Division of Pulmonary Medicine, Department of Medicine.
Alberta Respiratory Centre.
Ann Am Thorac Soc. 2024 Sep;21(9):1281-1288. doi: 10.1513/AnnalsATS.202312-1078OC.
Existing work suggests that patients with chronic obstructive pulmonary disease (pwCOPD) presented less frequently to the emergency department and were less likely to be hospitalized during the coronavirus disease (COVID-19) pandemic, but it is unclear if this was due to improved health and disease management or to increased barriers and/or avoidance of health care. The objective of this study was to determine the impact of the pandemic on inpatient and outpatient healthcare use, disease incidence, and mortality rates in pwCOPD. A retrospective population-based analysis using linked administrative datasets from Alberta, Canada 18 months before and after March 12, 2020 was conducted to measure hospitalization, emergency department and outpatient visits, and COPD outpatient exacerbations during these time periods. Mortality data were also analyzed before versus after the pandemic, taking confirmed COVID-19 infection within 30 days into account. Subgroup analysis based on COPD exacerbation risk stratification was undertaken to determine if healthcare use differed based on exacerbation risk. Finally, sex-based analysis of healthcare use during the pandemic was also completed. Hospitalization or emergency department visits and outpatient treatment for acute exacerbations of COPD dropped, whereas total outpatient COPD visits, including both virtual and in person, increased during the pandemic for pwCOPD. The mortality rate increased even after adjusting for COVID-19-associated deaths. Sex-based subgroup analysis showed a greater drop in acute care use for females, but the rise in mortality was seen for both sexes, with men experiencing a greater rate of mortality than women. Overall, pwCOPD accessed acute care resources less during the pandemic, which may have contributed to a rise in non-COVID-19 all-cause mortality.
现有研究表明，在冠状病毒病（COVID-19）大流行期间，慢性阻塞性肺疾病（pwCOPD）患者到急诊室就诊的频率较低，住院的可能性也较低，但尚不清楚这是由于健康状况和疾病管理的改善，还是由于获得医疗保健的障碍增加和/或对医疗保健的回避。本研究旨在确定大流行对 pwCOPD 患者住院和门诊医疗保健使用、疾病发病率和死亡率的影响。使用加拿大艾伯塔省的链接行政数据集，进行了回顾性基于人群的分析，该分析在 2020 年 3 月 12 日之前和之后的 18 个月内进行，以衡量这些时间段内的住院、急诊和门诊就诊以及 COPD 门诊加重的情况。还分析了大流行前后的死亡率数据，同时考虑了 COVID-19 感染确诊后 30 天内的情况。根据 COPD 加重风险分层进行亚组分析，以确定医疗保健使用是否因加重风险而异。最后，还完成了大流行期间基于性别的医疗保健使用分析。pwCOPD 的住院或急诊就诊和 COPD 急性加重的门诊治疗减少，而在大流行期间，包括虚拟和现场在内的 COPD 总门诊就诊增加。即使在调整了与 COVID-19 相关的死亡人数后，死亡率仍有所上升。基于性别的亚组分析显示，女性急性护理的使用率下降幅度更大，但男女两性的死亡率均有所上升，男性的死亡率高于女性。总体而言，pwCOPD 在大流行期间较少使用急性护理资源，这可能导致非 COVID-19 全因死亡率上升。
