Population-level trends in asthma and chronic obstructive pulmonary disease emergency department visits and hospitalizations before and during the coronavirus disease 2019 pandemic in the United States

Impact of the COVID-19 pandemic and COVID-19 downgrade on non-COVID-19 respiratory diseases in Japan

OBJECTIVES

A worldwide decrease in the incidence of respiratory diseases during the coronavirus disease (COVID-19) pandemic has been reported, largely due to non-pharmaceutical interventions (NPIs). However, the impact of lifting NPIs remains unclear. In Japan, NPIs were lifted rather drastically when COVID-19 was downgraded on May 8, 2023. This study aimed to evaluate the impact of the COVID-19 pandemic and its downgrade on non-COVID-19 respiratory diseases using nationwide databases.

STUDY DESIGN

Retrospective cohort study.

METHODS

Monthly hospitalisation and prescription rates between January 2017 and October 2023 were collected from the JMDC insurance claims database covering 16,485,812 insured individuals. The monthly mortality rates in Japan were collected from an open data source published by Ministry of Health, Labour and Welfare of Japan. Interrupted time series analyses using seasonal autoregressive integrated moving average models were performed.

RESULTS

While hospitalisation rates for diseases such as pneumonia, asthma, and aspiration pneumonia decreased during the pandemic, a step increase in hospitalisations for these diseases and prescriptions for anti-asthma drugs was observed following the COVID-19 downgrade. The pandemic impacted all age groups; however, the impact of COVID-19 downgrade was more pronounced in children aged 0-5 years. Although mortality from non-COVID-19 respiratory diseases decreased during the pandemic, no immediate step increase in mortality was observed following the downgrade.

CONCLUSIONS

Although hospitalisations for pneumonia and prescriptions for anti-asthma drugs increased immediately after downgrading COVID-19, no step increase in mortality was observed presumably because older people were less affected than children.

Source specific fine particles and rates of asthma and COPD healthcare encounters pre- and post-implementation of the Tier 3 vehicle emissions control regulations

We examined associations between seven source-specific PM2.5 concentrations and rates of asthma and COPD hospitalizations and emergency department (ED) visits in New York State and compared the changes in excess rates (ERs) between pre- (2014-2016) and post-implementation (2017-2019) of the Tier 3 automobile emission controls on new vehicles policy. A modified time-stratified case-crossover design and conditional logistic regression were employed to estimate the ERs of asthma and COPD hospitalizations and ED visits associated with interquartile range (IQR) increases in source-specific PM2.5 concentrations. The 7 PM2.5 sources were spark-ignition emissions (GAS), diesel (DIE), biomass burning (BB), road dust (RD), secondary nitrate (SN), secondary sulfate (SS), and pyrolyzed organic rich (OP). Residual PM2.5 (PM2.5 - specific source [e.g., GAS]), daily temperature, relative humidity, weekday, and holidays were included in the model. IQR increases in GAS, SS, RD, BB, and SN were associated with increased ERs of asthma ED visits (highest ERs: 0.5 %-3.1 %), while a negative association was observed with DIE and OP. The rate of asthma hospitalizations was associated with increased RD concentrations (ERs: 1.3 %-1.7 %). Both COPD ED visit and hospitalization rates were associated with increased OP (ERs: 2.1 %-3.4 %), and increased SS was positively associated with COPD ED visits (ER = 3.8 %). In summary, after Tier 3 implementation (2017-2019), we found lower ERs for COPD admissions associated with BB, RD, SN, and SS compared to 2014-2016. However, rates of asthma ED visits associated with source-specific PM2.5 concentrations were generally higher for all sources, except DIE, post- versus pre-implementation, requiring further research for validation.

The private well water climate impact index: Characterization of community-level climate-related hazards and vulnerability in the continental United States

BACKGROUND

Private wells use groundwater as their source and their drinking water quality is unregulated in the United States at the federal level. Due to the lack of water quality regulations, those reliant on private wells have the responsibility of ensuring that the water is safe to drink. Where extreme weather is projected to increase with climate change, contamination due to climate-related hazards adds further layers of complexity for those relying on private wells. We sought to characterize community-level climate-related hazards and vulnerability for persons dependent on private wells in the continental United States (CONUS). Additional objectives of this work were to quantify the burden to private well water communities by climate region and demographic group.

METHODS

Grounded in the latest climate change framework and private well water literature, we created the Private Well Water Climate Impact Index (PWWCII). We searched the literature and identified nationally consistent, publicly available, sub-county data to build Overall, Drought, Flood, and Wildfire PWWCIIs at the national and state scales. We adapted the technical construction of this relative index from the California Communities Environmental Health Screening Tool (CalEnviroScreen 4.0).

