COVID-19 did not result in increased hospitalization for stroke and transient ischemic attack: A nationwide study.
COVID-19
incidence
nationwide
stroke risk
Journal
European journal of neurology
ISSN: 1468-1331
Titre abrégé: Eur J Neurol
Pays: England
ID NLM: 9506311
Informations de publication
Date de publication:
08 2022
08 2022
Historique:
received:
16
03
2022
accepted:
31
03
2022
pubmed:
10
4
2022
medline:
19
7
2022
entrez:
9
4
2022
Statut:
ppublish
Résumé
The risk of thrombosis increases in infectious diseases, yet observational studies from single centers have shown a decrease in admission of acute ischemic stroke patients during the COVID-19 pandemic. To investigate unselected stroke admission rates we performed a nationwide study in Denmark. We extracted information from Danish national health registries. The following mutually exclusive time periods were compared to the year before the lockdown: (1) first national lockdown, (2) gradual reopening, (3) few restrictions, (4) regional lockdown, and (5) second national lockdown. Generally, admission rates were unchanged during the pandemic. In the unadjusted data, we observed a small decrease in the admission rate for all strokes under the first lockdown (incidence rate ratio: 0.93, confidence interval [CI]: 0.87-0.99) and a slight increase during the periods with gradual reopening, few restrictions, and the regional lockdown driven by ischemic strokes. We found no change in the rate of severe strokes, mild strokes, or 30-day mortality. An exception was the higher mortality for all strokes during the first lockdown (risk ratio: crude 1.30 [CI: 1.03-1.59]; adjusted 1.17 [CI: 0.93-1.47]). The quality of care remained unchanged. Stroke admission rates remained largely unchanged during the pandemic, while an increased short-term mortality rate in patients admitted with stroke observed during the first lockdown was seen, probably reflecting that the more frail patients constituted a higher proportion of admitted patients at the beginning of the pandemic.
Sections du résumé
BACKGROUND
The risk of thrombosis increases in infectious diseases, yet observational studies from single centers have shown a decrease in admission of acute ischemic stroke patients during the COVID-19 pandemic. To investigate unselected stroke admission rates we performed a nationwide study in Denmark.
METHODS
We extracted information from Danish national health registries. The following mutually exclusive time periods were compared to the year before the lockdown: (1) first national lockdown, (2) gradual reopening, (3) few restrictions, (4) regional lockdown, and (5) second national lockdown.
RESULTS
Generally, admission rates were unchanged during the pandemic. In the unadjusted data, we observed a small decrease in the admission rate for all strokes under the first lockdown (incidence rate ratio: 0.93, confidence interval [CI]: 0.87-0.99) and a slight increase during the periods with gradual reopening, few restrictions, and the regional lockdown driven by ischemic strokes. We found no change in the rate of severe strokes, mild strokes, or 30-day mortality. An exception was the higher mortality for all strokes during the first lockdown (risk ratio: crude 1.30 [CI: 1.03-1.59]; adjusted 1.17 [CI: 0.93-1.47]). The quality of care remained unchanged.
CONCLUSION
Stroke admission rates remained largely unchanged during the pandemic, while an increased short-term mortality rate in patients admitted with stroke observed during the first lockdown was seen, probably reflecting that the more frail patients constituted a higher proportion of admitted patients at the beginning of the pandemic.
Identifiants
pubmed: 35397183
doi: 10.1111/ene.15350
pmc: PMC9111678
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2269-2274Informations de copyright
© 2022 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.
Références
Front Cardiovasc Med. 2021 Mar 29;8:649922
pubmed: 33855053
J Epidemiol Community Health. 2021 Sep;75(9):829-835
pubmed: 33542032
Eur J Neurol. 2022 Aug;29(8):2269-2274
pubmed: 35397183
Stroke. 2017 Mar;48(3):574-580
pubmed: 28196938
Stroke. 2020 Dec;51(12):3570-3576
pubmed: 33106109
Euro Surveill. 2020 Nov;25(47):
pubmed: 33243355
Int J Environ Res Public Health. 2021 Jul 01;18(13):
pubmed: 34281004
J Stroke Cerebrovasc Dis. 2020 Dec;29(12):105325
pubmed: 32992196
Eur Stroke J. 2020 Dec;5(4):351-361
pubmed: 33598553
Euro Surveill. 2020 Apr;25(17):
pubmed: 32372757
Can J Neurol Sci. 2020 Sep;47(5):693-696
pubmed: 32450927
Front Neurol. 2021 Jan 06;11:607193
pubmed: 33488501
N Engl J Med. 2020 Jul 23;383(4):400-401
pubmed: 32383831
Front Neurol. 2020 Nov 30;11:601652
pubmed: 33424751
Circulation. 2020 Sep 22;142(12):1227-1229
pubmed: 32755320
Stroke. 2021 May;52(5):1885-1894
pubmed: 33794653
Lancet. 2021 Aug 14;398(10300):599-607
pubmed: 34332652
Acta Neurol Scand. 2022 Feb;145(2):160-170
pubmed: 34605006
Neurol Sci. 2021 Jan;42(1):15-20
pubmed: 33021704
Eur J Neurol. 2022 Mar;29(3):724-731
pubmed: 34894018
Clin Epidemiol. 2013 Dec 23;6:27-36
pubmed: 24399886
BMJ Open. 2021 Aug 25;11(8):e050680
pubmed: 34433606
Neurology. 2021 Jun 8;96(23):e2824-e2838
pubmed: 33766997
J Thromb Thrombolysis. 2020 Oct;50(3):587-595
pubmed: 32661757
N Engl J Med. 2020 May 14;382(20):e60
pubmed: 32343504
JAMA Neurol. 2020 Jun 1;77(6):683-690
pubmed: 32275288
JAMA Neurol. 2020 Jul 02;:
pubmed: 32614385
JAMA Netw Open. 2021 May 3;4(5):e2110314
pubmed: 33999162
Ann Neurol. 2021 Feb;89(2):380-388
pubmed: 33219563