A real world analysis of COVID-19 impact on hospitalizations in older adults with chronic conditions from an Italian region | Scientific Reports -…

In our study, we found that in Lombardyone of the most heavily areas hit by COVID-19 pandemic in Italy, probably on account of its elderly population and the fact that was the first area to be reached by COVID-19 outside Chinahospitalizations in older chronic patients have decreased by about 14% compared to the three previous years a consequence of the pressure the COVID-19 pandemic posed on health services. Such decreases were observed mainly for day-hospital hospitalizations and those involving surgical procedures. Consistent reductions in hospitalizations were found in individuals with many chronic conditions, but they were stronger in those with active tumours (by 53%), particularly when necessitating surgery (by 67%). We observed a decrease in hospitalizations for most MDCs, with the exception of those of the respiratory system, which are likely related to COVID-19. Considering the fact that we did not exclude hospitalizations due to COVID-19-related diagnoses, the reductions in hospital access during the 2020 COVID-19 pandemic could have been even larger in these populations. This notwithstanding, the declines in hospitalizations for chronic patients were more limited than those observed in non-chronic individuals.

Studies on the impact of COVID-19 emergency on hospitalization patterns in individuals with chronic conditions are scanty. A few earlier studies investigated hospitalization for acute (mainly cardiovascular) conditions and access to emergency departments, reporting significant reductions in hospitalization for acute myocardial infarction, stroke, heart failure, and other cardiovascular diseases20,21,23,25,26,27,28,29,30,31.

Consistently, in our study we found that individuals with various cardiovascular conditions, including ischemic and valvular cardiopathy, heart failure, and arterial and cerebral vasculopathy, had a reduced access to hospital during 2020. This notwithstanding the fact that individuals with cardiovascular diseasesas those with many other chronic conditionsmay have been at an increased risk of hospitalization for COVID-1915,17.

To the best of our knowledge no study investigated the impact of COVID-19 in individuals with diabetes32. We found an approximately 30% increase in hospitalizations for individuals with diabetes. This appears to be largely due to the rises in hospitalizations due to diseases of the nervous, respiratory, and circulatory system, which are likely attributable to COVID-19. Patients diabetes have indeed been reported to be among those at a high risk of more severe SARS-CoV-2 infection requiring hospitalization, due to the frequent presence of other concomitant disease15,17. The significant reduction in hospitalizations for diseases of the skin, musculoskeletal and connective tissue, on the contrary, can be due to a more frequent treatment at home during the COVID-19 emergency of diabetes-related complications included in MDC 09.

A few previous studies, mainly conducted in a single centre and on specific cancer sites, reported a reduction in hospital access in cancer patients during 202030. Our study confirms that hospitalizations for individuals with an active tumour, particularly those involving surgery, were strongly reduced during the COVID-19 pandemic in 2020. In cancer patients, hospitalizations declined particularly for diseases in MDC 09 which include malignancies of the breast. Our data underline the difficulty in providing optimal health care in cancer patients, that appear to be among those that suffered the most for the lack of necessary cure during the COVID-19 crisis33. The reduction in hospitalizations for cancer patients may have significant long-term effects on morbidity and mortality in those patients. It has indeed been estimated that even modest delays in surgery for cancer will determine a significant impact on survival34, and a few studies already reported an increase in out-of-hospital mortality mainly driven by deaths for neoplasms, cardiovascular and endocrine diseases20, although there will need some more time to quantify the exact extent of such impact.

With reference to respiratory diseases, we found an increase in hospitalizations for COPD but not for asthma. The increases in hospitalization of patients with COPD are likely due to the higher frequency of severe relapse of the illness and also of potentially COVID-19-related diseases, which have been shown to be at increased risk of SARS-CoV-2 infection15,17. However, a few previous studies which could analyse non-COVID-19 related hospitalizations for acute asthma and other respiratory diseases reported significant reductions, which have been partly attributed to a reduced exposure to air pollutants and other respiratory infections during the COVID-19 lockdowns23,26,28,30.

Among other chronic conditions, we reported a reduction by 30% in hospitalizations among patients with chronic renal failure. This is consistent with findings from a recent meta-analysis indicating that the COVID-19 pandemic led to reductions in access to kidney transplantation, dialysis, and in-person nephrology care, with an overall a 50% reduction in nephrology-related hospital admissions reported in four studies on a total of 4873 patients35.

There are two major explanations of the observed decrease in hospitalizations for many chronic patients, the first linked the reduction of health service offer, due to the restrictions in hospital services, with the reallocation of several hospital departments and personnel to the care of COVID-19 patients and the consequent cancellations of elective, routine, and non-urgent treatments, and the second related to the limited patients access, due to the patients fear of SARS-CoV-2 infection which kept them away from hospital, as well as from other health care services26,31,35. It is also possible that underlining trends in hospitalization explain some of our findings, although we did not find any meaningful trends in hospitalizations for chronic patients over the four calendar years considered.

Our study has the strength to be a large real-world, population-based study conducted on all older adults with chronic diseases in the study areas (including over 2.3 million older adults and 400,000 chronic patients), while most previous studies were conducted in single or few centres, and were focused on specific conditions. Most previous studies, moreover, were conducted on acute conditions, while very few analysed accesses to hospital among chronic patients. Furthermore, we could compare two populations from northern Italyboth particularly hit by COVID-19 during the first and second waveswhich provided extremely consistent results. Among the major limitations of the study, there is the fact that we could not distinguish COVID-19-related hospitalizations, since at the time of our analyses we had no information on hospitalizations for this cause. Considering that hospitalizations primarily due to COVID-19 have subsequently been estimated to be approximatively 7% in our population, the reductions in hospital access during the 2020 COVID-19 pandemic could have been even larger. Moreover, we could not analyse other outcomes, as cause-specific mortality rates, because no data on cause of death were available in our data.

In conclusion, the present study provides evidence of a significantly reduced hospital care for older adults with chronic conditions during the COVID-19 pandemic. This was noted in particular for those with cancer and necessitating surgery, suggesting that those patients may not have been receiving adequate health services and treatments since the pandemic began, with likely detrimental health consequences on the medium and long run. However, the declines in hospitalization rates were more modest than those observed in non-chronic patients, indicating that during the outbreaks of COVID-19 in 2020 there some attempt to foster the cure for these more vulnerable individuals.

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A real world analysis of COVID-19 impact on hospitalizations in older adults with chronic conditions from an Italian region | Scientific Reports -...