Department of Preventive Medicine, Dongguk University College of Medicine, Gyeongju, Korea.
Department of Occupational and Environmental Medicine, Dongguk University Gyeongju Hospital, Gyeongju, Korea.
Epidemiol Health. 2024;46:e2024081. doi: 10.4178/epih.e2024081. Epub 2024 Oct 1.
This study investigated the impact of the coronavirus disease 2019 (COVID-19) pandemic and associated control strategies on the incidence of appendicitis in Seoul, using data from 2018 to 2020 from Korea's National Health Insurance.
We analyzed records of total, complicated, and uncomplicated appendicitis cases, as well as the ratio of complicated to uncomplicated appendicitis, using natural spline and piecewise regression models to identify trends and breakpoints. Bayesian structural time-series (BSTS) models were used to evaluate the causal impact of social distancing on appendicitis incidences.
The spline regression analysis indicated decreasing trends in both total and uncomplicated appendicitis cases. Conversely, the incidence of complicated appendicitis and the ratio of complicated to uncomplicated cases increased. Breakpoints for a decline in uncomplicated appendicitis and a rise in the ratio occurred at 31 weeks in 2020 (95% confidence interval [CI], 23.2 to 38.8) and at 33.9 weeks (95% CI, 28.3 to 39.6), respectively. The BSTS model demonstrated a 7.8% reduction in total appendicitis cases (95% credible interval [CrI], -12.1 to -3.3). It also showed a 17.4% decrease in uncomplicated cases (95% CrI, -22.2 to -12.3) and increases of 12.8% (95% CrI, 4.9 to 22.0) in complicated cases and 39.0% (95% CrI, 27.0 to 53.3) in the ratio of complicated to uncomplicated appendicitis.
The COVID-19 pandemic resulted in a decrease in both total and uncomplicated appendicitis cases, while the number of complicated cases increased. Reduced medical visits likely accounted for these changes. Strategies are needed to manage changes in disease pathophysiology resulting from altered healthcare utilization during health crises.
本研究利用韩国国家健康保险 2018 年至 2020 年的数据，探讨 2019 年冠状病毒病（COVID-19）大流行及相关控制策略对首尔阑尾炎发病率的影响。
我们使用自然样条和分段回归模型分析了总阑尾炎、复杂阑尾炎和单纯阑尾炎病例以及复杂与单纯阑尾炎的比例，以确定趋势和转折点。贝叶斯结构时间序列（BSTS）模型用于评估社会隔离对阑尾炎发病率的因果影响。
样条回归分析表明，总阑尾炎和单纯阑尾炎的发病率均呈下降趋势。相反，复杂阑尾炎的发病率和复杂与单纯阑尾炎的比例均有所上升。单纯阑尾炎发病率下降和复杂与单纯阑尾炎比例上升的转折点分别出现在 2020 年第 31 周（95%置信区间[CI]，23.2 至 38.8）和第 33.9 周（95% CI，28.3 至 39.6）。BSTS 模型显示总阑尾炎病例减少 7.8%（95%可信区间[CrI]，-12.1 至-3.3）。单纯性阑尾炎病例减少 17.4%（95% CrI，-22.2 至-12.3），复杂性阑尾炎病例增加 12.8%（95% CrI，4.9 至 22.0），复杂性与单纯性阑尾炎的比例增加 39.0%（95% CrI，27.0 至 53.3）。
COVID-19 大流行导致总阑尾炎和单纯性阑尾炎病例减少，而复杂性阑尾炎病例增加。就诊次数减少可能是导致这些变化的原因。需要制定策略来管理因医疗保健利用改变而导致的疾病病理生理学变化。
