Steep decline in pediatric ED visits for asthma during COVID-19 shutdown
Pediatric ED visits for asthma in Massachusetts decreased 80% this year during the spring COVID-19 surge and lockdown, researchers reported in the Annals of the American Thoracic Society.
The retrospective cohort study evaluated medical records of individuals aged 2 to 22 years who visited the Boston Children’s Hospital ED and were treated with at least one asthma-related medication from January to May in 2018, 2019 and 2020. Schools and child care facilities in Massachusetts closed by March 15 and March 18, respectively, and a stay-at-home order went into effect on March 24 to mitigate the spread of COVID-19.
There were 2,543 asthma ED visits from January through May across all 3 years. According to the results, there were significantly fewer asthma ED visits in 2020 compared with 2018 and 2019 (630 vs. 955 and 958, respectively).
The percent of pediatric asthma exacerbations requiring hospital admission was not significantly higher in 2020 compared with 2018 (53.2% vs. 51.3%), but was higher than in 2019 (53.2% vs. 43.5%).
There was a significant decrease in the incidence of asthma ED visits after the COVID-19 shutdown in 2020 compared with in 2018 (incidence rate ratio [IRR] = 0.21; 95% CI, 0.11-0.37; P < .0001) and 2019 (IRR = 0.18; 95% CI, 0.1-0.32; P < .0001) after adjusting for year, weeks and pre- or post-shutdown, but not between 2018 and 2019 (P = .625), the researchers reported.
Pediatric asthma ED visit rates were similar in all 3 years during the week of March 15 to March 21, but pediatric asthma ED visit rates decreased in the following week by 80% compared with 2018 (IRR = 0.2; 95% CI, 0.14-0.28) and 82% compared with 2019 (IRR = 0.18; 95% CI, 0.13-0.25). This decrease continued through May 23 with an 82% and 87% reduction compared with 2018 and 2019, respectively, the researchers wrote.
“Our most significant finding was the drastic, sudden drop in ED visits shortly after schools closed and the stay-at-home order went into effect,” Tregony Simoneau, MD, assistant professor of pediatrics at Boston Children’s Hospital, said in a press release. “How this drop was sustained over several months is quite notable.”
Consistent with the overall findings, rates of ED asthma visits were significantly lower among Hispanic (n = 420) and non-Hispanic (n = 1,799) pediatric patients post-COVID-19 in 2020 compared with 2018 and 2019.
“[I]t will be important for future studies to specifically assess racial/ethnic variation in health care utilization,” the researchers wrote. “This phenomenon offers lessons to be learned and several areas for future investigation of this complex issue, serving as a framework for future prevention of childhood asthma exacerbations.”