COVID-19 volume declines mostly uniform, but higher in Black, Latino neighborhoods, study shows

By | September 28, 2020

Dive Brief:

  • Erosion in the volume of hospital inpatient admissions during the initial months of the COVID-19 pandemic was remarkably uniform, a study published Thursday in Health Affairs concluded. The volumes began to bounce back significantly in June. However, there were some differences among demographic groups.
  • Admissions among patients living in majority Black and Latino neighborhoods dipped well below the highest point of decline in April 2020, according to the study. And there were also higher overall drops in admissions for conditions such as pneumonia, chronic obstructive pulmonary disease/asthma and sepsis, regardless of race.
  • The study’s authors noted that many admissions in general are “for conditions that are reasonably managed at home in many circumstances. It is plausible that many patients, in consultation with their physicians, made informed decisions to defer or avoid hospitalization early during the pandemic.”

Dive Insight:

The hospital volume declines as COVID-19 spurred stay-at-home orders have significantly impacted the earnings of for-profit hospital chains, although federal relief funds have helped soften the blow. Hospitals, however, have been saying for months that the money isn’t enough and another round of bailouts is needed.

Although House Speaker Nancy Pelosi, D-Calif., has made another push for such legislation, the parties still seem far apart on a deal and gridlock has only intensified as the presidential election nears.

The latest report to quantify the impact of COVID-19 on hospital admissions was performed by researchers from the Geisel School of Medicine at Dartmouth College and Sound Physicians, a Tacoma, Washington-based hospitalist group that works with some 4,000 doctors nationwide.

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Researchers analyzed data on about 1 million hospital admissions in and around the time COVID-19 became a pandemic. Altogether, data from 201 hospitals in 36 states was scrutinized, with a focus on April 2020 admissions versus April 2019, and February 2020 admissions used as a baseline.

At the admissions nadir in April, non-COVID admissions declined 42.8% and all medical admissions were down 34.1% for the month. At some hospitals, the decline was as high as 50%. Even hospitals that saw a minimal impact from COVID-19 saw their admissions drop 39.5%.

Admissions from predominantly Black neighborhoods declined 45.2% at the nadir; they were down 44.2% from Latino neighborhoods. Admissions from poorer neighborhoods were down 44%. Despite the decline, in-hospital mortality rates increased 0.3% in April, although it declined to normal levels by the following month.

Among specific medical conditions, admissions for pancreatitis declined 23.7% at the low point and 24.7% for strokes. By early summer, pancreatitis admissions reached their pre-COVID levels. However, admissions for urinary tract infections were still down 24.7%; sepsis admissions were down 25.1%; and pneumonia admissions were down 44.1%.

“The most plausible explanation for the broad-based declines in medical admissions is that patients avoided seeking hospital care, perhaps in response to fear of contagion arising from media reports, or as a result of state stay-at-home orders,” the study’s authors wrote. “Conversely, our results do not suggest access challenges at hospitals overrun with COVID-19 patients as a major reason for admission declines.”

Admissions had rebounded by July, in line with other data indicating patients are more comfortable undergoing medical procedures. However, they still remained 16% below baseline levels, even as providers campaign for people to resume preventive care in particular.

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