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Wai AKC, Yip TF, Wong YH, Chu CK, Lee T, Yu KHO, So WL, Wong JYH, Wong CKH, Ho JW, Rainer T. The Effect of the COVID-19 Pandemic on Non-COVID-19 Deaths: Population-Wide Retrospective Cohort Study. JMIR Public Health Surveill 2024; 10:e41792. [PMID: 38349717 PMCID: PMC10866203 DOI: 10.2196/41792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/23/2023] [Accepted: 12/14/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Health care avoidance in the COVID-19 pandemic has been widely reported. Yet few studies have investigated the dynamics of hospital avoidance behavior during pandemic waves and inferred its impact on excess non-COVID-19 deaths. OBJECTIVE This study aimed to measure the impact of hospital avoidance on excess non-COVID-19 deaths in public hospitals in Hong Kong. METHODS This was a retrospective cohort study involving 11,966,786 patients examined between January 1, 2016, and December 31, 2021, in Hong Kong. All data were linked to service, treatment, and outcomes. To estimate excess mortality, the 2-stage least squares method was used with daily tallies of emergency department (ED) visits and 28-day mortality. Records for older people were categorized by long-term care (LTC) home status, and comorbidities were used to explain the demographic and clinical attributes of excess 28-day mortality. The primary outcome was actual excess death in 2020 and 2021. The 2-stage least squares method was used to estimate the daily excess 28-day mortality by daily reduced visits. RESULTS Compared with the prepandemic (2016-2019) average, there was a reduction in total ED visits in 2020 of 25.4% (548,116/2,142,609). During the same period, the 28-day mortality of non-COVID-19 ED deaths increased by 7.82% (2689/34,370) compared with 2016-2019. The actual excess deaths in 2020 and 2021 were 3143 and 4013, respectively. The estimated total excess non-COVID-19 28-day deaths among older people in 2020 to 2021 were 1958 (95% CI 1100-2820; no time lag). Deaths on arrival (DOAs) or deaths before arrival (DBAs) increased by 33.6% (1457/4336) in 2020, while non-DOA/DBAs increased only by a moderate 4.97% (1202/24,204). In both types of deaths, the increases were higher during wave periods than in nonwave periods. Moreover, non-LTC patients saw a greater reduction in ED visits than LTC patients across all waves, by more than 10% (non-LTC: 93,896/363,879, 25.8%; LTC: 7,956/67,090, 11.9%). Most of the comorbidity subsets demonstrated an annualized reduction in visits in 2020. Renal diseases and severe liver diseases saw notable increases in deaths. CONCLUSIONS We demonstrated a statistical method to estimate hospital avoidance behavior during a pandemic and quantified the consequent excess 28-day mortality with a focus on older people, who had high frequencies of ED visits and deaths. This study serves as an informed alert and possible investigational guideline for health care professionals for hospital avoidance behavior and its consequences.
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Affiliation(s)
- Abraham Ka-Chung Wai
- Department of Emergency Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
- Department of Accident & Emergency, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Accident & Emergency, Queen Mary Hospital, Hong Kong, China (Hong Kong)
| | - Tsz Fung Yip
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Yui Hang Wong
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Chun Kit Chu
- Department of Emergency Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Teddy Lee
- Department of Emergency Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Ken Hung On Yu
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Wang Leong So
- Department of Emergency Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Janet Y H Wong
- School of Nursing & Health Studies, Hong Kong Metropolitan University, Kowloon, China (Hong Kong)
| | - Carlos King-Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Joshua W Ho
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Timothy Rainer
- Department of Emergency Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
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Feng B, Bian H, Zhang K, Meng C, Gong X, Ma X, Su C, Zhou M, Xu J, Zhang W, Zhang X, Zhou Y, Shang D. The workload change and depression among emergency medical staff after the open policy during COVID-19: a cross-sectional survey in Shandong, China. Front Public Health 2023; 11:1281787. [PMID: 38026268 PMCID: PMC10655007 DOI: 10.3389/fpubh.2023.1281787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction In the middle of December 2022, the Chinese government adjusted the lockdown policy on coronavirus disease 2019 (COVID-19), a large number of infected patients flooded into the emergency department. The emergency medical staff encountered significant working and mental stress while fighting the COVID-19 pandemic. We aimed to investigate the workload change, and the prevalence