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Shin J, Hong MJ, Park JB, Lee YJ. The impact of the COVID-19 pandemic on the rehabilitation therapy of children and adolescents with cerebral palsy: a nationwide, health insurance data-based study. Front Public Health 2024; 12:1374766. [PMID: 38873308 PMCID: PMC11169719 DOI: 10.3389/fpubh.2024.1374766] [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: 01/22/2024] [Accepted: 05/03/2024] [Indexed: 06/15/2024] Open
Abstract
Introduction The coronavirus disease 2019 (COVID-19) pandemic has profoundly affected the utilization of rehabilitation services. Existing evidence investigating this issue at the nationwide level is lacking, and it is uncertain whether the effects of the COVID-19 pandemic on the use of rehabilitation therapy of children and adolescents with cerebral palsy. This study aimed to investigate the impact of COVID-19 on the rehabilitation therapy of children and adolescents with cerebral palsy. Methods We obtained data from South Korea's Health Insurance Review and Assessment Agency for 2017-2021. By analyzing the claims data, we focused on rehabilitation therapy in individuals with CP under 18 years of age. We categorized these according to therapy type (physical, occupational, or dysphagia), medical facility, hospital visits, and insurance. We calculated the patient counts and average claims per person and compared the average from before to during the COVID-19 pandemic. Results Over the 5 years, there was a significant decline in the number of patients undergoing rehabilitation therapy (trend p = 0.004), but the average claims per person remained stable (trend p = 0.971). During the COVID-19 pandemic, the average number of claims per person decreased significantly compared to the control period (p = 0.013). Both the physical (p = 0.049) and occupational therapy groups (p = 0.019) showed significant differences in claims. General hospitals and hospitals experienced a decrease in average cases by 2.2 (p < 0.001) and 2.4 (p < 0.001) respectively, while long-term care hospitals increased by 3.1 cases (p < 0.001). Outpatients showed a decline of 2.0 cases (p < 0.001), whereas inpatients showed an increase of 5.9 cases (p < 0.001). Individuals with health insurance decreased by 0.5 cases (p = 0.007), but the decrease of 0.08 cases among medical aid-covered individuals was not statistically significant (p = 0.898). Conclusion In 2020-2021, the average number of claims per person showed a significant decrease compared to the pre-COVID-19 pandemic period (2017-2019). Depending on the type of treatment, the number of claims for physical and occupational therapy significantly decreased.
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Affiliation(s)
- Jieun Shin
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Mi Jin Hong
- Department of Rehabilitation Medicine, College of Medicine, Konyang University Hospital, Daejeon, Republic of Korea
| | - Jong Bum Park
- Department of Rehabilitation Medicine, College of Medicine, Konyang University Hospital, Daejeon, Republic of Korea
| | - Yung Jin Lee
- Department of Rehabilitation Medicine, College of Medicine, Konyang University Hospital, Daejeon, Republic of Korea
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Hu X, Yuan D, Zeng Y, Guo C. Impact of the First-Wave COVID-19 Pandemic on Medical Expenditure for Older Adults in China: Lessons from a Natural Experiment. J Aging Soc Policy 2024:1-21. [PMID: 38734975 DOI: 10.1080/08959420.2024.2348967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/24/2024] [Indexed: 05/13/2024]
Abstract
Older adults' access to healthcare services may have been affected by the COVID-19 pandemic. This study explored the effect of the first wave pandemic on the medical expenditure of older adults in China. Difference-in-Difference models captured both temporal and geographical variation in COVID-19 exposure to estimate the impacts of the pandemic on medical expenditure through a quasi-natural experiment. Data derived from the China Family Panel Studies. Results indicate that exposure to the pandemic significantly decreased total medical expenditures, hospital expenditures, and non-hospital medical expenditures of Chinese older adults by 15% (95% CI 12%-17%), 5% (95% CI 2%-7%), and 15% (95% CI 13%-16%), respectively, for each standardized severity increment. Females, less well-educated people, and individuals without internet access were most susceptible to experiencing these reductions. This study revealed that COVID-19 exerted a detrimental influence on the medical expenditure of older adults in mainland China. The "hidden epidemic" of non-COVID-19 medical needs of older adults deserves more attention on the part of policymakers.
