Non-COVID-19 hospitalization and mortality during the COVID-19 pandemic in Iran: a longitudinal assessment of 41 million people in 2019-2022.
COVID-19
Cardiovascular disease
Hospitalization
Injuries
Iran health insurance organization
Mental health
Mortality
Non-COVID-19
Respiratory diseases
Journal
BMC public health
ISSN: 1471-2458
Titre abrégé: BMC Public Health
Pays: England
ID NLM: 100968562
Informations de publication
Date de publication:
05 Feb 2024
05 Feb 2024
Historique:
received:
08
06
2023
accepted:
19
01
2024
medline:
6
2
2024
pubmed:
6
2
2024
entrez:
5
2
2024
Statut:
epublish
Résumé
During a COVID-19 pandemic, it is imperative to investigate the outcomes of all non-COVID-19 diseases. This study determines hospital admissions and mortality rates related to non-COVID-19 diseases during the COVID-19 pandemic among 41 million Iranians. This nationwide retrospective study used data from the Iran Health Insurance Organization. From September 23, 2019, to Feb 19, 2022, there were four study periods: pre-pandemic (Sept 23-Feb 19, 2020), first peak (Mar 20-Apr 19, 2020), first year (Feb 20, 2020-Feb 18, 2021), and the second year (Feb 19, 2021-Feb 19, 2022) following the pandemic. Cause-specific hospital admission and in-hospital mortality are the main outcomes analyzed based on age and sex. Negative binomial regression was used to estimate the monthly adjusted Incidence Rate Ratio (IRR) to compare hospital admission rates in aggregated data. A logistic regression was used to estimate the monthly adjusted in-hospital mortality Odds Ratio (OR) for different pandemic periods. During the study there were 6,522,114 non-COVID-19 hospital admissions and 139,679 deaths. Prior to the COVID-19 outbreak, the standardized hospital admission rate per million person-month was 7115.19, which decreased to 2856.35 during the first peak (IRR 0.40, [0.25-0.64]). In-hospital mortality also increased from 20.20 to 31.99 (OR 2.05, [1.97-2.13]). All age and sex groups had decreased admission rates, except for females at productive ages. Two years after the COVID-19 outbreak, the non-COVID-19 hospital admission rate (IRR 1.25, [1.13-1.40]) and mortality rate (OR 1.05, [1.04-1.07]) increased compared to the rates before the pandemic. The respiratory disease admission rate decreased in the first (IRR 0.23, [0.17-0.31]) and second years (IRR 0.35, [0.26-0.47] compared to the rate before the pandemic. There was a significant reduction in hospitalizations for pneumonia (IRR 0.30, [0.21-0.42]), influenza (IRR 0.04, [0.03-0.06]) and COPD (IRR 0.39, [0.23-0.65]) during the second year. There was a significant and continuous rise in the hematological admission rate during the study, reaching 186.99 per million person-month in the second year, reflecting an IRR of 2.84 [2.42-3.33] compared to the pre-pandemic period. The mortality rates of mental disorders (OR 2.15, [1.65-2.78]) and musculoskeletal (OR 1.48, [1.20-1.82), nervous system (OR 1.42, [1.26-1.60]), metabolic (OR 1.99, [1.80-2.19]) and circulatory diseases (OR 1.35, [1.31-1.39]) increased in the second year compare to pre-pandemic. Myocardial infarction (OR 1.33, [1.19-1.49]), heart failure (OR 1.59, [1.35-1.87]) and stroke (OR 1.35, [1.24-1.47]) showed an increase in mortality rates without changes in hospitalization. In the era of COVID-19, the changes seem to have had a long-term effect on non-COVID-19 diseases. Countries should prepare for similar crises in the future to ensure medical services are not suspended.
Sections du résumé
BACKGROUND
BACKGROUND
During a COVID-19 pandemic, it is imperative to investigate the outcomes of all non-COVID-19 diseases. This study determines hospital admissions and mortality rates related to non-COVID-19 diseases during the COVID-19 pandemic among 41 million Iranians.
