Preprints with The Lancet is part of SSRN´s First Look, a place where journals identify content of interest prior to publication. Authors have opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early stage research papers that have not been peer-reviewed. The findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed. For more information on this collaboration, see the comments published in The Lancet about the trial period, and our decision to make this a permanent offering, or visit The Lancet´s FAQ page, and for any feedback please contact email@example.com.
A Reduction in Hospitalizations and Concurrent Increase in Mortality During the First Year of the COVID-19 Pandemic in Hong Kong, China
27 Pages Posted: 12 Aug 2022More...
Background: Hong Kong followed a strict COVID-19 elimination strategy in 2020. We estimated the impact of the COVID-19 pandemic responses on all-cause and cause-specific hospitalizations and deaths in 2020.
Methods: Interrupted time-series analysis using Poisson regression accounting for seasonality and long-term trend was used on weekly 2010-2020 data to estimate the change in hospitalization rate and excess mortality occurring both within and out of hospitals.
Findings: In 2020, as compared to a 2010-2019 baseline, we observed an overall reduction in all-cause hospitalizations, and a concurrent increase in deaths. The overall hospitalization reduction (per 100,000 population per year) was 4,670 (95% CI: 4,041, 5,300) in 2020, with respiratory diseases (635, 95% CI: 560, 710) and cardiovascular diseases (293, 95% CI: 228, 358) contributing most. The overall excess mortality (per 100,000 population per year) was 22 (95% CI: 10, 34) in 2020, mostly among individuals with pre-existing cardiovascular diseases (12, 95% CI: 8, 16). A reduction in excess in-hospital mortality (-10 per 100,000 per year, 95% CI: -19, 0) was accompanied by an increase in excess out-of-hospital mortality (32, 95% CI: 21, 42).
Interpretation: The COVID-19 pandemic might have caused indirect impact on population morbidity and mortality likely through changed healthcare seeking particularly in youngest and oldest individuals and those with cardiovascular diseases. Better healthcare planning is needed during public health emergencies with disruptions in healthcare services.
Funding: Health and Medical Research Fund, Collaborative Research Scheme, AIR@InnoHK and RGC Senior Research Fellow Scheme, Hong Kong
Declaration of Interest: BJC consults for AstraZeneca, Fosun Pharma, GlaxoSmithKline, Moderna, Pfizer, Roche and Sanofi Pasteur. JN previously worked for, and owns shares in, Sanofi. The other authors report no other potential conflicts of interest.
Keywords: COVID-19, Hospitalization, Excess mortality, In-hospital mortality, Out-of-hospital mortality
Suggested Citation: Suggested Citation