ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man.
CMAJ. 2024 Jan 15;196(1):E1-E13. doi: 10.1503/cmaj.221726.
The effects of the decline in health care use at the start of the COVID-19 pandemic on the health of children are unclear. We sought to estimate changes in rates of severe and potentially preventable health outcomes among children during the pandemic.
We conducted a repeated cross-sectional study of children aged 0-17 years using linked population health administrative and disease registry data from January 2017 through August 2022 in Ontario, Canada. We compared observed rates of emergency department visits and hospital admissions during the pandemic to predicted rates based on the 3 years preceding the pandemic. We evaluated outcomes among children and neonates overall, among children with chronic health conditions and among children with specific diseases sensitive to delays in care.
All acute care use for children decreased immediately at the onset of the pandemic, reaching its lowest rate in April 2020 for emergency department visits (adjusted relative rate [RR] 0.28, 95% confidence interval [CI] 0.28-0.29) and hospital admissions (adjusted RR 0.43, 95% CI 0.42-0.44). These decreases were sustained until September 2021 and May 2022, respectively. During the pandemic overall, rates of all-cause mortality, admissions for ambulatory care-sensitive conditions, newborn readmissions or emergency department visits or hospital admissions among children with chronic health conditions did not exceed predicted rates. However, after declining significantly between March and May 2020, new presentations of diabetes mellitus increased significantly during most of 2021 (peak adjusted RR 1.49, 95% CI 1.28-1.74 in July 2021) and much of 2022. Among these children, presentations for diabetic ketoacidosis were significantly higher than expected during the pandemic overall (adjusted RR 1.14, 95% CI 1.00-1.30). We observed similar time trends for new presentations of cancer, but we observed no excess presentations of severe cancer overall (adjusted RR 0.91, 95% CI 0.62-1.34).
In the first 30 months of the pandemic, disruptions to care were associated with important delays in new diagnoses of diabetes but not with other acute presentations of select preventable conditions or with mortality. Mitigation strategies in future pandemics or other health system disruptions should include education campaigns around important symptoms in children that require medical attention.
COVID-19 大流行开始时医疗保健使用量下降对儿童健康的影响尚不清楚。我们试图估计大流行期间儿童严重和潜在可预防健康结果的发生率变化。
我们使用加拿大安大略省 2017 年 1 月至 2022 年 8 月期间的人口健康行政和疾病登记数据，对 0-17 岁儿童进行了一项重复的横断面研究。我们将大流行期间的急诊就诊和住院率与大流行前 3 年的预测率进行了比较。我们评估了整体儿童和新生儿、患有慢性疾病的儿童以及对护理延迟敏感的特定疾病的儿童的结果。
大流行开始时，所有儿童的急性护理使用率立即下降，急诊就诊率在 2020 年 4 月达到最低水平（调整后的相对比率 [RR] 0.28，95%置信区间 [CI] 0.28-0.29）和住院率（调整后的 RR 0.43，95% CI 0.42-0.44）。这些下降一直持续到 2021 年 9 月和 2022 年 5 月。在大流行期间，整体而言，患有慢性疾病的儿童的所有原因死亡率、门诊保健敏感疾病的住院率、新生儿再入院或急诊就诊或住院率均未超过预测率。然而，在 2020 年 3 月至 5 月期间显著下降后，2021 年大部分时间（2021 年 7 月调整后的 RR 为 1.49，95%CI 为 1.28-1.74）和 2022 年大部分时间内，新诊断的糖尿病明显增加。在这些儿童中，糖尿病酮症酸中毒的就诊率明显高于大流行期间的预期水平（调整后的 RR 为 1.14，95%CI 为 1.00-1.30）。我们观察到癌症新发病例的类似时间趋势，但总体上未观察到严重癌症的就诊率过高（调整后的 RR 为 0.91，95%CI 为 0.62-1.34）。
在大流行的头 30 个月中，护理中断与新诊断糖尿病的重要延误有关，但与其他选定可预防疾病的急性就诊或死亡率无关。未来大流行或其他卫生系统中断的缓解策略应包括针对需要医疗关注的儿童的重要症状的教育活动。
