic testing during the first pandemic year were associated with increased risk for hospitalizations, emergency department (ED) visits, or death.
Projected monthly visit rates (per 100,000 people) for outpatient visits, electroencephalography, magnetic resonance, computed tomography, all-cause ED visits, hospitalizations, and mortality were calculated based on historical data by fitting monthly time series autoregressive integrated moving-average models. Two-way interactions were calculated using Quasi-Poisson models.
In adults with epilepsy during the first quarter of the pandemic, we demonstrated a reduction in all-cause outpatient visits, diagnostic testing, ED visits and hospitalizations, and a temporary increase in mortality (observed rates of 355.8 vs projected 308.8, 95% CI: 276.3-345.1). By the end of the year, outpatient visits increased (85,535.4 vs 76,620.6, 95% CI: 71,546.9-82,059.4), and most of the diagnostic test rates returned to the projected. The increase in the rate of all-cause mortality during the pandemic, compared to pre-pandemic, was greater during months with the lower frequency of diagnostic tests than months with higher frequency (interaction -values <.0001).
We described the impact of the pandemic on healthcare utilization and mortality in adults with epilepsy during the first year. We demonstrated that access to relevant diagnostic testing is likely important for this population while planning restrictions on non-urgent health services.
我们利用安大略省卫生行政数据进行了一项基于人群的研究，以描述癫痫成年患者在大流行的第一年（2020年3月至2021年3月）与历史数据（2016 - 2019年）相比的医疗保健利用和死亡率趋势。我们还调查了大流行第一年门诊就诊和诊断检测的变化是否与住院、急诊就诊或死亡风险增加相关。
通过拟合月度时间序列自回归积分移动平均模型，根据历史数据计算门诊就诊、脑电图、磁共振成像、计算机断层扫描、全因急诊就诊、住院和死亡率的预计月度就诊率（每10万人）。使用准泊松模型计算双向交互作用。
在大流行的第一季度，癫痫成年患者的全因门诊就诊、诊断检测、急诊就诊和住院减少，死亡率暂时增加（观察率为355.8，而预计为308.8，95%置信区间：276.3 - 345.1）。到年底，门诊就诊增加（85,535.4对76,620.6，95%置信区间：71,546.9 - 82,059.4），大多数诊断检测率恢复到预计水平。与大流行前相比，大流行期间诊断检测频率较低的月份全因死亡率增加幅度大于频率较高的月份（交互作用值<.0001）。
我们描述了大流行第一年对癫痫成年患者医疗保健利用和死亡率的影响。我们证明，在规划对非紧急医疗服务的限制时，获得相关诊断检测对该人群可能很重要。
