- Hospitalizations for several medical conditions at a major New York City-area hospital system plunged after the COVID-19 pandemic began, a new research letter published in JAMA Internal Medicine by researchers at New York University and the University of Michigan medical schools finds. And even amid a recent rebound, admissions still remain well below pre-pandemic levels. Similar conclusions were made by researchers at Stanford University Medical Center and Weill Cornell Medical College examining their respective healthcare institutions.
- While the NYU/Michigan researchers suggest patients may be avoiding the hospital or may have lost their health insurance as a result of the economic fallout from the pandemic, they also cited two other reasons: Many healthcare services may be overused, and patients — particularly those with chronic conditions — might be taking better care of themselves.
- Yet there is another disturbing trend that is coming into focus: According to the Stanford/Weill Cornell researchers, significantly more patients with serious medical conditions are dying at home, possibly as the result of deferring crucial care.
Most hospitals in the U.S. promptly canceled elective procedures after COVID-19 was declared a pandemic back in March. Those restrictions have since eased. But while elective procedures have rebounded close to pre-pandemic levels, other forms of hospital admissions have lagged. The research by the two teams put a number of the decline.
The NYU/Michigan researchers focused on the NYU Langone hospital system. They studied non-COVID-19 inpatient admissions between March 1 and May 9 for the years 2018, 2019 and 2020. They discovered admissions dropped 31.9% this year compared to 2019. They were down 43% this year when compared to 2018 data.
Patients admitted for myocardial infarctions dropped by 75%; nearly 65% for heart failure and more than 50% for septicemia, among other conditions. Admissions for most conditions showed rebounds later in the study period as COVID-19 restrictions eased up, but they still remained well below pre-pandemic levels. Pregnancy-related admissions were actually lower by the late period of the study.
"Notably, while hospitalizations for acute events began recovering in the late COVID-19 period, many of those related to chronic diseases generally did not," the NYU/Michigan researchers noted. "The implications of the decreases in hospitalizations for chronic disease are concerning for the possibility that sick patients are not obtaining necessary hospital care; alternatively, this trend could suggest prior overuse of hospitalization or improved self-management."
Some data suggest that elective procedures are rebounding — at least as long as COVID-19 cases are not spiking. Meanwhile, a recent Kaufman Hall survey suggested hospital volumes wouldn't fully rebound until 2022.
Findings were fairly similar when the Stanford and New York Presbyterian/Weill Cornell Medical Center data was analyzed. The daily volumes for myocardial infarctions declined 39% at New York Presbyterian and 26% at Stanford; ischemic stroke volumes declined 49% at New York Presbyterian and 16% at Stanford; and non-traumatic subarachnoid hemorrhages declined 33% and 21%, respectively.
However, the researchers in that instance suggest that the decline in hospitalizations may have a darker conclusion.
"Recent data suggest that deaths resulting from COVID-19 account for only half of the excess number of at-home deaths during the pandemic," they observed, citing data from the British Medical Journal. "The combination of fewer patients presenting with medical emergencies and an increased number of non–COVID-19–related at-home deaths is concerning. Fear of exposure to patients with COVID-19 may lead individuals to defer care for acute conditions."