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Affiliation(s)
- Xiyuan Hu
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, USA
- Institute of Population Research, Peking University, Beijing, China
| | - Dianqi Yuan
- Institute of Population Research, Peking University, Beijing, China
| | - Yuyu Zeng
- Institute of Population Research, Peking University, Beijing, China
| | - Chao Guo
- Institute of Population Research, Peking University, Beijing, China
- APEC Health Science Academy (HeSAY), Peking University, Beijing, China
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Agogo GO, Munywoki PK, Audi A, Auko J, Aol G, Oduor C, Kiplangat S, Ouma A, Komo T, Herman-Roloff A, Munyua P, Bigogo G. The effect of COVID-19 pandemic on healthcare seeking in an urban informal settlement in Nairobi and a rural setting in western Kenya. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002968. [PMID: 38630844 PMCID: PMC11023466 DOI: 10.1371/journal.pgph.0002968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/27/2024] [Indexed: 04/19/2024]
Abstract
The COVID-19 pandemic caused widespread changes and disruptions to healthcare seeking behavior. There are limited studies on the effect of the COVID-19 pandemic on healthcare seeking patterns in low-and middle-income countries (LMICs), especially in settings with inequitable access to healthcare in rural and urban informal settlements. We investigated the effect of the COVID-19 pandemic on reported healthcare seeking at health facilities and chemists using morbidity data from participants in an ongoing population-based infectious disease surveillance platform in Asembo in Siaya County, a rural setting in western Kenya and Kibera, an urban informal settlement in Nairobi County. We described healthcare seeking patterns before (from 1st January 2016 to 12th March 2020) and during the pandemic (from 13th March 2020 to 31st August 2022) by gender and age for any reported illness and select clinical syndromes using frequencies and percentages. We used a generalized estimating equation with an exchangeable correlation structure to assess the effect of the pandemic on healthcare seeking adjusting for gender and age. Overall, there was a 19% (adjusted odds ratio, aOR: 0.81; 95% Confidence Interval, CI: 0.79-0.83) decline in odds of seeking healthcare at health facilities for any illness in Asembo during the pandemic, and a 30% (aOR: 0.70; 95% CI: 0.67-0.73) decline in Kibera. Similarly, there was a decline in seeking healthcare by clinical syndromes, e.g., for ARI, aOR: 0.76; 95% CI:0.73-0.79 in Asembo, and aOR: 0.68; 95% CI:0.64-0.72 in Kibera. The pandemic resulted in increased healthcare seeking at chemists (aOR: 1.23; 95% CI: 1.20-1.27 in Asembo, and aOR: 1.40; 95% CI: 1.35-1.46 in Kibera). This study highlights interruptions to healthcare seeking in resource-limited settings due to the COVID-19 pandemic. The pandemic resulted in a substantial decline in seeking care at health facilities, and an increase of the same at chemists.
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Affiliation(s)
- George O. Agogo
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Patrick K. Munywoki
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Allan Audi
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Joshua Auko
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - George Aol
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Clifford Oduor
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Samuel Kiplangat
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Alice Ouma
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Terry Komo
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Amy Herman-Roloff
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Peninah Munyua
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Godfrey Bigogo
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
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Guo C, Yuan D, Tang H, Hu X, Lei Y. Impact of a pandemic shock on unmet medical needs of middle-aged and older adults in 10 countries. BMJ Health Care Inform 2024; 31:e100865. [PMID: 38589212 PMCID: PMC11015184 DOI: 10.1136/bmjhci-2023-100865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/09/2024] [Indexed: 04/10/2024] Open
Abstract
OBJECTIVE The objective is to explore the impact of the pandemic shock on the unmet medical needs of middle-aged and older adults worldwide. METHODS The COVID-19 pandemic starting in 2020 was used as a quasiexperiment. Exposure to the pandemic was defined based on an individual's context within the global pandemic. Data were obtained from the Integrated Values Surveys. A total of 11 932 middle-aged and older adults aged 45 years and above from 10 countries where the surveys conducted two times during 2011 and 2022 were analysed. We used logistic regression models with the difference-in-difference method to estimate the impact of pandemic exposure on unmet medical needs by comparing differences before and after the pandemic across areas with varying degrees of severity. RESULTS Among the 11 932 middle-aged and older adults, 3647 reported unmet medical needs, with a pooled unmet rate of 30.56% (95% CI: 29.74% to 31.40%). The pandemic significantly increased the risk of unmet medical needs among middle-aged and older adults (OR: 2.33, 95% CI: 1.94 to 2.79). The deleterious effect of the pandemic on unmet medical needs was prevalent among middle-aged adults (2.53, 2.00 to 3.20) and older adults (2.00, 1.48 to 2.69), as well as among men (2.24, 1.74 to 2.90) and women (2.34, 1.82 to 3.03). The results remained robust in a series of sensitivity analyses. CONCLUSION These findings suggest that efforts should be made by policymakers and healthcare professionals to balance healthcare resources to adequately address the comprehensive healthcare demands of individuals regarding multiple health issues, taking into account the challenges posed by pandemics.
