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Impact of COVID-19 on hospitalisation for diverse conditions in European countries

Abstract Background The COVID-19 pandemic has had an unprecedented impact on Europe. Health systems came under strain, with non-urgent treatments postponed and resources reserved for treatment of COVID-19 patients. Delayed care seeking has been reported, for fear of infection with SARS-CoV2. Yet, the scale of this impact remains under researched. This study aims to compare indirect effects of the pandemic in a European cross-country study aiming to highlight the potential of Population Health Information Research Infrastructures (www.phiri.eu). Methods Focusing on (i) major vascular events (MVE) and (ii) elective surgery for joint replacements (ESJR) as well as (iii) serious trauma this study analyses individual level hospital data in a standardised harmonised data model. We compared pre-pandemic incidence rates (2018-2019) with rates for 2020 and 2021. Analyses are systematically contrasted with SARS CoV2 incidence rates, and policy measures taken based on the OxCGRT index. Results A drop in hospital discharge rates was observed during the pandemic in all countries but differing by condition and month. Socio-economic differences also varied by condition. Our evidence suggests that periods of more severe policy measures also correlated with more dramatic drops in regular hospital activities. Conclusions Our findings provide new insights on the dramatic level of de-prioritisation of essential services faced by non-COVID-19 patients in Europe. From a public health perspective, hospital escalation plans should be developed early on to avoid negative mid and long-term health and financial consequences of indirect effects. The study demonstrates the tremendous potential in exploiting health information systems in a systematic way across countries and the value of the PHIRI system. Further research should investigate policy trade-offs involved in severe lockdown measures during a pandemic and variations in health service resilience for future pandemic preparedness.

The COVID-19 pandemic has clearly demonstrated the urgent need for a cross-border and structured European mechanism to exchange, organise and access reliable health information between countries, especially in the area of population health. Population health information, defined by data on health status, health determinants and healthcare systems performance, allows for oriented research to increase the knowledge base in Europe and underpin political decision-making. Its exchange requires timely and topical provision of high-quality health information. There are many indirect effects of the COVID-19 pandemic that affect health through various pathways including secondary consequences on health and wellbeing due to delayed prevention, diagnosis and medical treatment. Within the Population Health Information Research Infrastructure (PHIRI) we look at four use cases measuring the impact of COVID-19 on population health and demonstrating how a broad variety of routine data can be pooled and/or used for secondary analysis in a distributed way across Europe aiming to facilitate research by making scalable, reproducible methods available. These use cases represent pilot activities for the benefits and added value of an infrastructure supporting federated analysis by bringing together data from different European countries and feeding the results into the federated research infrastructure. In over 20 data hubs, data is mobilised and ready to be analysed in a distributed manner. The use case outputs will be processed in an interoperable way by formalising data models, data management processes and analytical pipelines, all of which are part of the client-server PHIRI federated infrastructure implemented as here 10.5281/ zenodo.6483177. The workshop aims to ensure a better understanding of COVID-19 impacts in specific subgroups and risk settings by conducting research through real-life use cases of immediate relevance. The FAIRified use cases analysis results focusing on comparisons between countries are presented and provide actionable outcomes to guide policy makers in preparedness and response scenarios. Knowledge and expertise developed across Europe is shared in this workshop. The four presentations will focus on selected aspects of COVID-19 impacts on population health. The first presentation will be on direct and indirect determinants of COVID-19 infection and outcomes in vulnerable population groups with reference to inequalities. This will be followed by a contribution of COVID-19 related delayed care in breast cancer patients. The third presentation looks at the impacts of COVID-19 on perinatal health inequalities followed by the fourth on insights in COVID-19 related changes in population mental health. Exchange with the audience will facilitate knowledge and opinion exchange through an interactive Mentimeter poll during the session.

Key messages:
The results will support the exchange of knowledge and expertise by facilitating insights in the impacts of COVID-19 in specific subgroups and risk settings compared across European countries. Actionable outcomes to guide political decision-making in preparedness and response scenarios will be provided.

