Pandemic-related reductions in emergency department (ED) visits and hospitalizations for chronic obstructive pulmonary disease (COPD) and asthma were greater in disadvantaged communities than in the general US population, according to study findings published in Annals of Allergy, Asthma & Immunology.
Investigators examined the population-level effects of COVID-19 on asthma and COPD exacerbations in the US, with a focus on disadvantaged communities. The researchers also assessed trends in mortality from chronic lower respiratory illness before and during the COVID-19 pandemic.
The investigators conducted analysis of respiratory disease mortality, hospitalizations and ED visits, and demographics using population-level data from the Center for Disease Control and Prevention (CDC) WONDER database (Wide-ranging ONline Data for Epidemiologic Research), the CDC National Environmental Public Health Tracking Network, and the 2016-2020 American Community Survey (ACS), conducted by the US Census Bureau. The researchers also used the 2016-2020 National Hospital Ambulatory Care Survey (NHAMCS), conducted by the CDC, for supplementary analysis of ED visits.
Overall, county-level data analysis included 685 counties in 13 states. In comparing 2019 with 2020 data, the investigators found large reductions in visit rates for COPD (ED visit rate reduction, 21.5 per 10,000 persons; 95% CI, -23.8 to -19.1) and asthma (ER visit rate reduction, 21.3 per 10,000; 95% CI, -25.1 to -17.5). The researchers noted smaller reductions in hospitalization rates (COPD hospitalization rate reduction, 6.9 per 10,000; 95% CI, -7.6 to -6.1) and (asthma hospitalization rate reduction, 3.0 per 10,000; 95% CI, -3.6 to -2.4). Myocardial infarction (MI) hospitalizations were used as a comparator condition (MI hospitalization rate reduction, 4.1 per 10,000).
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[W]e observed significant reductions in ED visits and hospitalizations from asthma and COPD during the first year of the COVID pandemic, with greater absolute reductions in
disadvantaged communities.
Chronic lower respiratory mortality rate had smaller reductions (1.7 per 100,000).
Disadvantaged communities had mostly higher baseline rates of respiratory morbidity as well as generally larger pandemic-related absolute declines in hospitalizations and ED visits. The researchers postulated that the higher pre-pandemic COPD and asthma exacerbation levels in disadvantaged communities were likely related to higher baseline exposure to harmful environmental factors, and that these communities thus had “more to gain” when the pandemic curtailed exposure to such factors.
According to supplementary analysis of NHAMCS national ED data, the 4.1 million annual asthma-related ED visits from 2016 through 2019 fell to 2.8 million in 2020 (33% decline). Annual COPD-related ED visits, which were 1.1 million from 2016 through 2019, fell to 0.5 million in 2020 (a 51% decline). In contrast, all-cause ED visits decreased by only 7% during this same time period, the researchers noted.
Study limitations include its reliance primarily on county-level data rather than national data. Additionally, mortality data for 2020 included pre-pandemic trends.
“[W]e observed significant reductions in ED visits and hospitalizations from asthma and COPD during the first year of the COVID pandemic, with greater absolute reductions in disadvantaged communities,” the study authors concluded. “[O]ur findings provide support for the hypothesis that longstanding disparities in asthma and COPD morbidity are, at least in part, mediated by differential exposure to respiratory viruses,” the study authors postulated. “The mechanisms producing such disparities in viral exposure might include household crowding, workplace exposures- or other factors, issues requiring further study,” said the study authors, who further noted that “Understanding the mechanism of this reduction might inform future efforts to prevent exacerbations.”