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Affiliation(s)
- Chao Guo
- Institute of Population Research, Peking University, Beijing, China
- APEC Health Science Academy, Peking University, Beijing, China
| | - Dianqi Yuan
- Institute of Population Research, Peking University, Beijing, China
| | - Huameng Tang
- Institute of Population Research, Peking University, Beijing, China
| | - Xiyuan Hu
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Yiyang Lei
- Institute of Population Research, Peking University, Beijing, China
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Gonzalez-Gonzalez C, Orozco-Rocha K, DeGraff DS, Samper-Ternent R, Wong R. COVID-19 And Mental Health Outcomes Of Older Adults: Evidence From Mexico. Health Aff (Millwood) 2023; 42:1675-1680. [PMID: 38048498 DOI: 10.1377/hlthaff.2023.00698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Estimates using data from the Mexican Health and Aging Study, a national longitudinal sample of older adults in Mexico, show elevated risk for negative mental health outcomes for those experiencing COVID-19 infection or major COVID-19-related adverse events. Predicted elevated probabilities were greater for a major adverse event than for COVID-19 infection, and they varied across sociodemographic groups defined by age, sex, education, and urban-rural residence.
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Affiliation(s)
| | | | | | | | - Rebeca Wong
- Rebeca Wong , University of Texas, Galveston, Texas
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Conboy NE, Nickow A, Awoonor-Williams JK, Hirschhorn LR. Self-reported delays in care-seeking in West Africa during the first wave of the COVID-19 pandemic. BMC Health Serv Res 2023; 23:785. [PMID: 37481561 PMCID: PMC10363320 DOI: 10.1186/s12913-023-09812-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 07/13/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic caused delays in care-seeking due to fears of infection and decreased healthcare access globally. These delays have been linked in some countries to COVID-19 perceptions, decreased income, and food insecurity, but little is known about patient-level factors for decreased care-seeking specifically at the beginning of COVID-19 in West Africa. Understanding these factors is important to identify those at highest risk and address healthcare-related barriers. METHODS This study used self-reported data from telephone surveys in a population-based sample in Burkina Faso (n = 1352), Ghana (n = 1621), and Sierra Leone (n = 1301) in May-June 2020. Questions assessed delays in care-seeking, sociodemographic variables, COVID-19 beliefs, and food insecurity. Bivariate analyses using chi-square and multivariate analyses using logistic regression were used to explore associations between factors and delays in care-seeking by country. Independent variables were chosen based on prior research suggesting that financial insecurity, older age, female sex, rural location, and COVID-related concerns are associated with delays. RESULTS Between March-June 2020, 9.9%, 10.6%, and 5.7% of participants in Burkina Faso, Ghana, and Sierra Leone, respectively, delayed care-seeking. Food insecurity was prevalent (21.8-46.1%) and in bivariate analyses was associated with delays in care-seeking in Burkina Faso and Ghana. Concern about risk of household contraction of COVID-19 was common (18.1-36.0%) and in Ghana and Sierra Leone was associated with delays in care-seeking in both bivariate and multivariate analyses. In bivariate analyses, females showed more delays in Burkina Faso, while age above 30 and urban location were associated with delays in Ghana. In multivariate analyses, food insecurity was associated with increased delayed care-seeking in Burkina Faso. CONCLUSIONS Multiple factors were associated with delays in care-seeking early in the COVID-19 pandemic, with food insecurity and concerns about infection showing significant associations in multiple countries. These findings highlight the need to invest in clinic accessibility, community education, and financial assistance to address barriers in healthcare. While many delays have subsided since the initial phase of the COVID-19 pandemic, understanding factors associated with early disruptions of care-seeking at the patient and household level will inform strategies for maintaining healthcare access during future pandemics in West Africa.
