Saqib Kiran, Dubin Joel A, Goel Vivek, VanderDoes Jeremy, Butt Zahid A
School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada.
BMJ Public Health. 2025 Mar 18;3(1):e001576. doi: 10.1136/bmjph-2024-001576. eCollection 2025.
This study explores changing patterns of healthcare utilisation for chronic diseases during the COVID-19 pandemic in Ontario, Canada. It compares prepandemic and pandemic morbidity and mortality, focusing on physician and emergency department visits, hospitalisations for anxiety, depression and chronic diseases, as well as all-cause mortality rates.
We constructed a cohort of 2 950 384 adults (18+ years), using administrative health databases, who were living in Ontario, Canada, between the period of January 2017 and March 2023 and recorded the number of visits each individual had in the follow-up period related to chronic conditions. The data were then analysed using an interrupted time-series design to observe changes from before compared with during the pandemic in (1) monthly physician or emergency visits and hospitalisations and (2) monthly all-cause deaths. The exposure in this study was the onset of the COVID-19 pandemic in Ontario, Canada.
In the prepandemic period, mean monthly PCR-tested visits in Ontario were 364 880, with a steady increase of 1210 visits per month. During the initial phase of the COVID-19 pandemic, there was a decline in physician visits and hospitalisations for chronic diseases. This trend changed, leading to a significant rise in visits that peaked in March 2021, increasing by 1690 visits monthly. From 2022 onwards, visits saw a notable decline, decreasing by 6830 per month (p<0.05), reflecting reduced healthcare utilisation in the later pandemic phases.
The COVID-19 pandemic caused significant fluctuations in healthcare utilisation in Ontario. These changes suggest increased risks of missed diagnoses and delayed care, impacting morbidity and mortality. The results emphasise the importance of adaptable healthcare systems and strong pandemic preparedness to maintain care continuity, especially for chronic disease management, during resource-limited periods.
本研究探讨了加拿大安大略省在新冠疫情期间慢性病医疗服务利用模式的变化。它比较了疫情前和疫情期间的发病率和死亡率，重点关注医生诊疗、急诊科就诊、焦虑症、抑郁症和慢性病住院情况以及全因死亡率。
我们利用行政卫生数据库构建了一个由2950384名成年人（18岁及以上）组成的队列，这些人在2017年1月至2023年3月期间居住在加拿大安大略省，并记录了随访期间每个人与慢性病相关的就诊次数。然后使用中断时间序列设计对数据进行分析，以观察疫情前与疫情期间在以下方面的变化：（1）每月的医生诊疗或急诊就诊及住院情况；（2）每月的全因死亡情况。本研究中的暴露因素是加拿大安大略省新冠疫情的爆发。
在疫情前时期，安大略省每月接受聚合酶链反应检测的就诊平均次数为364880次，每月稳步增加1210次。在新冠疫情初期，慢性病的医生诊疗和住院次数有所下降。这一趋势发生了变化，导致就诊次数大幅上升，在2021年3月达到峰值每月增加1690次。从2022年起，就诊次数显著下降，每月减少6830次（p<0.05），反映出疫情后期医疗服务利用减少。
新冠疫情导致安大略省医疗服务利用出现显著波动。这些变化表明漏诊和延误治疗的风险增加，影响发病率和死亡率。结果强调了适应性强的医疗系统和强大的疫情防范措施对于在资源有限时期维持医疗服务连续性的重要性，尤其是对于慢性病管理。