and associated factors for depression symptoms among emergency medical staff after the policy adjustment. Methods We conducted a cross-sectional online survey of emergency medical staff who fought against COVID-19 in Shandong Province during January 16 to 31, 2023. The respondents' sociodemographic and work information were collected, and they were asked to complete the 9-item Patient Health Questionnaire (PHQ-9) then. Univariate and multivariate logistic regression analyses were applied to identify the potential associated factors for major depression. Results Nine hundred and sixteen emergency medical personnel from 108 hospitals responded to this survey. The respondents' weekly working hours (53.65 ± 17.36 vs 49.68 ± 14.84) and monthly night shifts (7.25 ± 3.85 vs 6.80 ± 3.77) increased after the open policy. About 54.3% of the respondents scored more than 10 points on the PHQ-9 standardized test, which is associated with depressive symptoms. In univariate analysis, being doctors, living with family members aged ≤16 or ≥ 65 years old, COVID-19 infection and increased weekly working hours after the open policy were significantly associated with a PHQ-9 score ≥ 10 points. In the multivariate analysis, only increased weekly working hours showed significant association with scoring ≥10 points. Conclusion Emergency medical staff' workload had increased after the open policy announcement, which was strongly associated with a higher PHQ-9 scores, indicating a very high risk for major depression. Emergency medical staff working as doctors or with an intermediate title from grade-A tertiary hospitals had higher PHQ-9 scores, while COVID-19 infection and weekly working hours of 60 or more after the open policy were associated with higher PHQ-9 scores for those from grade-B tertiary hospitals. Hospital administrators should reinforce the importance of targeted emergency medical staff support during future outbreaks.
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Affiliation(s)
- Baobao Feng
- Department of Emergency, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Hongjun Bian
- Department of Emergency, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Ke Zhang
- Department of Emergency, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Chong Meng
- Department of Emergency, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xianwei Gong
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xueqiang Ma
- Department of Emergency Internal Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chunhua Su
- Department of Emergency, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, China
| | - Mingxiang Zhou
- Department of Emergency, Shandong Public Health Clinical Center Affiliated to Shandong University, Jinan, China
| | - Jiarui Xu
- Department of Emergency, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Wei Zhang
- Department of Emergency, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xingguo Zhang
- Department of Emergency, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yi Zhou
- Department of Emergency, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Deya Shang
- Department of Emergency, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Liu S, Han W, Shen C, Zhu C, Wang Q, Liang X, He X, Xie Q, Wei J, Wu M, Zhao X, Liu H, Liu D, Guo X, Nie S, Cao L, Lu L, Fang Y, Lu Z, Wu Y, Zhao M, Han J, Zhang X, Chang J, Xu S, Ma W, Si J, Qi S, Peng P, Chai Y, Cao Y, Jiang Y, Yin W, Wang Y, Zhan H, Huang Y, Deng Y, Song J, Yang L, Wu J, Ding B, Zheng D, Qian C, Huang R, Lin J, Xu Z, Zhang G, Hu Y, Dou Q, Zhang X, Tian Y, Yao D, Walline JH, Zhu H, Xu J, Li Y, Yu X. Depressive State in the Emergency Department During COVID-19: A National Cross-Sectional Survey in China. Front Psychiatry 2021; 12:566990. [PMID: 34194341 PMCID: PMC8236535 DOI: 10.3389/fpsyt.2021.566990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 05/10/2021] [Indexed: 02/05/2023] Open
Abstract
Chinese emergency department (ED) staff encountered significant mental stress while fighting the coronavirus disease 2019 (COVID-19) pandemic. We sought to investigate the prevalence and associated factors for depressive symptoms among ED staff (including physicians, nurses, allied health, and auxiliary ED staff). A cross-sectional national survey of ED staff who were on duty and participated in combating the COVID-19 pandemic was conducted March 1-15, 2020. A total of 6,588 emergency medical personnel from 1,060 hospitals responded to this survey. A majority of respondents scored above 10 points on the PHQ-9 standardized test, which is associated with depressive symptoms. Those aged 31-45, those working in the COVID-19 isolation unit, and those with relatives ≤ 16 or ≥70 years old at home all had statistically significant associations with scoring >10 points. Depressive symptoms among Chinese emergency medical staff were likely quite common during the response to the COVID-19 pandemic and reinforce the importance of targeted ED staff support during future outbreaks.