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Affiliation(s)
- Natalie E Conboy
- Northwestern University Feinberg School of Medicine, IL, Chicago, USA.
| | - Andre Nickow
- Northwestern University Global Poverty Research Lab, Evanston, IL, USA
| | - John Koku Awoonor-Williams
- Formerly of the Department of Policy, Planning, Monitoring and Evaluation, Ghana Health Service, Accra, Ghana
| | - Lisa R Hirschhorn
- Northwestern University Feinberg School of Medicine, IL, Chicago, USA
- Robert J. Havey Institute of Global Health, Chicago, IL, USA
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Chua F, Lam A, Mak YH, Lee ZH, Dacay LM, Yew JL, Puar T, Khoo J, Chow W, Tan VH, Tong KL, Liew BW, Yeo C, Loh WJ. Undiagnosed cardiovascular risk factors including elevated lipoprotein(a) in patients with ischaemic heart disease. FRONTIERS IN EPIDEMIOLOGY 2023; 3:1207752. [PMID: 38455910 PMCID: PMC10911051 DOI: 10.3389/fepid.2023.1207752] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/29/2023] [Indexed: 03/09/2024]
Abstract
Objectives This study aims to investigate the prevalence of undiagnosed cardiovascular risk factors in patients with ischaemic heart disease (IHD). Methods We assessed the prevalence of previously undiagnosed cardiovascular risk factors, including elevated lipoprotein(a) [Lp(a)], among consenting patients with IHD who were admitted to hospital. Clinical information, including dietary history, from patients with newly diagnosed IHD and known IHD were compared. Results Of the 555 patients, 82.3% were males and 48.5% of Chinese ethnicity. Overall, 13.3% were newly diagnosed with hypertension, 14.8% with hypercholesterolemia, and 5% with type 2 diabetes (T2DM). Patients with newly diagnosed IHD, compared to those with known IHD, had a higher prevalence of new diagnoses of hypercholesterolemia (29.1% vs. 2.0%, p < 0.001), hypertension (24.5% vs. 3.4%, p < 0.001) and T2DM (7.3% vs. 3.1%, p = 0.023). Active smoking was prevalent in 28.3% of patients, and higher in newly diagnosed IHD (34.1% vs. 23.2%, p = 0.005). Elevated Lp(a) of ≥120 nmol/L was detected in 15.6% of all patients, none of whom were previously diagnosed. Dietary habits of >50% of patients in both groups did not meet national recommendations for fruits, vegetables, wholegrain and oily fish intake. However, patients with known IHD had a more regular omega-3 supplement intake (23.4% vs. 10.3%, p = 0.024). Conclusion Increased detection efforts is necessary to diagnose chronic metabolic diseases (hypertension, hypercholesterolemia, T2DM) especially among patients at high risk for IHD. Cardiovascular risk factors, in particular elevated Lp(a), smoking, and suboptimal dietary intake in patients with IHD deserve further attention.
