Effect of COVID-19 on First-Time Acute Stroke and Transient Ischemic Attack Admission Rates and Prognosis in Denmark
Jawad H. Butt, Emil Loldrup Fosbøl, Lauge Østergaard, Adelina Yafasova, Charlotte Andersson, Morten Schou, Thomas Alexander Gerds, Matthew Phelps, Christina Kruuse, Gunnar Gislason, Christian Torp‐Pedersen, Lars Køber
Abstract
On March 13, 2020, the Danish authorities imposed extensive nationwide lockdown measures to prevent the spread of the novel coronavirus disease 2019 (COVID-19) and reprioritized limited healthcare resources.However, this strategy may have a detrimental effect on medical care to patients with other acute conditions such as stroke and may increase the reluctance of patients with symptoms to contact emergency medical services.To shed light on the possible collateral effects of a lockdown strategy and reprioritization within the healthcare system, we performed a nationwide cohort study to investigate stroke and transient ischemic attack (TIA) admission rates and prognosis in Denmark during the COVID-19 pandemic.Data from several nationwide administrative registries were obtained, and they have been described previously. 1 The study population comprised every Danish citizen in 2 periods: (1) a combined period of January 2 to May 8 (2017-2019), and (2) January 2 to May 7, 2020.Weekly incidence rates and incidence rates before and after March 13 of first-time stroke/TIA admissions, overall and according to subtypes, in the 2 periods were compared with unadjusted Poisson regression.Furthermore, mortality rates among patients admitted with stroke/TIA, overall and according to subtypes, before and after March 13, were compared with the use of unadjusted Cox regression.The study is approved by the Capital Region of Denmark (approval P-2019-191) in accordance with the General Data Protection Regulation.Before March 13, an average of 2862 patients were admitted with stroke/TIA in 2017 to 2019 compared with 2954 patients in 2020.After March 13, the corresponding numbers were 2323 and 2029, respectively.The admission rates of stroke/TIA were significantly lower during the first weeks of lockdown in 2020 but returned to a rate similar to that observed in 2017 to 2019 toward the end of the study period (Figure [A]).However, results differed according to subtypes.Although the admission rates of ischemic stroke and TIA were significantly lower during the first weeks of lockdown in 2020 before returning to rates similar to those observed in 2017 to 2019 toward the end of the study period, the admission rate of hemorrhagic stroke was not significantly different after lockdown in 2020 compared with 2017 to 2019 (Figure [B through D]).These results were consistent regardless of sex and age.In addition, expanding the study population to patients with a history of stroke/TIA yielded similar findings.The mortality rates among patients admitted with stroke/TIA, overall and according to subtypes, before and after March 13 were not significantly different in 2020 compared with 2017 to 2019 (Figure [E]).3][4] The reasons for the significant decline in stroke admissions after lockdown are unclear.