1
|
Lu D, Dhanoa S, Cheema H, Lewis K, Geeraert P, Merrick B, Vander Leek A, Sebastianski M, Kula B, Chaudhuri D, Basmaji J, Agrawal A, Niven D, Fiest K, Stelfox HT, Zuege DJ, Rewa OG, Bagshaw SM, Lau VI. Coronavirus disease 2019 (COVID-19) excess mortality outcomes associated with pandemic effects study (COPES): A systematic review and meta-analysis. Front Med (Lausanne) 2022; 9:999225. [PMID: 36590965 PMCID: PMC9800609 DOI: 10.3389/fmed.2022.999225] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
Background and aim With the Coronavirus Disease 2019 (COVID-19) pandemic continuing to impact healthcare systems around the world, healthcare providers are attempting to balance resources devoted to COVID-19 patients while minimizing excess mortality overall (both COVID-19 and non-COVID-19 patients). To this end, we conducted a systematic review (SR) to describe the effect of the COVID-19 pandemic on all-cause excess mortality (COVID-19 and non-COVID-19) during the pandemic timeframe compared to non-pandemic times. Methods We searched EMBASE, Cochrane Database of SRs, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Cochrane Controlled Trials Register (CENTRAL), from inception (1948) to December 31, 2020. We used a two-stage review process to screen/extract data. We assessed risk of bias using Newcastle-Ottawa Scale (NOS). We used Critical Appraisal and Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Results Of 11,581 citations, 194 studies met eligibility. Of these studies, 31 had mortality comparisons (n = 433,196,345 participants). Compared to pre-pandemic times, during the COVID-19 pandemic, our meta-analysis demonstrated that COVID-19 mortality had an increased risk difference (RD) of 0.06% (95% CI: 0.06-0.06% p < 0.00001). All-cause mortality also increased [relative risk (RR): 1.53, 95% confidence interval (CI): 1.38-1.70, p < 0.00001] alongside non-COVID-19 mortality (RR: 1.18, 1.07-1.30, p < 0.00001). There was "very low" certainty of evidence through GRADE assessment for all outcomes studied, demonstrating the evidence as uncertain. Interpretation The COVID-19 pandemic may have caused significant increases in all-cause excess mortality, greater than those accounted for by increases due to COVID-19 mortality alone, although the evidence is uncertain. Systematic review registration [https://www.crd.york.ac.uk/prospero/#recordDetails], identifier [CRD42020201256].
Collapse
Affiliation(s)
- David Lu
- Faculty of Medicine and Dentistry, Alberta Health Services, University of Alberta, Edmonton, AB, Canada
| | - Sumeet Dhanoa
- Faculty of Medicine and Dentistry, Alberta Health Services, University of Alberta, Edmonton, AB, Canada
| | - Harleen Cheema
- Faculty of Medicine and Dentistry, Alberta Health Services, University of Alberta, Edmonton, AB, Canada
| | - Kimberley Lewis
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Division of Critical Care Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Patrick Geeraert
- Faculty of Medicine and Dentistry, Alberta Health Services, University of Alberta, Edmonton, AB, Canada
| | - Benjamin Merrick
- Faculty of Medicine and Dentistry, Alberta Health Services, University of Alberta, Edmonton, AB, Canada
| | - Aaron Vander Leek
- Faculty of Medicine and Dentistry, Alberta Health Services, University of Alberta, Edmonton, AB, Canada
| | - Meghan Sebastianski
- Alberta Strategy for Patient-Oriented Research Knowledge Translation Platform, University of Alberta, Edmonton, AB, Canada
| | - Brittany Kula
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine and Dentistry, Alberta Health Services, University of Alberta, Edmonton, AB, Canada
| | - Dipayan Chaudhuri
- Division of Critical Care Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - John Basmaji
- Division of Critical Care, Department of Medicine, Western University, London, ON, Canada
| | - Arnav Agrawal
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Dan Niven
- Department of Critical Care Medicine, Cumming School of Medicine, Alberta Health Services, University of Calgary, Calgary, AB, Canada
| | - Kirsten Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, Alberta Health Services, University of Calgary, Calgary, AB, Canada
| | - Henry T. Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, Alberta Health Services, University of Calgary, Calgary, AB, Canada
| | - Danny J. Zuege
- Department of Critical Care Medicine, Cumming School of Medicine, Alberta Health Services, University of Calgary, Calgary, AB, Canada
| | - Oleksa G. Rewa
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, Alberta Health Services, University of Alberta, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Sean M. Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, Alberta Health Services, University of Alberta, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Vincent I. Lau