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Affiliation(s)
- Fionn Chua
- Dietetics Department, Changi General Hospital, Singapore, Singapore
| | - Audrey Lam
- Department of Pharmacy, Changi General Hospital, Singapore, Singapore
| | - Ying Hui Mak
- Department of Pharmacy, Changi General Hospital, Singapore, Singapore
| | - Zhong Hui Lee
- Department of Pharmacy, Changi General Hospital, Singapore, Singapore
| | - Lily Mae Dacay
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Jie Lin Yew
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Troy Puar
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Joan Khoo
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Weien Chow
- Department of Cardiology, Changi General Hospital, Singapore, Singapore
| | - Vern Hsen Tan
- Department of Cardiology, Changi General Hospital, Singapore, Singapore
| | - Khim Leng Tong
- Department of Cardiology, Changi General Hospital, Singapore, Singapore
| | - Boon Wah Liew
- Department of Cardiology, Changi General Hospital, Singapore, Singapore
| | - Colin Yeo
- Department of Cardiology, Changi General Hospital, Singapore, Singapore
| | - Wann Jia Loh
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Hussain A, Okobi OE, Obi CB, Chukwuedozie VC, Sike CG, Etomi EH, Akinyemi FB. Association Between Self-Rated Health and Medical Care Disruption Due to COVID-19 Among Individuals With Atherosclerotic Cardiovascular Disease. Cureus 2023; 15:e40697. [PMID: 37485099 PMCID: PMC10359049 DOI: 10.7759/cureus.40697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has disrupted medical care across diverse populations with varying outcomes. In this study, we evaluated the relationship between health rating and disruption in medical care due to COVID-19 among individuals with atherosclerotic cardiovascular disease (ASCVD). METHODS Data from the 2020 National Health Interview Survey was used for this study. ASCVD sample included those with self-reported coronary heart disease, stroke, and heart attack. Health rating was represented as fair to poor, good, and very good to excellent. The outcome variable was a disruption of medical care due to COVID-19 (delay in medical care or did not get care). The chi-square test was used for the descriptive analysis and multiple logistic regression was used to evaluate the relationship between health rating and disruption in medical care with demographic factors, comorbidities, and cumulative social risk adjusted for. RESULTS Among the 31,568 adults, 1,707/31,568 representing 9,385,855 adults 18 years and above with ASCVD reported experiencing or not experiencing a disruption in medical care. After adjusting for cumulative risk, the odds of not getting medical care due to COVID-19 were high for those who rated their health as fair/poor as compared to excellent (adjusted odds ratio (AOR) = 1.95, 95% CI = 1.24-3.08, p = 0.004). These odds remained about the same after adjusting for cumulative social risk, demographic factors, and comorbidities (AOR = 1.84, 95% CI = 1.11-3.06, p = 0.018). After adjusting for cumulative risk, medical care utilization (received, delayed, did not receive) was rated. Those who rated their health as fair to poor as compared to excellent were more likely to report a delay in health care due to COVID-19 (AOR = 1.85, 95% CI = 1.28-2.68, p = 0.001) and remained about the same after adjusting for cumulative social risk, demographic factors, and comorbidities (AOR = 1.86, 95% CI = 1.22-2.82, p = 0.004). Female respondents with ASCVD who rated their health as fair/poor were more likely to experience a delay in medical care due to COVID-19 (AOR = 2.06, 95% CI = 1.06-4.01, p = 0.033) or not get medical care due to COVID-19 (AOR = 2.86, 95% CI = 1.42-5.76, p = 0.003) as compared to those who rated their health as excellent. With regards to men with ASCVD, health rating was not related to their reported disruption of medical care due to COVID-19. CONCLUSIONS A poor to fair health rating is associated with a delay in getting or not getting medical care among individuals with ASCVD. Further studies are needed to evaluate this relationship further.
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Affiliation(s)
- Akbar Hussain
- Internal Medicine, Appalachian Regional Health, Harlan, USA
| | - Okelue E Okobi
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | | | | | - Cherechi G Sike
- General Practice, Windsor University School of Medicine, Cayon, KNA
| | - Eghogho H Etomi
- Cardiology, Kharkiv National Medical University, Kharkiv, UKR
- Research, Texas Southern University, Houston, USA
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Raisi-Estabragh Z, Mamas MA. Cardiovascular Health Care Implications of the COVID-19 pandemic. Heart Fail Clin 2023; 19:265-272. [PMID: 36863818 PMCID: PMC9973542 DOI: 10.1016/j.hfc.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has challenged the capacity of health care systems around the world, including substantial disruptions to cardiovascular care across key areas of health care delivery. In this narrative review, we examine the implications of the COVID-19 pandemic for cardiovascular health care, including excess cardiovascular mortality, acute and elective cardiovascular care, and disease prevention. Additionally, we consider the long-term public health consequences of disruptions to cardiovascular care across both primary and secondary care settings. Finally, we review health care inequalities and their driving factors, as highlighted by the pandemic, and consider their importance in the context of cardiovascular health care.