RESULTS

The distribution of climate-related impact census tracts varied across CONUS by nationally-normed PWWCII type. Compared to the Southeast where the majority of the 2010 estimated U.S. private well water population lived, the estimated persons dependent upon private well water living in the West had an increased odds of living in higher impact census tracts for the Overall, Drought, and Wildfire PWWCIIs across CONUS. Compared to non-Hispanic White persons, non-Hispanic American Indian and Alaska Native (AI/AN) persons had an increased odds of living in higher impact census tracts for all four PWWCII types across CONUS.

CONCLUSIONS

The PWWCII fills a gap as it provides a baseline understanding of potential climate-related impacts to communities reliant on private well water across CONUS.

Health system resilience during the COVID-19 pandemic: A comparative analysis of disruptions in care from 32 countries

OBJECTIVE

To quantify disruptions in hospitalization and ambulatory care throughout the coronavirus disease 2019 (COVID-19) pandemic for 32 countries, and examine associations of health system characteristics and COVID-19 response strategies on disruptions.

DATA SOURCES

We utilized aggregated inpatient hospitalization and surgical procedure data from the Organization for Economic Co-operation and Development Health Database from 2010 to 2021. Covariate data were extracted from the Organization for Economic Co-operation and Development Health Database, World Health Organization, and Oxford COVID-19 Government Response Tracker.

STUDY DESIGN

This is a descriptive study using time-series analyses to quantify the annual effect of the COVID-19 pandemic on non-COVID-19 hospitalizations for 20 diagnostic categories and 15 surgical procedures. We compared expected hospitalizations had the pandemic never occurred in 2020-2021, estimated using autoregressive integrated moving average modeling with data from 2010 to 2019, with observed hospitalizations. Observed-to-expected ratios and missed hospitalizations were computed as measures of COVID-19 impact. Mixed linear models were employed to examine associations between hospitalization observed-to-expected ratios and covariates.

PRINCIPAL FINDINGS

The COVID-19 pandemic was associated with 16,300,000 (95% uncertainty interval 14,700,000-17,900,000; 18.0% [16.5%-19.4%]) missed hospitalizations in 2020. Diseases of the respiratory (-2,030,000 [-2,300,000 to -1,780,000]), circulatory (-1,680,000 [-1,960,000 to -1,410,000]), and musculoskeletal (-1,480,000 [-1,720,000 to -1,260,000]) systems contributed most to the declines. In 2021, there were an additional 14,700,000 (95% uncertainty interval 13,100,000-16,400,000; 16.3% [14.9%-17.9%]) missed hospitalizations. Total healthcare workers per capita (β = 1.02 [95% CI 1.00, 1.04]) and insurance coverage (β = 1.05 [1.02, 1.09]) were associated with fewer missed hospitalizations. Stringency index (β = 0.98 [0.98, 0.99]) and excess all-cause deaths (β = 0.98 [0.96, 0.99]) were associated with more missed hospitalizations.

CONCLUSIONS

There was marked cross-country variability in disruptions to hospitalizations and ambulatory care. Certain health system characteristics appeared to be more protective, such as insurance coverage, and number of inputs including healthcare workforce and beds.

WHAT IS KNOWN ON THIS TOPIC

Substantial disruptions in health services associated with the coronavirus disease 2019 pandemic have placed a renewed interest in health system resilience. While there is a growing body of evidence documenting disruptions in services, there are limited comparative assessments across diverse countries with different health system designs, preparedness levels, and public health responses. Learning and adapting from health system-specific gaps and challenges highlighted by the pandemic will be critical for improving resilience.

WHAT THIS STUDY ADDS

All countries experienced disruptions to hospitalizations and surgical procedures with a combined total of 30 million missed hospitalizations and 4 million missed surgical procedures in 2020-2021, but there was marked cross-country heterogeneity in disruptions. Countries with greater baseline healthcare workers, insurance coverage, and hospital beds had disproportionately lower disruptions in care. National health planning discussions may need to balance health system resiliency and efficiency to avert preventable morbidity and mortality.

Cognitive Functioning Influences Mortality Risk Among Older Adults with COPD

Background/Objeectives: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of mortality in the United States (U.S.), with rates varying by disease severity, comorbidities, and sociodemographic factors. Cognitive impairment has been independently associated with increased mortality, but has not been well studied in relation to COPD despite being a frequently overlooked comorbidity in COPD patients. The purpose of this nationwide study was to assess the relationship between low cognitive performance and the risk of mortality among older adults with COPD while adjusting for major sociodemographic and health-related characteristics.

