Hospital admissions and mortality for acute exacerbations of COPD during the COVID-19 pandemic: A nationwide study in France
BackgroundA global reduction in hospital admissions for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) was observed during the first months of the COVID-19 pandemic. Large-scale studies covering the entire pandemic period are lacking. We investigated hospitalizations for AECOP...
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Frontiers Media S.A.
2022-09-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2022.995016/full |
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| author | Jonas Poucineau Jonas Poucineau Tristan Delory Tristan Delory Tristan Delory Nathanaël Lapidus Gilles Hejblum Christos Chouaïd Christos Chouaïd Sophie Le Cœur Myriam Khlat |
| author_facet | Jonas Poucineau Jonas Poucineau Tristan Delory Tristan Delory Tristan Delory Nathanaël Lapidus Gilles Hejblum Christos Chouaïd Christos Chouaïd Sophie Le Cœur Myriam Khlat |
| author_sort | Jonas Poucineau |
| collection | DOAJ |
| description | BackgroundA global reduction in hospital admissions for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) was observed during the first months of the COVID-19 pandemic. Large-scale studies covering the entire pandemic period are lacking. We investigated hospitalizations for AECOPD and the associated in-hospital mortality at the national level in France during the first 2 years of the pandemic.MethodsWe used the French National Hospital Database to analyse the time trends in (1) monthly incidences of hospitalizations for AECOPD, considering intensive care unit (ICU) admission and COVID-19 diagnoses, and (2) the related in-hospital mortality, from January 2016 to November 2021. Pandemic years were compared with the pre-pandemic years using Poisson regressions.ResultsThe database included 565,890 hospitalizations for AECOPD during the study period. The median age at admission was 74 years (interquartile range 65–83), and 37% of the stays concerned women. We found: (1) a dramatic and sustainable decline in hospitalizations for AECOPD over the pandemic period (from 8,899 to 6,032 monthly admissions, relative risk (RR) 0.65, 95% confidence interval (CI) 0.65–0.66), and (2) a concomitant increase in in-hospital mortality for AECOPD stays (from 6.2 to 7.6% per month, RR 1.24, 95% CI 1.21–1.27). The proportion of stays yielding ICU admission was similar in the pre-pandemic and pandemic years, 21.5 and 21.3%, respectively. In-hospital mortality increased to a greater extent for stays without ICU admission (RR 1.39, 95% CI 1.35–1.43) than for those with ICU admission (RR 1.09, 95% CI 1.05–1.13). Since January 2020, only 1.5% of stays were associated with a diagnosis of COVID-19, and their mortality rate was nearly three-times higher than those without COVID-19 (RR 2.66, 95% CI 2.41–2.93).ConclusionThe decline in admissions for AECOPD during the pandemic could be attributed to a decrease in the incidence of exacerbations for COPD patients and/or to a possible shift from hospital to community care. The rise in in-hospital mortality is partially explained by COVID-19, and could be related to restricted access to ICUs for some patients and/or to greater proportions of severe cases among the patients hospitalized during the pandemic. |
| first_indexed | 2024-12-10T10:37:38Z |
| format | Article |
| id | doaj.art-cbefce84d5164330b36e91f8656ab69c |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-10T10:37:38Z |
| publishDate | 2022-09-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Medicine |
| spelling | doaj.art-cbefce84d5164330b36e91f8656ab69c2022-12-22T01:52:23ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2022-09-01910.3389/fmed.2022.995016995016Hospital admissions and mortality for acute exacerbations of COPD during the COVID-19 pandemic: A nationwide study in FranceJonas Poucineau0Jonas Poucineau1Tristan Delory2Tristan Delory3Tristan Delory4Nathanaël Lapidus5Gilles Hejblum6Christos Chouaïd7Christos Chouaïd8Sophie Le Cœur9Myriam Khlat10French Institute for Demographic Studies (INED), Mortality, Health and Epidemiology Unit, Aubervilliers, FranceInstitute for Research and Information in Health Economics (IRDES), Paris, FranceFrench Institute for Demographic Studies (INED), Mortality, Health and Epidemiology Unit, Aubervilliers, FranceAnnecy-Genevois Hospital