A real world analysis of COVID-19 impact on hospitalizations in older adults with chronic conditions from an Italian region
Cristina Bosetti, Magda Rognoni, Roberta Ciampichini, Luca Paroni, Marco Scala, Luca Cavalieri d’Oro, Alberto Zucchi, Andrea Amerio, Licia Iacoviello, Simone Ghislandi, Anna Odone, David Stückler, Silvano Gallus, Lost in Lombardia Project Investigators, Cristina Bosetti, Silvano Gallus, Carlotta Micaela Jarach, Alessandra Lugo, Chiara Stival, Andrea Amerio, Mario Amore, Gianluca Serafini, Roberto De Sena, Simone Ghislandi, David Stückler, Yuxi Wang, Marialaura Bonaccio, Francesco Gianfagna, Licia Iacoviello, Giansanto Mosconi, Anna Odone, Carlo Signorelli, Giacomo Pietro Vigezzi, Luca Cavalieri d’Oro, Luca Paroni, M. Moretti Sala, Magda Rognoni, Roberta Ciampichini, Alberto Zucchi
Abstract
Healthcare delivery reorganization during the COVID-19 emergency may have had a significant impact on access to care for older adults with chronic conditions. We investigated such impact among all adults with chronic conditions aged ≥ 65 years, identified through the electronic health databases of two local health agencies-ATS Brianza and ATS Bergamo-from the Lombardy region, Italy. We considered hospitalizations for 2020 compared to the average 2017-2019 and quantified differences using rate ratios (RRs). Overall, in 2017-2019 there were a mean of 374,855 older adults with ≥ 1 chronic condition per year in the two ATS and 405,371 in 2020. Hospitalizations significantly decreased from 84,624 (225.8/1000) in 2017-2019 to 78,345 (193.3/1000) in 2020 (RR 0.86). Declines were reported in individuals with many chronic conditions and for most Major Diagnostic Categories, except for diseases of the respiratory system. The strongest reductions were observed in hospitalizations for individuals with active tumours, particularly for surgical ones. Hospitalization rates increased in individuals with diabetes, likely due to COVID-19-related diseases. Although determinants of the decrease in demand and supply for care among chronic older adults are to be further explored, this raises awareness on their impacts on chronic patients' health in the medium and long run.