Background:
The COVID-19 pandemic has had an unprecedented impact on Europe. Health systems came under strain, with non-urgent treatments postponed and resources reserved for treatment of COVID-19 patients. Delayed care seeking has been reported, for fear of infection with SARS-CoV2. Yet, the scale of this impact remains under researched. This study aims to compare indirect effects of the pandemic in a European cross-country study aiming to highlight the potential of Population Health Information Research Infrastructures (www.phiri.eu).

Methods:
Focusing on (i) major vascular events (MVE) and (ii) elective surgery for joint replacements (ESJR) as well as (iii) serious trauma this study analyses individual level hospital data in a standardised harmonised data model. We compared prepandemic incidence rates (2018-2019) with rates for 2020 and 2021. Analyses are systematically contrasted with SARS CoV2 incidence rates, and policy measures taken based on the OxCGRT index.

Results:
A drop in hospital discharge rates was observed during the pandemic in all countries but differing by condition and 15th European Public Health Conference 2022 month. Socio-economic differences also varied by condition. Our evidence suggests that periods of more severe policy measures also correlated with more dramatic drops in regular hospital activities.

Conclusions:
Our findings provide new insights on the dramatic level of deprioritisation of essential services faced by non-COVID-19 patients in Europe. From a public health perspective, hospital escalation plans should be developed early on to avoid negative mid and long-term health and financial consequences of indirect effects. The study demonstrates the tremendous potential in exploiting health information systems in a systematic way across countries and the value of the PHIRI system. Further research should investigate policy trade-offs involved in severe lockdown measures during a pandemic and variations in health service resilience for future pandemic preparedness.

Background:
Healthcare systems across Europe reorganized services to provide attention to COVID-19 patients. In the event of the surge of cases, countries were forced to cancel or postpone non-urgent care. The objective of this work is to investigate whether there were time-to-treatment delays in breast cancer due to April-May 2020 restrictions, and whether the delays were permanent and different across countries. Methods: Design: Quasi-experimental pre-post study with a historical control. Population: Virtually the universe of breast cancer patients receiving elective surgery, radiotherapy, hormonal therapy or chemotherapy since January 2017 (until December 2021) in the participant regions -Belgium, Marché (IT), Riga (LV), Portugal, Wales, and Aragon (ES). The main endpoint is the change in the median time-to-treatment before and after an empirical joint-point. The study variables are detailed here https://doi.org/10.5281/zenodo.5148022. Analysis: Distributed generalized additive models using https://cran.r-project.org/ package = mgcv.

Results:
Preliminary results show that the impact in March-April 2020 time-to-treatment evolved differently across countries. For instance, while the median time from diagnosis to surgery, as the first treatment, increased from approximately 39 days (2018-2019) to more than 45 days (2020)(2021) in Wales, in the Marche region (IT) the median time decreased from 52 days in 2017-2019 to 47 days in 2020. Complete analyses for the rest of the participant countries are currently undergoing.

Conclusions:
We have observed differences in time to treatment in women with breast cancer across countries; however, the magnitude and direction of the effect has been uneven across countries.

Background:
The COVID-19 pandemic and lockdowns may adversely affect pregnancy outcomes due to disrupted healthcare provision and increased stress, anxiety and economic hardship. We assessed changes in perinatal outcomes in 2020 using population birth data in Europe.

Methods:
25 Countries in the Euro-Peristat Network implemented a federated analysis using routine national data. Countries generated anonymised aggregate data files using R scripts from individual-level data formatted to a common data model with 22 variables. We compared preterm birth, stillbirth, neonatal death and caesarean delivery rates in 2020 to 2015-2019 for 2 periods: full-year (FY) and pandemic (March-September [MS]). Data from October onward were not included in the MS period because potentially declining pandemic-related fertility may affect perinatal indicators. Country-specific relative risks (RR) for the periods, adjusted for linear trends, overall and by socio-economic (SES) group, were calculated and pooled using random effects metaanalysis.

Conclusions:
In 2020, there was an unexpected decline in preterm birth in some countries, while increases in stillbirths and caesarean occurred in others. High country-level heterogeneity suggests that some government policies to mitigate the pandemic might have been more protective of pregnant women and newborns than others.