Utilizing its dataset of medical claims, representing care received by more than 2.2 million people, the Midwest Health Initiative (MHI) has evaluated COVID-19 related utilization trends among Missouri’s commercially insured adults aged 18-64 years from the arrival of COVID-19 in Missouri through the first quarter of 2021. This analysis is intended to complement other works in the area: this brief reports trends in the diagnosis of acute conditions and the utilization of acute care facility services and preventative screenings. Emergency Department and Urgent Care Services: Early in the pandemic, the issuance of stay-at-home orders and government recommendations for the redirection of scarce medical resources to COVID-19 care affected the use of emergency services, which serve as an umbrella for the treatment of general acute conditions. The CDC reported a 42% decline in ED visits from March to April 2020 following the onset of COVID-19.1 Another study found that both ED and urgent care utilization declined rapidly followed by a rise representing a local increase in COVID cases.2 There was also another decline during the January to February 2021 period corresponding to the second wave of COVID-19.3 MHI observed similar trends with about 60% and 75% decline in ED and urgent care utilization respectively, following the arrival of COVID-19 in Missouri. This was followed by a rebound with urgent care visits largely returning to usual trends while ED visits have remained lower than the baseline levels. Commercially insured Missourians averaged 8 times more urgent care center visits than ED visits in the months following the state’s stay-at-home order.
Surgeries: One study found that utilization of surgical procedures reduced by about 48% in the period following the initial shutdown from March to April 2020 followed by a rebound to pre-pandemic rates.4 This initial decline may be attributable to the cancellation of elective surgical procedures. MHI found there were an average of 40% fewer surgeries in April 2020 than pre-pandemic rates, and these remained below baseline rates through the first quarter of 2021 in the Missouri MSA.
Heart Attacks: A study by Bhatt and colleagues found a decrease in heart attack hospitalization by 43% in March 2020 compared to March 2019. This decline may not represent true heart attack rates but may be due to deferment of care-seeking from fear of contracting the virus and changes in the healthcare system leading to delayed medical care.5 MHI found a drop in heart attack rates during the first four months of 2020; the rate of heart attacks per 100,000 persons in January of 2020 was 9.0, and by April of 2020 had declined to 6.4.
Strokes: Several reports have shown a fall in stroke rates during the pandemic, as was one study by Weigler and colleagues. These researchers found a 38% reduction in new stroke diagnoses in a comprehensive stroke center in New Jersey.6 This reduction was due to a decline in the number of patients presenting with mild stroke symptoms, while the number of patients with more severe stroke symptoms remained stable.6 This caused an overall decrease in stroke diagnosis. Similar trends were observed in Missouri as the rate of strokes per 100,000 persons declined from 10.4 in January 2020 to 8.2 in April of 2020. While monthly fluctuations in the average stroke volume remained, the overall rates remained lower during the first year of the pandemic than the baseline rates.
Colon cancer screening: One study by McBain and colleagues found a 95% decline in colon cancer screenings following the emergency declaration, from a rate of 15.1 per 10,000 to 0.9 per 10,000 persons in the US. These rates had rebounded to 12.1 per 10,000 persons by the end of July.7 In Missouri MSA, there was an approximate 80% decrease in routine colon cancer screening rates during the first month of the pandemic. Rates declined from a monthly average of about 6.4 to 1.1 per 1,000 persons. This was followed by a rebound between June 2020 and February 2021, averaging about 6.0 per 1,000 persons monthly.
Mammography: Routine mammography screenings experienced a 96% decline following the emergency declaration in the US. However, this was followed by a rebound in July 2020 to baseline levels.7 Similar trends were noted among the commercially insured in Missouri with a steep decline in April of 2020 corresponding to the arrival of COVID-19 in Missouri and the issuance of the stay-at-home order.
Please stay tuned for MHI’s Chartbook COVID-19: Trends in Missouri’s Commercially Insured Population, Year Two. This volume will include:
An analysis of COVID-19 vaccination and treatment measures
An expanded analysis of preventive care with a focus on the association of COVID-19 with influenza vaccination and other immunizations.
A follow-up on the trends of the measures reported in Volume One.
MHI welcomes feedback from the greater community related to important measures of interest that may impact work and are eager to explore the additional information needs of our community.
For more information about the Midwest Health Initiative and its work please visit our website.
References
Hartnett KP, Kite-Powell A, DeVies J, et al. Impact of the COVID-19 Pandemic on Emergency Department Visits — United States, January 1, 2019–May 30, 2020. MMWR Morb Mortal Wkly Rep. 2022;69(23):699-704. doi:10.15585/MMWR.MM6923E1
Jeffery MM, D’Onofrio G, Paek H, et al. Trends in Emergency Department Visits and Hospital Admissions in Health Care Systems in 5 States in the First Months of the COVID-19 Pandemic in the US. JAMA Intern Med. 2020;180(10):1328-1333. doi:10.1001/JAMAINTERNMED.2020.3288
Mafi JN, Craff M, Vangala S, et al. Trends in US Ambulatory Care Patterns During the COVID-19 Pandemic, 2019-2021. JAMA. 2022;327(3):237-247. doi:10.1001/JAMA.2021.24294
Mattingly AS, Rose L, Eddington HS, et al. Trends in US Surgical Procedures and Health Care System Response to Policies Curtailing Elective Surgical Operations During the COVID-19 Pandemic. JAMA Netw Open. 2021;4(12):e2138038-e2138038. doi:10.1001/JAMANETWORKOPEN.2021.38038
Bhatt AS, Moscone A, McElrath EE, et al. Fewer Hospitalizations for Acute Cardiovascular Conditions During the COVID-19 Pandemic. J Am Coll Cardiol. 2020;76(3):280. doi:10.1016/J.JACC.2020.05.038
Siegler JE, Heslin ME, Thau L, Smith A, Jovin TG. Falling stroke rates during COVID-19 pandemic at a comprehensive stroke center. J Stroke Cerebrovasc Dis. 2020;29(8):104953. doi:10.1016/J.JSTROKECEREBROVASDIS.2020.104953
McBain, R. K., Cantor, J. H., Jena, A. B., Pera, M. F., Bravata, D. M., & Whaley, C. M. (2021). Decline and Rebound in Routine Cancer Screening Rates During the COVID-19 Pandemic. Journal of General Internal Medicine, 36(6), 1829. doi.org/10.1007/S11606-021-06660-5
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