TY  - JOUR
AU  - Wai, Abraham Ka-chung
AU  - Yip, Tsz Fung
AU  - Wong, Yui Hang
AU  - Chu, Chun Kit
AU  - Lee, Teddy
AU  - Yu, Ken Hung On
AU  - So, Wang Leong
AU  - Wong, Janet Y H
AU  - Wong, Carlos King-ho
AU  - Ho, Joshua W
AU  - Rainer, Timothy
PY  - 2024
DA  - 2024/2/13
TI  - The Effect of the COVID-19 Pandemic on Non–COVID-19 Deaths: Population-Wide Retrospective Cohort Study
JO  - JMIR Public Health Surveill
SP  - e41792
VL  - 10
KW  - excess death
KW  - causal inference
KW  - health care avoidance
KW  - emergency department
KW  - COVID-19
KW  - hospital avoidance behavior
KW  - mortality
KW  - epidemiology
KW  - health care
KW  - hospital care
KW  - death rate
KW  - death
KW  - hospital
KW  - avoidance
KW  - population
KW  - cohort
KW  - death toll
KW  - impact
KW  - excess
KW  - Hong Kong
AB  - 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. 
SN  - 2369-2960
UR  - https://publichealth.jmir.org/2024/1/e41792
UR  - https://doi.org/10.2196/41792
UR  - http://www.ncbi.nlm.nih.gov/pubmed/38349717
DO  - 10.2196/41792
ID  - info:doi/10.2196/41792
ER  -