Editor’s Note: Read Dr. Cedric Dark’s commentary on this EMRA + PolicyRx Health Policy Journal Club article.

After the declaration of the COVID-19 pandemic in the United States in March 2020, hospital admissions nationwide, including those for non-COVID-19 diagnoses, fell substantially.¹ Despite an uptick in health care use beginning in June and July 2020, non-COVID-19 admissions remained significantly beneath pre-pandemic baseline volumes as many patients continued to defer hospital care for acute and sometimes even life-threatening medical conditions. However, the differential impacts of the pandemic and rebound on admission patterns among demographic groups are not well understood.

A recent study investigated the pandemic’s impact on admissions in relation to patient demographic factors and admission diagnoses.² Using a nationally representative hospital group’s data comprising more than 1 million admissions across 36 states, the authors compared weekly non-COVID-19 and total admissions in 2020 to corresponding weeks in 2019. They also collected data on patient demographics including age, race, ethnicity, poverty rate of the patient’s ZIP code, insurance coverage, and hospital COVID-19 volume.

The authors found that non-COVID-19 admissions decreased 42.8 percent below baseline as of the nadir in April 2020 before rebounding to 15.9 percent below baseline during the summer of 2020. Somewhat larger but significant declines were witnessed in patients over the age of 70; patients residing in majority-Hispanic, majority-Black, or high-poverty ZIP codes; uninsured patients; and hospitals belonging to the highest quintile of COVID-19 exposure. Most notably, during the rebound in June and July, non-COVID-19 admissions for patients residing in majority-Hispanic ZIP codes remained especially low at 31.8 percent below baseline. Moreover, admissions for non-COVID-19 diagnoses in this study decreased by at least 20 percent by April 2020 and remained below pre-pandemic baselines during the rebound.

COVID-19 has presented new public health challenges, highlighting the systemic inequities in the modern health care system and access barriers facing patients requiring hospital care.³ Deferred treatment for acute medical conditions likely contribute to adverse outcomes that disproportionately harm minority and low-income populations. Some of that may not be immediately detectable, though some is. Without a quick return to normalcy within reach, hospitals, health care systems, and public health authorities must collaborate to ensure that all patients can obtain needed hospital care during the pandemic in a timely, just, and equitable manner.

This Health Policy Journal Club review is a collaboration between Policy Prescriptions and the Emergency Medicine Residents’ Association.

Clinton Lam is a medical student at Touro University Nevada College of Osteopathic Medicine.

References

1. WHO Director-General’s opening remarks at the media briefing on COVID-19 – 11 March 2020. World Health Organization website. Accessed April 15, 2021.
2. Birkmeyer JD, Barnato A, Birkmeyer N, et al. The impact of the COVID-19 pandemic on hospital admissions in the United States. Health Aff (Millwood). 2020;39(11):2010-2017.
3. Dr. Uché Blackstock on why COVID-19 is the pandemic of inequities. Facebook website. Accessed April 15, 2021.