Denmark Saw Fewer Non-COVID-19 Hospitalizations, Higher 30-Day Mortality During Lockdowns

By Brandon May

June 09, 2021

NEW YORK (Reuters Health) - Denmark saw a drastic reduction in hospital admissions for diseases other than COVID-19 during the national lockdowns last year, and this decrease tended to be accompanied by increased death rates among those hospitalized, according to new findings.

The reasons behind the higher mortality are complex, however, Dr. Jacob Bodilsen of Aalborg University Hospital told Reuters Health by email.

"First, the re-organization of healthcare services combined with extensive media coverage of mortality and morbidity associated with COVID-19 may have selected for only the most severely ill patients to be hospitalized during the pandemic," thus driving up mortality, he said.

But it's also possible that some patients may have ignored symptoms of serious disease and delayed going to a hospital during the pandemic, he added, resulting in more-severe disease at time of admission.

Previous observations suggest that, early in the pandemic, many people with chronic or new-onset disease delayed visiting their doctors from fear of contracting the virus, and many elective interventions were put on hold.

"(W)e cannot exclude that the re-organization of essential healthcare services in Denmark during the pandemic may have disrupted standard of care and timeliness of treatment for patients with other acute or serious medical conditions than non-COVID-19," Dr. Bodilsen said. "This is also based on personal clinical observations, especially in mimics of COVID-19 such as sepsis, heart failure, pneumonia, and other serious respiratory diseases."

To gauge the pandemic's impact on non-COVID-19-related health outcomes, Dr. Bodilsen and his colleagues examined population-based healthcare registries encompassing the entire Danish population between March 2020 and January 2021.

They focused on comparing hospital admission and mortality rates during the pandemic with the pre-pandemic period spanning March 2019 to March 2020.

They identified 1.1 million hospitalizations among just over 675,000 people, the researchers report in The BMJ. The overall rate of admissions for conditions not related to COVID-19 dropped significantly over the study, from a mean of 204.1 per 100,000/week before the pandemic to 142.8 per 100,000/week during the first national lockdown (rate ratio, 0.70; 95% confidence interval, 0.66 to 0.74).

While there was a gradual return for hospital admissions to baseline levels, the rate decreased again to 158.3 per 100,000/week following the second national lockdown.

The overall 30-day mortality rates among those who were hospitalized were higher during the first lockdown (RR, 1.28; 95% CI, 1.23 to 1.32) and second lockdown (RR, 1.20; 95% CI, 1.16 to 1.24). The mortality increases were particularly pronounced for non-COVID-19 respiratory diseases, cancer, pneumonia and sepsis.

Dr. Bodilsen said the findings were consistent with previous study from different countries.

"Based on the overall population mortality and reports of fairly unchanged productivity of primary healthcare in Denmark during the pandemic, it seems like the lower hospitalizations rates for many conditions reflected a genuine decrease in disease occurrence," he added. In other words, it does not appear that people suffering heart attack or stroke had to go without needed medical care during the lockdowns, although this observation requires further study, according to the researcher.

Among other things, he said the study is "a reminder for healthcare administrators and clinical staff to ensure a continued focus on appropriate diagnostic algorithms and treatment of hospitalized patients despite the considerable challenges of providing high-quality care during times of extensive hygienic precautions, quarantines, and isolation procedures of patients until point-of-care test results for SARS-CoV-2 are available."

SOURCE: https://bit.ly/3pkJ7Bq The BMJ, online May 25, 2021.

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