Effects of COVID-19-targeted non-pharmaceutical interventions on pediatric hospital admissions in North Italian hospitals, 2017 to 2022: a quasi-experimental study interrupted time-series analysis
BackgroundThe use of Non-Pharmaceutical Interventions (NPIs), such as lockdowns, social distancing and school closures, against the COVID-19 epidemic is debated, particularly for the possible negative effects on vulnerable populations, including children and adolescents. This study therefore aimed t...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-04-01
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| Series: | Frontiers in Public Health |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2024.1393677/full |
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| author | Giuseppe Maglietta Matteo Puntoni Caterina Caminiti Andrea Pession Marcello Lanari Fabio Caramelli Federico Marchetti Alessandro De Fanti Lorenzo Iughetti Giacomo Biasucci Giacomo Biasucci Agnese Suppiej Andrea Miceli Chiara Ghizzi Gianluca Vergine Melodie Aricò Marcello Stella Susanna Esposito Susanna Esposito on behalf of Emilia-Romagna Paediatric COVID-19 network |
| author_facet | Giuseppe Maglietta Matteo Puntoni Caterina Caminiti Andrea Pession Marcello Lanari Fabio Caramelli Federico Marchetti Alessandro De Fanti Lorenzo Iughetti Giacomo Biasucci Giacomo Biasucci Agnese Suppiej Andrea Miceli Chiara Ghizzi Gianluca Vergine Melodie Aricò Marcello Stella Susanna Esposito Susanna Esposito on behalf of Emilia-Romagna Paediatric COVID-19 network |
| author_sort | Giuseppe Maglietta |
| collection | DOAJ |
| description | BackgroundThe use of Non-Pharmaceutical Interventions (NPIs), such as lockdowns, social distancing and school closures, against the COVID-19 epidemic is debated, particularly for the possible negative effects on vulnerable populations, including children and adolescents. This study therefore aimed to quantify the impact of NPIs on the trend of pediatric hospitalizations during 2 years of pandemic compared to the previous 3 years, also considering two pandemic phases according to the type of adopted NPIs.MethodsThis is a multicenter, quasi-experimental before-after study conducted in 12 hospitals of the Emilia-Romagna Region, Northern Italy, with NPI implementation as the intervention event. The 3 years preceding the beginning of NPI implementation (in March 2020) constituted the pre-pandemic phase. The subsequent 2 years were further subdivided into a school closure phase (up to September 2020) and a subsequent mitigation measures phase with less stringent restrictions. School closure was chosen as delimitation as it particularly concerns young people. Interrupted Time Series (ITS) regression analysis was applied to calculate Hospitalization Rate Ratios (HRR) on the diagnostic categories exhibiting the greatest variation. ITS allows the estimation of changes attributable to an intervention, both in terms of immediate (level change) and sustained (slope change) effects, while accounting for pre-intervention secular trends.ResultsOverall, in the 60 months of the study there were 84,368 cases. Compared to the pre-pandemic years, statistically significant 35 and 19% decreases in hospitalizations were observed during school closure and in the following mitigation measures phase, respectively. The greatest reduction was recorded for “Respiratory Diseases,” whereas the “Mental Disorders” category exhibited a significant increase during mitigation measures. ITS analysis confirms a high reduction of level change during school closure for Respiratory Diseases (HRR 0.19, 95%CI 0.08–0.47) and a similar but smaller significant reduction when mitigation measures were enacted. Level change for Mental Disorders significantly decreased during school closure (HRR 0.50, 95%CI 0.30–0.82) but increased during mitigation measures by 28% (HRR 1.28, 95%CI 0.98–1.69).ConclusionOur findings provide information on the impact of COVID-19 NPIs which may inform public health policies in future health crises, plan effective control and preventative interventions and target resources where needed. |
| first_indexed | 2024-04-24T07:48:52Z |
| format | Article |
| id | doaj.art-5c8e1238a97c42218331549f154cc6b2 |
| institution | Directory Open Access Journal |
| issn | 2296-2565 |
| language | English |
| last_indexed | 2024-04-24T07:48:52Z |
| publishDate | 2024-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Public Health |
| spelling | doaj.art-5c8e1238a97c42218331549f154cc6b22024-04-18T14:31:35ZengFrontiers Media S.A.Frontiers in Public Health2296-25652024-04-011210.3389/fpubh.2024.13936771393677Effects of COVID-19-targeted non-pharmaceutical interventions on pediatric hospital admissions in North Italian hospitals, 2017 to 2022: a quasi-experimental study interrupted time-series analysisGiuseppe Maglietta0Matteo Puntoni1Caterina Caminiti2Andrea Pession3Marcello Lanari4Fabio Caramelli5Federico Marchetti6Alessandro De Fanti7Lorenzo Iughetti8Giacomo Biasucci9Giacomo Biasucci10Agnese Suppiej11Andrea Miceli12Chiara Ghizzi13Gianluca Vergine14Melodie Aricò15Marcello Stella16Susanna Esposito17Susanna Esposito18on behalf of Emilia-Romagna Paediatric COVID-19 networkClinical and Epidemiological Research Unit, University Hospital of Parma, Parma, ItalyClinical and Epidemiological Research Unit, University Hospital of Parma, Parma, ItalyClinical and Epidemiological Research Unit, University Hospital of Parma, Parma, ItalyPediatric Clinic, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, ItalyPediatric Emergency Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, ItalyPediatric Intensive Care Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, ItalyPediatrics and Neonatology Unit, Ravenna Hospital, AUSL Romagna, Ravenna, ItalyPaediatrics Unit, Santa Maria Nuova