Center, Annecy, FranceSorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, FranceSorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, Unité de Santé Publique, Paris, FranceSorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, FranceINSERM, IMRB (Clinical Epidemiology and Aging Unit), Paris Est Créteil University, Créteil, FrancePneumology Department, Intercommunal Hospital Center of Créteil, Créteil, FranceFrench Institute for Demographic Studies (INED), Mortality, Health and Epidemiology Unit, Aubervilliers, FranceFrench Institute for Demographic Studies (INED), Mortality, Health and Epidemiology Unit, Aubervilliers, FranceBackgroundA global reduction in hospital admissions for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) was observed during the first months of the COVID-19 pandemic. Large-scale studies covering the entire pandemic period are lacking. We investigated hospitalizations for AECOPD and the associated in-hospital mortality at the national level in France during the first 2 years of the pandemic.MethodsWe used the French National Hospital Database to analyse the time trends in (1) monthly incidences of hospitalizations for AECOPD, considering intensive care unit (ICU) admission and COVID-19 diagnoses, and (2) the related in-hospital mortality, from January 2016 to November 2021. Pandemic years were compared with the pre-pandemic years using Poisson regressions.ResultsThe database included 565,890 hospitalizations for AECOPD during the study period. The median age at admission was 74 years (interquartile range 65–83), and 37% of the stays concerned women. We found: (1) a dramatic and sustainable decline in hospitalizations for AECOPD over the pandemic period (from 8,899 to 6,032 monthly admissions, relative risk (RR) 0.65, 95% confidence interval (CI) 0.65–0.66), and (2) a concomitant increase in in-hospital mortality for AECOPD stays (from 6.2 to 7.6% per month, RR 1.24, 95% CI 1.21–1.27). The proportion of stays yielding ICU admission was similar in the pre-pandemic and pandemic years, 21.5 and 21.3%, respectively. In-hospital mortality increased to a greater extent for stays without ICU admission (RR 1.39, 95% CI 1.35–1.43) than for those with ICU admission (RR 1.09, 95% CI 1.05–1.13). Since January 2020, only 1.5% of stays were associated with a diagnosis of COVID-19, and their mortality rate was nearly three-times higher than those without COVID-19 (RR 2.66, 95% CI 2.41–2.93).ConclusionThe decline in admissions for AECOPD during the pandemic could be attributed to a decrease in the incidence of exacerbations for COPD patients and/or to a possible shift from hospital to community care. The rise in in-hospital mortality is partially explained by COVID-19, and could be related to restricted access to ICUs for some patients and/or to greater proportions of severe cases among the patients hospitalized during the pandemic.https://www.frontiersin.org/articles/10.3389/fmed.2022.995016/fullAECOPDhospitalizationsCOVID-19 pandemicmortalitynationwide studyFrance |
| spellingShingle | Jonas Poucineau Jonas Poucineau Tristan Delory Tristan Delory Tristan Delory Nathanaël Lapidus Gilles Hejblum Christos Chouaïd Christos Chouaïd Sophie Le Cœur Myriam Khlat Hospital admissions and mortality for acute exacerbations of COPD during the COVID-19 pandemic: A nationwide study in France Frontiers in Medicine AECOPD hospitalizations COVID-19 pandemic mortality nationwide study France |
| title | Hospital admissions and mortality for acute exacerbations of COPD during the COVID-19 pandemic: A nationwide study in France |
| title_full | Hospital admissions and mortality for acute exacerbations of COPD during the COVID-19 pandemic: A nationwide study in France |
| title_fullStr | Hospital admissions and mortality for acute exacerbations of COPD during the COVID-19 pandemic: A nationwide study in France |
| title_full_unstemmed | Hospital admissions and mortality for acute exacerbations of COPD during the COVID-19 pandemic: A nationwide study in France |
| title_short | Hospital admissions and mortality for acute exacerbations of COPD during the COVID-19 pandemic: A nationwide study in France |
| title_sort | hospital admissions and mortality for acute exacerbations of copd during the covid 19 pandemic a nationwide study in france |
| topic | AECOPD hospitalizations COVID-19 pandemic mortality nationwide study France |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2022.995016/full |
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