Non-COVID-19 patients in times of pandemic: Emergency department visits, hospitalizations and cause-specific mortality in Northern Italy

PLoS One. 2021 Mar 22;16(3):e0248995. doi: 10.1371/journal.pone.0248995. eCollection 2021.

Abstract

The COVID-19 pandemic forced healthcare services organization to adjust to mutating healthcare needs. Not exhaustive data are available on the consequences of this on non-COVID-19 patients. The aim of this study was to assess the impact of the pandemic on non-COVID-19 patients living in a one-million inhabitants' area in Northern Italy (Bologna Metropolitan Area-BMA), analyzing time trends of Emergency Department (ED) visits, hospitalizations and mortality. We conducted a retrospective observational study using data extracted from BMA healthcare informative systems. Weekly trends of ED visits, hospitalizations, in- and out-of-hospital, all-cause and cause-specific mortality between December 1st, 2019 to May 31st, 2020, were compared with those of the same period of the previous year. Non-COVID-19 ED visits and hospitalizations showed a stable trend until the first Italian case of COVID-19 has been recorded, on February 19th, 2020, when they dropped simultaneously. The reduction of ED visits was observed in all age groups and across all severity and diagnosis groups. In the lockdown period a significant increase was found in overall out-of-hospital mortality (43.2%) and cause-specific out-of-hospital mortality related to neoplasms (76.7%), endocrine, nutritional and metabolic (79.5%) as well as cardiovascular (32.7%) diseases. The pandemic caused a sudden drop of ED visits and hospitalizations of non-COVID-19 patients during the lockdown period, and a concurrent increase in out-of-hospital mortality mainly driven by deaths for neoplasms, cardiovascular and endocrine diseases. As recurrencies of the COVID-19 pandemic are underway, the scenario described in this study might be useful to understand both the population reaction and the healthcare system response at the early phases of the pandemic in terms of reduced demand of care and systems capability in intercepting it.

MeSH terms

  • COVID-19 / epidemiology
  • COVID-19 / pathology
  • COVID-19 / virology
  • Cardiovascular Diseases / mortality
  • Cardiovascular Diseases / pathology
  • Cause of Death*
  • Emergency Service, Hospital / statistics & numerical data*
  • Hospitalization / statistics & numerical data*
  • Humans
  • Italy / epidemiology
  • Metabolic Diseases / mortality
  • Metabolic Diseases / pathology
  • Neoplasms / mortality
  • Neoplasms / pathology
  • Pandemics
  • Quarantine
  • Retrospective Studies
  • SARS-CoV-2 / isolation & purification

Grants and funding

The authors received no specific funding for this work.