METHODS

This study utilized the 1999-2002 National Health and Nutrition Examination Survey (NHANES) and the respiratory mortality data of noninstitutionalized US adults aged over 65 years. Survival curves showing the combined effect of cognitive decline and COPD using the Kaplan-Meier product-limit method to estimate the percent survival of the subject at each point in time were used.

RESULTS

The final sample included 2013 older adults, with 39.1% showing low cognitive performance and 12.7% having COPD. Those with low cognitive performance were older, less educated, had lower income, were more likely to be racial/ethnic minorities, and had a history of cardiovascular diseases (CVD); they were also more likely to have COPD or chronic kidney disease (CKD). The adjusted hazard ratio for respiratory-related mortality risk was highest for individuals with both COPD and low cognitive performance (hazards ratio = 8.53), people with COPD alone also had a higher respiratory-related mortality risk (hazards ratio = 4.92), but low cognitive performance alone did not significantly increase respiratory-related mortality risk.

CONCLUSIONS

These findings provide clearer insights into how cognitive impairment affects mortality risk in older adults with COPD and we discuss potential strategies to address this dual chronic health challenge effectively.

Trends in US Pediatric Asthma Hospitalizations, by Race and Ethnicity, 2012-2020

Introduction

Some racial and ethnic minority communities have long faced a higher asthma burden than non-Hispanic White communities. Prior research on racial and ethnic pediatric asthma disparities found stable or increasing disparities, but more recent data allow for updated analysis of these trends.

Methods

Using 2012-2020 National Inpatient Sample data, we estimated the number of pediatric asthma hospitalizations by sex, age, and race and ethnicity. We converted these estimates into rates using data from the US Census Bureau and then conducted meta-regression to assess changes over time. Because the analysis spanned a 2015 change in diagnostic coding, we performed separate analyses for periods before and after the change. We also excluded 2020 data from the regression analysis.

Results

The number of pediatric asthma hospitalizations decreased over the analysis period. Non-Hispanic Black children had the highest prevalence (range, 9.8-36.7 hospitalizations per 10,000 children), whereas prevalence was lowest among non-Hispanic White children (range, 2.2-9.4 hospitalizations per 10,000 children). Although some evidence suggests that race-specific trends varied modestly across groups, results overall were consistent with a similar rate of decrease across all groups (2012-2015, slope = -0.83 [95% CI, -1.14 to -0.52]; 2016-2019, slope = -0.35 [95% CI, -0.58 to -0.12]).

Conclusion

Non-Hispanic Black children remain disproportionately burdened by asthma-related hospitalizations. Although the prevalence of asthma hospitalization is decreasing among all racial and ethnic groups, the rates of decline are similar across groups. Therefore, previously identified disparities persist. Interventions that consider the specific needs of members of disproportionately affected groups may reduce these disparities.

Epidemiology of asylum seekers and refugees at the Mexico-US border: a cross-sectional analysis from the migrant settlement camp in Matamoros, Mexico

BACKGROUND

The number of migrants and asylum seekers at the Mexico-US border has increased to historic levels. Our objective was to determine the medical diagnoses and treatments of migrating people seeking care in humanitarian clinics in Matamoros, Mexico.

METHODS

We conducted a cross-sectional study of patient encounters by migrating people through a humanitarian clinic in Matamoros, Mexico, from November 22, 2019, to March 18, 2021. The clinics were operated by Global Response Medicine in concert with local non-governmental organizations. Clinical encounters were each coded to the appropriate ICD-10/CPT code and categorized according to organ system. We categorized medications using the WHO List of Essential Medicines and used multivariable logistic regression to determine associations between demographic variables and condition frequency.

RESULTS

We found a total of 8,156 clinical encounters, which included 9,744 diagnoses encompassing 132 conditions (median age 26.8 years, female sex 58.2%). People originated from 24 countries, with the majority from Central America (n = 5598, 68.6%). The most common conditions were respiratory (n = 1466, 15.0%), musculoskeletal (n = 1081, 11.1%), and skin diseases (n = 473, 4.8%). Children were at higher risk for respiratory disease (aOR = 1.84, 95% CI: 1.61-2.10), while older adults had greater risk for joint disorders (aOR = 3.35, 95% CI: 1.73-6.02). Women had decreased risk for injury (aOR = 0.50, 95% CI: 0.40-0.63) and higher risk for genitourinary diseases (aOR = 4.99, 95% CI: 3.72-6.85) compared with men. Among 10,405 medications administered, analgesics were the most common (n = 3190, 30.7%) followed by anti-infectives (n = 2175, 21.1%).

CONCLUSIONS

In this large study of a migrating population at the Mexico-US border, we found a variety of clinical conditions, with respiratory, musculoskeletal, and skin illnesses the most common in this study period which encompassed a period of restrictive immigration policy and the first year of the COVID-19 pandemic.