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Affiliation(s)
- Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University, London EC1M 6BQ, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele ST5 5BG, United Kingdom; Department of Cardiology, Thomas Jefferson University, Philadelphia, PA 19107, USA; Institute of Population Health, University of Manchester, Manchester M13 9PT, United kingdom.
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Endaryanto A, Dewi A, Kusbaryanto, Nugraha RA. Trend in the admissions of patients with non-COVID-19 respiratory symptoms during COVID-19 pandemic and its impact on hospital finances in surabaya, Indonesia. Heliyon 2023; 9:e15122. [PMID: 37035376 PMCID: PMC10065813 DOI: 10.1016/j.heliyon.2023.e15122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 03/11/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Background COVID-19 cases surge, it has a crucial impact on healthcare systems, with rapidly increasing demand for healthcare resources in hospitals and intensive care units (ICUs) in Indonesia and worldwide. It is necessary to quantify the extent to which the effects of the COVID-19 pandemic on the hospital admissions, and clinical and financial outcomes of patients with non-COVID-19 respiratory symptoms. Objective To determine whether the COVID-19 pandemic changed the hospitalisation of child and adult patients with non-COVID-19 respiratory conditions and whether these changes affected the patient's disease condition, clinical outcomes, and hospital finances. Methods A retrospective cohort study was conducted from May 1, 2018 (before the COVID-19 pandemic) until December 31, 2021. Total sampling was done to compare hospital admission of patients with non-COVID-19 respiratory symptoms before versus during the COVID-19 pandemic. The results were analyzed using SPSS 26.0 and SmartPLS.v.3.2.9. Results There was a reduction in hospitalisations for respiratory disorders unrelated to COVID-19 during the pandemic by 55.3% in children and 47.8% in adult patients. During the pandemic, the average hospital revenue per patient of child and adult patients increased significantly, but the profit per patient decreased. Pathway analysis showed that in children, the COVID-19 Pandemic changed disease severity and complexity (β = 0.132, P < 0.001), as well as clinical outcomes (β = 0.029, P < 0.05). In adults, the COVID-19 pandemic improves disease severity and complexity (β = -0.020, P < 0.001), as well as clinical outcomes (β = -0.013, P < 0.001). COVID-19 pandemic increases care charges (in children with β = 0.135, P < 0.001; and in the adult patients with β = 0.110, P < 0.001), worsens hospital financial outcomes relating to child (β = -0.093, P < 0.001) and adult patient (β = -0.073, P < 0.001). In adult patients, seasonal variations moderate the impact of the COVID-19 pandemic on improving disease conditions (β = -0.032, P=<0.001). The child structural model effectively predicted clinical outcomes (Q2 = 0.215) and financial outcomes (Q2 = 0.462). The adult structural model effectively predicted clinical outcomes (Q2 = 0.06) and financial outcomes (Q2 = 0.472). Conclusion The conclusions are that the number of non-COVID respiratory patients decreased during the COVID-19 pandemic (47.8% in adult patients, 55.3% in child patients). Disease severity and complexity increased in child patients but decreased in adult patient. Costs of care and insurance payments increased. Since the insurance payments did not increase as much as the cost of care, hospital profit decreased.
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Delay or postponement of medical care among older adults in the Netherlands at earlier and later stages of the COVID-19 pandemic. Aging Clin Exp Res 2022; 34:2913-2917. [PMID: 36260212 PMCID: PMC9579526 DOI: 10.1007/s40520-022-02266-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/21/2022] [Indexed: 11/27/2022]
Abstract
Aims The aim of the current study was to compare cancellations or postponement of medical care among older adults during the COVID-19 pandemic between 2021 and 2020.
Methods Data of respondents aged ≥ 62 years were used from the longitudinal aging study Amsterdam (LASA), collected in 2020 and 2021, directly after the main COVID-19 waves in the Netherlands. A questionnaire assessed cancellations of medical care and postponed help-seeking behavior. Descriptive analyses were performed.
