Effects of the 2020 health crisis on acute alcohol intoxication: A nationwide retrospective observational study

Hospitalization for SARS-CoV-2 and the risk of self-harm readmission: a French nationwide retrospective cohort study

AIMS

The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on the risk of self-harming behaviours warrants further investigation. Here, we hypothesized that people with a history of hospitalization for self-harm may be particularly at risk of readmission in case of SARS-CoV-2 hospitalization.

METHODS

We conducted a retrospective analysis based on the French national hospitalization database. We identified all patients hospitalized for deliberate self-harm (10th edition of the International Classification of Diseases codes X60-X84) between March 2020 and March 2021. To study the effect of SARS-CoV-2 hospitalization on the risk of readmission for self-harm at 1-year of the inclusion, we performed a multivariable Fine and Gray model considering hospital death as a competing event.

RESULTS

A total of 61,782 individuals were hospitalized for self-harm. During the 1-year follow-up, 9,403 (15.22%) were readmitted for self-harm. Between inclusion and self-harm readmission or the end of follow-up, 1,214 (1.96% of the study cohort) were hospitalized with SARS-CoV-2 (mean age 60 years, 52.9% women) while 60,568 were not (mean age 45 years, 57% women). Multivariate models revealed that the factors independently associated with self-harm readmission were: hospitalization with SARS-CoV-2 (adjusted hazard ratio (aHR) = 3.04 [2.73-3.37]), psychiatric disorders (aHR = 1.61 [1.53-1.69]), self-harm history (aHR = 2.00 [1.88-2.04]), intensive care and age above 80.

CONCLUSIONS

In hospitalized people with a personal history of self-harm, infection with SARS-CoV-2 increased the risk of readmission of self-harm, with an effect that seemed to add to the effect of a history of mental disorders, with an equally significant magnitude. Infection may be a significantly stressful condition that precipitates self-harming acts in vulnerable individuals. Clinicians should pay particular attention to the emergence of suicidal ideation in these patients in the aftermath of SARS-CoV-2 infection.

Comparison of emergency transport for acute alcohol intoxication before and after the coronavirus disease 2019 pandemic: A retrospective observational study

The ongoing coronavirus disease 2019 (COVID-19) pandemic has had a broad effect on social, economic, educational, and political systems. We investigated the effect of COVID-19 on emergency transportation due to acute alcohol intoxication in the Kochi Prefecture in Japan, a region with high alcohol consumption. This retrospective observational study was conducted using the data of 62,138 patients from the Kochi-Iryo-Net database, Kochi Prefecture's emergency medical and wide-area disaster information system. Chi-square tests and multiple logistic regression analyses were performed to examine the association between emergency transportation and alcohol intoxication. This analysis compared the monthly number of transportations during 2019 (as reference) with that throughout 2020 and 2021. Approximately 1.5 % of all emergency transportation cases were related to acute alcohol intoxication. The number of emergency transportation cases due to acute alcohol intoxication declined by 0.5 % in 2020 and 0.7 % in 2021 compared with that in 2019. Moreover, compared with that in 2019, the number of cases of emergency transportation due to acute alcohol intoxication significantly decreased in 2020 (incidence rate ratio: 0.78; 95 % confidence interval: 0.67-0.91) and 2021 (incidence rate ratio: 0.73; 95 % confidence interval: 0.63-0.86). Lifestyle changes due to the COVID-19 pandemic affected the number of emergency transports due to acute alcohol intoxication in 2020 and 2021 (during the COVID-19 pandemic) compared to that in 2019 (before the pandemic).

General hospital admissions in young and middle-aged people who use psychoactive substances: Impact of Covid-19 lockdowns

BACKGROUNDS

The Covid-19 pandemic offered a unique opportunity to investigate trends in hospitalizations related to psychoactive substance intoxication, since the usual health burden of social use at parties and gatherings was likely to be decreased during lockdowns and curfew periods. Since young adults are the main users of psychoactive substances for experimental and recreational purposes, this study identified and compared hospitalization trends in young adults and adults over 30 years old.