Hospital, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, ItalyPediatrics Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, ItalyPediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, Piacenza, ItalyDepartment of Medicine and Surgery, University of Parma, Parma, Italy0Pediatric Clinic, University of Ferrara, Ferrara, Italy1Pediatric Unit, Pavullo Hospital, AUSL Modena, Modena, Italy2Paediatrics Unit, Maggiore Hospital, Bologna, Italy3Pediatric Clinic, Rimini Hospital, AUSL Romagna, Rimini, Italy4Pediatric Unit, G.B. Morgagni – L. Pierantoni Hospital, AUSL Romagna, Forlì, Italy5Pediatric Unit, AUSL Romagna, Cesena, Italy6Pediatric Clinic, University Hospital of Parma, Parma, Italy7Department of Medicine and Surgery, University of Parma, Parma, ItalyBackgroundThe use of Non-Pharmaceutical Interventions (NPIs), such as lockdowns, social distancing and school closures, against the COVID-19 epidemic is debated, particularly for the possible negative effects on vulnerable populations, including children and adolescents. This study therefore aimed to quantify the impact of NPIs on the trend of pediatric hospitalizations during 2 years of pandemic compared to the previous 3 years, also considering two pandemic phases according to the type of adopted NPIs.MethodsThis is a multicenter, quasi-experimental before-after study conducted in 12 hospitals of the Emilia-Romagna Region, Northern Italy, with NPI implementation as the intervention event. The 3 years preceding the beginning of NPI implementation (in March 2020) constituted the pre-pandemic phase. The subsequent 2 years were further subdivided into a school closure phase (up to September 2020) and a subsequent mitigation measures phase with less stringent restrictions. School closure was chosen as delimitation as it particularly concerns young people. Interrupted Time Series (ITS) regression analysis was applied to calculate Hospitalization Rate Ratios (HRR) on the diagnostic categories exhibiting the greatest variation. ITS allows the estimation of changes attributable to an intervention, both in terms of immediate (level change) and sustained (slope change) effects, while accounting for pre-intervention secular trends.ResultsOverall, in the 60 months of the study there were 84,368 cases. Compared to the pre-pandemic years, statistically significant 35 and 19% decreases in hospitalizations were observed during school closure and in the following mitigation measures phase, respectively. The greatest reduction was recorded for “Respiratory Diseases,” whereas the “Mental Disorders” category exhibited a significant increase during mitigation measures. ITS analysis confirms a high reduction of level change during school closure for Respiratory Diseases (HRR 0.19, 95%CI 0.08–0.47) and a similar but smaller significant reduction when mitigation measures were enacted. Level change for Mental Disorders significantly decreased during school closure (HRR 0.50, 95%CI 0.30–0.82) but increased during mitigation measures by 28% (HRR 1.28, 95%CI 0.98–1.69).ConclusionOur findings provide information on the impact of COVID-19 NPIs which may inform public health policies in future health crises, plan effective control and preventative interventions and target resources where needed.https://www.frontiersin.org/articles/10.3389/fpubh.2024.1393677/fullCOVID-19 epidemiologynon-pharmaceutical intervention (NPI)quasi-experimental designobservational studyInterrupted Time Series (ITS) regression analysistime series analysis |
| spellingShingle | Giuseppe Maglietta Matteo Puntoni Caterina Caminiti Andrea Pession Marcello Lanari Fabio Caramelli Federico Marchetti Alessandro De Fanti Lorenzo Iughetti Giacomo Biasucci Giacomo Biasucci Agnese Suppiej Andrea Miceli Chiara Ghizzi Gianluca Vergine Melodie Aricò Marcello Stella Susanna Esposito Susanna Esposito on behalf of Emilia-Romagna Paediatric COVID-19 network Effects of COVID-19-targeted non-pharmaceutical interventions on pediatric hospital admissions in North Italian hospitals, 2017 to 2022: a quasi-experimental study interrupted time-series analysis Frontiers in Public Health COVID-19 epidemiology non-pharmaceutical intervention (NPI) quasi-experimental design observational study Interrupted Time Series (ITS) regression analysis time series analysis |
| title | Effects of COVID-19-targeted non-pharmaceutical interventions on pediatric hospital admissions in North Italian hospitals, 2017 to 2022: a quasi-experimental study interrupted time-series analysis |
| title_full | Effects of COVID-19-targeted non-pharmaceutical interventions on pediatric hospital admissions in North Italian hospitals, 2017 to 2022: a quasi-experimental study interrupted time-series analysis |
| title_fullStr | Effects of COVID-19-targeted non-pharmaceutical interventions on pediatric hospital admissions in North Italian hospitals, 2017 to 2022: a quasi-experimental study interrupted time-series analysis |
| title_full_unstemmed | Effects of COVID-19-targeted non-pharmaceutical interventions on pediatric hospital admissions in North Italian hospitals, 2017 to 2022: a quasi-experimental study interrupted time-series analysis |
| title_short | Effects of COVID-19-targeted non-pharmaceutical interventions on pediatric hospital admissions in North Italian hospitals, 2017 to 2022: a quasi-experimental study interrupted time-series analysis |
| title_sort | effects of covid 19 targeted non pharmaceutical interventions on pediatric hospital admissions in north italian hospitals 2017 to 2022 a quasi experimental study interrupted time series analysis |
| topic | COVID-19 epidemiology non-pharmaceutical intervention (NPI) quasi-experimental design observational study Interrupted Time Series (ITS) regression analysis time series analysis |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2024.1393677/full |
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