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, Alberta Health Services, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
2
|
Lau VI, Dhanoa S, Cheema H, Lewis K, Geeraert P, Lu D, Merrick B, Vander Leek A, Sebastianski M, Kula B, Chaudhuri D, Agarwal A, Niven DJ, Fiest KM, Stelfox HT, Zuege DJ, Rewa OG, Bagshaw SM. Non-COVID outcomes associated with the coronavirus disease-2019 (COVID-19) pandemic effects study (COPES): A systematic review and meta-analysis. PLoS One 2022; 17:e0269871. [PMID: 35749400 PMCID: PMC9231780 DOI: 10.1371/journal.pone.0269871] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 05/29/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND As the Coronavirus Disease-2019 (COVID-19) pandemic continues, healthcare providers struggle to manage both COVID-19 and non-COVID patients while still providing high-quality care. We conducted a systematic review/meta-analysis to describe the effects of the COVID-19 pandemic on patients with non-COVID illness and on healthcare systems compared to non-pandemic epochs. METHODS We searched Ovid MEDLINE/EMBASE/Cochrane Database of Systematic Reviews/CENTRAL/CINAHL (inception to December 31, 2020). All study types with COVID-pandemic time period (after December 31, 2019) with comparative non-pandemic time periods (prior to December 31, 2019). Data regarding study characteristics/case-mix/interventions/comparators/ outcomes (primary: mortality; secondary: morbidity/hospitalizations/disruptions-to-care. Paired reviewers conducted screening and abstraction, with conflicts resolved by discussion. Effect sizes for specific therapies were pooled using random-effects models. Risk of bias was assessed by Newcastle-Ottawa Scale, with evidence rating using GRADE methodology. RESULTS Of 11,581 citations, 167 studies met eligibility. Our meta-analysis showed an increased mortality of 16% during the COVID pandemic for non-COVID illness compared with 11% mortality during the pre-pandemic period (RR 1.38, 95% CI: 1.28-1.50; absolute risk difference: 5% [95% CI: 4-6%], p<0.00001, very low certainty evidence). Twenty-eight studies (17%) reported significant changes in morbidity (where 93% reported increases), while 30 studies (18%) reported no significant change (very low certainty). Thirty-nine studies (23%) reported significant changes in hospitalizations (97% reporting decreases), while 111 studies (66%) reported no significant change (very low certainty). Sixty-two studies (37%) reported significant disruptions in standards-to-care (73% reporting increases), while 62 studies (37%) reported no significant change (very low certainty). CONCLUSIONS There was a significant increase in mortality during the COVID pandemic compared to pre-pandemic times for non-COVID illnesses. When significant changes were reported, there was increased morbidity, decreased hospitalizations and increased disruptions in standards-of-care. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020201256 (Sept 2, 2020).
Collapse
Affiliation(s)
- Vincent Issac Lau
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
| | - Sumeet Dhanoa
- Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
| | - Harleen Cheema
- Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
| | - Kimberley Lewis
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- Division of Critical Care Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Patrick Geeraert
- Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
| | - David Lu
- Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
| | - Benjamin Merrick
- Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
| | - Aaron Vander Leek
- Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
| | - Meghan Sebastianski
- Alberta Strategy for Patient-Orientated Research Knowledge Translation Platform, University of Alberta, Edmonton, Alberta, Canada
| | - Brittany Kula
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
| | - Dipayan Chaudhuri
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- Division of Critical Care Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Arnav Agarwal
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, General Internal Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, and Alberta Health Services, Calgary, Alberta, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, and Alberta Health Services, Calgary, Alberta, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, and Alberta Health Services, Calgary, Alberta, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Danny J Zuege
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, and Alberta Health Services, Calgary, Alberta, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Oleksa G Rewa
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|