Results Overall, cancellations declined from 35% in 2020 (sample n = 1128) to 17% in 2021 (sample n = 1020). Healthcare-initiated cancellations declined from 29 to 8%. Respondent-initiated cancellations declined from 12 to 7%. Postponed help-seeking remained around 8%. Conclusions In 2021, less cancellations were reported compared to just after the first wave of the pandemic in 2020, while postponed help-seeking remained the same. It is important to investigate how cancellations and postponed help-seeking can be prevented in future pandemics.
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Yun JY, Sim JA, Lee S, Yun YH. Stronger association of perceived health with socio-economic inequality during COVID-19 pandemic than pre-pandemic era. BMC Public Health 2022; 22:1757. [PMID: 36114525 PMCID: PMC9479296 DOI: 10.1186/s12889-022-14176-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 09/13/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Objective
The COVID-19 pandemic has changed peoples’ routine of daily living and posed major risks to global health and economy. Few studies have examined differential impacts of economic factors on health during pandemic compared to pre-pandemic. We aimed to compare the strength of associations between perceived health and socioeconomic position (household income, educational attainment, and employment) estimated before and during the pandemic.
Methods
Two waves of nationwide survey [on 2018(T1;n = 1200) and 2021(T2;n = 1000)] were done for 2200 community adults. A balanced distribution of confounders (demographics and socioeconomic position) were achieved across the T2 and T1 by use of the inverse probability of treatment weighting. Distributions of perceived health [= (excellent or very good)/(bad, fair, or good)] for physical-mental-social-spiritual subdomains were compared between T1 and T2. Odds of bad/fair/good health for demographics and socioeconomic position were obtained by univariate logistic regression. Adjusted odds (aOR) of bad/fair/good health in lower household income(< 3000 U.S. dollars/month) were retrieved using the multiple hierarchical logistic regression models of T1 and T2.
Results
Perceived health of excellent/very good at T2 was higher than T1 for physical(T1 = 36.05%, T2 = 39.13%; P = 0.04), but were lower for mental(T1 = 38.71%, T2 = 35.17%; P = 0.01) and social(T1 = 42.48%, T2 = 35.17%; P < 0.001) subdomains. Odds of bad/fair/good health were significantly increased at T2 than T1 for household income (physical-mental-social; all Ps < 0.001) and educational attainment (social; P = 0.04) but not for employment (all Ps > 0.05). AORs of bad/fair/good health in lower household income were stronger in T2 than T1, for mental [aOR (95% CI) = 2.15(1.68–2.77) in T2, 1.33(1.06–1.68) in T1; aOR difference = 0.82(P < 0.001)], physical [aOR (95% CI) = 2.64(2.05–3.41) in T2, 1.50(1.18–1.90) in T1; aOR difference = 1.14(P < 0.001)] and social [aOR (95% CI) = 2.15(1.68–2.77) in T2, 1.33(1.06–1.68) in T1; aOR difference = 0.35(P = 0.049)] subdomains.
Conclusions
Risks of perceived health worsening for mental and social subdomains in people with lower monthly household income or lower educational attainment became stronger during the COVID-19 pandemic compared to pre-pandemic era. In consideration of the prolonged pandemic as of mid-2022, policies aiming not only to sustain the monthly household income and compulsory education but also to actively enhance the perceived mental-social health status have to be executed and maintained.
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Abstract
The coronavirus disease 2019 (COVID-19) pandemic has challenged the capacity of health care systems around the world, including substantial disruptions to cardiovascular care across key areas of health care delivery. In this narrative review, we examine the implications of the COVID-19 pandemic for cardiovascular health care, including excess cardiovascular mortality, acute and elective cardiovascular care, and disease prevention. Additionally, we consider the long-term public health consequences of disruptions to cardiovascular care across both primary and secondary care settings. Finally, we review health care inequalities and their driving factors, as highlighted by the pandemic, and consider their importance in the context of cardiovascular health care.
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Affiliation(s)
- Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University, London EC1M 6BQ, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, United Kingdom
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- Keele Cardiovascular Research Group, Keele University, Keele ST5 5BG, United Kingdom; Department of Cardiology, Thomas Jefferson University, Philadelphia, PA 19107, USA; Institute of Population Health, University of Manchester, Manchester M13 9PT, United kingdom.
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