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Affiliation(s)
- Shuang Liu
- Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Han
- Institute of Basic Medical Sciences, School of Basic Medicine, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Chenyu Shen
- Department of Psychiatric, Yuquan Hospital Tsinghua University, Beijing, China
| | - Changju Zhu
- Department of Emergency Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiaofang Wang
- Department of Emergency Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xianquan Liang
- Department of Emergency Medicine, The Second People's Hospital of Guiyang, Guiyang, China
| | - Xiangxi He
- Department of Emergency Medicine, The Second People's Hospital of Guiyang, Guiyang, China
| | - Qin Xie
- Department of Intensive Care, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jie Wei
- Department of Emergency Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Miao Wu
- Department of Emergency Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiaodong Zhao
- Department of Emergency Medicine, Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Hongsheng Liu
- Department of Emergency Medicine, Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Danping Liu
- Department of Emergency Medicine, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Xiaowang Guo
- Department of Emergency Medicine, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Shinan Nie
- Department of Emergency Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Liping Cao
- Department of Emergency Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Linxin Lu
- Department of Emergency Medicine, Shanxi Bethune Hospital, Taiyuan, China
| | - Yaqin Fang
- Department of Emergency Medicine, Shanxi Bethune Hospital, Taiyuan, China
| | - Zhongqiu Lu
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yixu Wu
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Min Zhao
- Department of Emergency Medicine, China Medical University of Shengjing Hospital, Shenyang, China
| | - Jun Han
- Department of Emergency Medicine, China Medical University of Shengjing Hospital, Shenyang, China
| | - Xinchao Zhang
- Department of Emergency Medicine, Beijing Hospital, Beijing, China
| | - Jie Chang
- Department of Emergency Medicine, Beijing Hospital, Beijing, China
| | - Shuogui Xu
- Department of Emergency Medicine, Changhai Hospital, Shanghai, China
| | - Wenjie Ma
- Department of Emergency Medicine, Changhai Hospital, Shanghai, China
| | - Junli Si
- Department of Emergency Medicine, Qingdao Municipal Hospital, Qingdao, China
| | - Suxia Qi
- Department of Emergency Medicine, Qingdao Municipal Hospital, Qingdao, China
| | - Peng Peng
- Department of Emergency Medicine, The First Affiliate Hospital of Xinjiang Medical University, Wulumuqi, China
| | - Yage Chai
- Department of Emergency Medicine, The First Affiliate Hospital of Xinjiang Medical University, Wulumuqi, China
| | - Yu Cao
- Department of Emergency Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Yaowen Jiang
- Department of Emergency Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Wen Yin
- Department of Emergency Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yanjun Wang
- Department of Emergency Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Hong Zhan
- Department of Emergency Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yingxiong Huang
- Department of Emergency Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ying Deng
- Department of Emergency Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Juanjuan Song
- Department of Emergency Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lishan Yang
- Department of Emergency Medicine, General Hospital of Ningxia Medical University, Nanjing, China
| | - Jiali Wu
- Department of Emergency Medicine, General Hospital of Ningxia Medical University, Nanjing, China
| | - Banghan Ding
- Department of Emergency Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Danwen Zheng
- Department of Emergency Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Chuanyun Qian
- Department of Emergency Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Rui Huang
- Department of Emergency Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jiyan Lin
- Department of Emergency Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Zhihong Xu
- Department of Emergency Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Guoxiu Zhang
- Department of Emergency Medicine, The First Affiliated Hospital and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Yingying Hu
- Department of Emergency Medicine, The First Affiliated Hospital and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Qingli Dou
- Department of Emergency Medicine, People's Hospital of Shenzhen, Shenzhen, China
| | - Xiaoming Zhang
- Department of Emergency Medicine, People's Hospital of Shenzhen, Shenzhen, China
| | - Yingping Tian
- Department of Emergency Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Dongqi Yao
- Department of Emergency Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Joseph Harold Walline
- Accident and Emergency Medicine Academic Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Huadong Zhu
- Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jun Xu
- Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yi Li
- Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xuezhong Yu
- Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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