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Decreased Rate of Presentation, but Worsened Racial-Ethnic Disparity in Acute Gastrointestinal Bleeding During
Sumana Reddy1, Beyla Patel2, Luke Baldelli3
1Department of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
Insights
During COVID-19 stay-at-home orders, fewer gastrointestinal bleeding (GIB) cases presented to emergency departments. However, GIB cases that did present were more severe, particularly for minority patients.
Area of Science:
- Gastroenterology
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic and associated
- stay-at-home
- orders may have altered emergency condition presentations.
- Gastrointestinal bleeding (GIB) is a significant emergent condition.
Purpose of the Study:
- To compare the incidence and severity of GIB during the strictest COVID-19 lockdown period with pre-COVID periods.
- To analyze demographic factors influencing GIB outcomes during the pandemic.
Main Methods:
- Retrospective cohort study comparing weekly emergency department (ED) visits for GIB.
- Data collected from March 27 to May 7, 2020 (COVID period) and compared to pre-COVID periods in 2019 and 2020.
- Severity assessed by blood transfusion requirements, ICU admission, shock, and procedures.
Main Results:
- Fewer ED visits for GIB occurred during the COVID period (534) compared to 2019 (904).
- A higher proportion of COVID-period GIB visits resulted in inpatient admission (73.6%) and severe GIB (19.3%).
- Patients during COVID experienced worse outcomes, including higher rates of transfusion, shock, and critical hemoglobin/lactate levels. Non-white patients showed disproportionately worse outcomes.
Conclusions:
- The COVID-19 pandemic saw a decrease in GIB presentations but an increase in severity.
- Minority populations experienced disproportionately worse GIB outcomes during the pandemic.
- Public health interventions during pandemics may impact emergent condition care and outcomes.
Purpose:
In spring 2020, Coronavirus Disease 2019 (COVID-19) "stay-at-home" orders may have led to later, more acute disease presentations of emergent conditions such as gastrointestinal bleeding (GIB). In this retrospective cohort study, we compared incidence and severity of GIB during the strictest COVID shutdown to pre-COVID periods.
Patients And Methods:
We compared weekly counts of emergency department (ED) visits for GIB between March 27 and May 7, 2020 (COVID period) and pre-COVID periods in 2019 and 2020 in a US statewide network of hospitals. We compared the severity of GIB presentations using incident rate ratios (IRR) of "severe" GIB (requiring ≥4 units of blood, endoscopic therapy, interventional radiology or surgical procedure), intensive care (ICU) admission and shock. We also looked for effect modification of demographic covariates on associations between year and GIB outcomes.
Results:
Fewer patients presented to ED for GIB during COVID than during the same dates in 2019 (534 versus 904; IRR 0.59, 95% CI 0.53-0.66). A greater proportion of COVID-period ED visits required inpatient admission (73.6% vs 67.8%, p = 0.02) and had severe GIB (19.3% vs 14.9%, p = 0.03). Proportion of patients requiring transfusion (p < 0.001), with shock (p < 0.01), or with critical hemoglobin (p = 0.003) or lactate (p = 0.02) were worse during COVID. Non-white patients experienced disproportionately worse outcomes during COVID than in 2019, with greater absolute counts of shock (65 vs 62, p = 0.01 for interaction) or ICU admission (40 vs 35, p = 0.01 for interaction).
Conclusion:
Fewer acute GIB presented during the pandemic period compared to the year prior. The severity of pandemic presentations was greater, driven by disproportionately worse outcomes in minorities.
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