METHODS

This national cohort study was conducted using the French hospital discharge database. An interrupted time-series analysis for the period between 2014 and 2020 was performed in two groups: young (age 18-29) and other adults (30+) to ascertain the trends in the monthly incidence of hospitalization related to psychoactive substance intoxication (opiates, cocaine, benzodiazepines, psychostimulants, alcohol and cannabis). Hospitalization characteristics during the first and second lockdown and the period between them were compared to the reference period (from 01/01/2014 to 29/02/2020).

RESULTS

Among 1,358,007 stays associated with psychoactive substance intoxication, 215,430 concerned young adults. Compared with adults 30+, hospitalization trends in young adults showed a greater decrease in the number of stays during lockdown, with a maximum decrease of -39% during the first lockdown (1,566 vs. 2,576; CI95%: 2,285-2,868) versus -20% (10,212 vs. 12,894; CI95%: 12,001-13,787) in the second lockdown. Presentations for alcohol intoxication decreased throughout the pandemic, particularly during the second lockdown, while admissions for benzodiazepine intoxication increased during both lockdowns. Admissions for cannabis intoxication increased throughout the entire period.

CONCLUSIONS

Lockdowns were associated with fewer hospitalizations related to psychoactive substance intoxication in both age groups, especially among young adults, which might reflect a decrease in social use. Recreational use might therefore be an important target for prevention and risk minimization.

Effect of Obesity among Hospitalized Cancer Patients with or without COVID-19 on a National Level

Cancer and obesity are well-known prognostic factors in COVID-19. Our objective was to study the effect of obesity (and its severity) on the risk of intensive care unit (ICU) admission, severe complications, and in-hospital mortality, in a population of cancer patients hospitalized with or without COVID-19. All patients hospitalized in France for cancer from 1 March 2020 to 28 February 2022 were included from the French national administrative database. The effect of obesity was estimated in COVID-19 and in non-COVID-19 cancer patients using logistic and survival regressions, taking into account age, sex, comorbidities, and different types of cancer. Among the 992,899 cancer patients, we identified 53,090 patients with COVID-19 (5.35%), of which 3260 were obese (6.1%). After adjustment, for patients with or without COVID-19, there is an increased risk of ICU admission or severe complications in obese patients, regardless of the type of obesity. Regarding in-hospital mortality, there is no excess risk associated with overall obesity. However, massive obesity appears to be associated with an increased risk of in-hospital mortality, with a significantly stronger effect in solid cancer patients without COVID-19 and a significantly stronger effect in hematological cancer patients with COVID-19. This study showed that in France, among hospitalized patients with cancer and with or without COVID-19, increased vigilance is needed for obese patients, both in epidemic and non-epidemic periods. This vigilance should be further strengthened in patients with massive obesity for whom the risk of in-hospital mortality is higher, particularly in epidemic periods for patients with hematological cancers.

Évolution du nombre de passages aux urgences pour intoxications aiguës lors des périodes de confinement de Covid-19 en Bourgogne-Franche-Comté

Objectif : Estimer l’évolution du nombre de passages aux urgences pour intoxications aiguës (IA) lors des périodes de confinement en 2020 par rapport à l’année précédente.

Matériels et méthode : Une étude rétrospective multicentrique de type transversale a été menée en utilisant les données des résumés de passages aux urgences. Deux périodes ont été étudiées en 2020 : période 1 = 1er confinement et période 2 = 2e confinement et ont été comparées aux mêmes périodes en 2019. Les diagnostics pour IA volontaires ou accidentelles toutes causes ont été définis à partir du code CIM-10. Le critère de jugement principal a été la variation du nombre de passages aux urgences pour IA entre les périodes de confinement en 2020 et les périodes de référence en 2019.

Résultats : Comparé à la même période en 2019, le nombre de passages aux urgences pour IA a baissé de 31 % (p = 0,001) pendant le premier confinement et de 18 % (p = 0,07) pendant le deuxième confinement. Le nombre de passages pour IA médicamenteuse a baissé de 3 % (p = 0,035) pendant le deuxième confinement en comparaison à 2019. Les caractéristiques des patients consultant pour IA étaient comparables dans chacune des périodes.

Conclusion : Dans cette étude, une diminution du nombre de passages aux urgences pour IA a été observée pendant les périodes de confinement en 2020 par rapport aux mêmes périodes l’année précédente.