METHOD
METHODS
This nationwide retrospective study used data from the Iran Health Insurance Organization. From September 23, 2019, to Feb 19, 2022, there were four study periods: pre-pandemic (Sept 23-Feb 19, 2020), first peak (Mar 20-Apr 19, 2020), first year (Feb 20, 2020-Feb 18, 2021), and the second year (Feb 19, 2021-Feb 19, 2022) following the pandemic. Cause-specific hospital admission and in-hospital mortality are the main outcomes analyzed based on age and sex. Negative binomial regression was used to estimate the monthly adjusted Incidence Rate Ratio (IRR) to compare hospital admission rates in aggregated data. A logistic regression was used to estimate the monthly adjusted in-hospital mortality Odds Ratio (OR) for different pandemic periods.
RESULTS
RESULTS
During the study there were 6,522,114 non-COVID-19 hospital admissions and 139,679 deaths. Prior to the COVID-19 outbreak, the standardized hospital admission rate per million person-month was 7115.19, which decreased to 2856.35 during the first peak (IRR 0.40, [0.25-0.64]). In-hospital mortality also increased from 20.20 to 31.99 (OR 2.05, [1.97-2.13]). All age and sex groups had decreased admission rates, except for females at productive ages. Two years after the COVID-19 outbreak, the non-COVID-19 hospital admission rate (IRR 1.25, [1.13-1.40]) and mortality rate (OR 1.05, [1.04-1.07]) increased compared to the rates before the pandemic. The respiratory disease admission rate decreased in the first (IRR 0.23, [0.17-0.31]) and second years (IRR 0.35, [0.26-0.47] compared to the rate before the pandemic. There was a significant reduction in hospitalizations for pneumonia (IRR 0.30, [0.21-0.42]), influenza (IRR 0.04, [0.03-0.06]) and COPD (IRR 0.39, [0.23-0.65]) during the second year. There was a significant and continuous rise in the hematological admission rate during the study, reaching 186.99 per million person-month in the second year, reflecting an IRR of 2.84 [2.42-3.33] compared to the pre-pandemic period. The mortality rates of mental disorders (OR 2.15, [1.65-2.78]) and musculoskeletal (OR 1.48, [1.20-1.82), nervous system (OR 1.42, [1.26-1.60]), metabolic (OR 1.99, [1.80-2.19]) and circulatory diseases (OR 1.35, [1.31-1.39]) increased in the second year compare to pre-pandemic. Myocardial infarction (OR 1.33, [1.19-1.49]), heart failure (OR 1.59, [1.35-1.87]) and stroke (OR 1.35, [1.24-1.47]) showed an increase in mortality rates without changes in hospitalization.
CONCLUSIONS
CONCLUSIONS
In the era of COVID-19, the changes seem to have had a long-term effect on non-COVID-19 diseases. Countries should prepare for similar crises in the future to ensure medical services are not suspended.
Identifiants
pubmed: 38317148
doi: 10.1186/s12889-024-17819-0
pii: 10.1186/s12889-024-17819-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
380Informations de copyright
© 2024. The Author(s).
Références
Carvalho T, Krammer F, Iwasaki A. The first 12 months of COVID-19: a timeline of immunological insights. Nat Rev Immunol. 2021;21(4):245–56.
pubmed: 33723416
pmcid: 7958099
doi: 10.1038/s41577-021-00522-1
World Health Organization. Iran (Islamic Republic of) Coronavirus (COVID-19) statistics. https://covid19.who.int/region/emro/country/ir . Accessed Aug 2023.
Roy CM, Bollman EB, Carson LM, Northrop AJ, Jackson EF, Moresky RT. Assessing the indirect effects of COVID-19 on healthcare delivery, utilization, and health outcomes: a scoping review. Eur J Pub Health. 2021;31.
Kaczorowski J, Del Grande C. Beyond the tip of the iceberg: direct and indirect effects of COVID-19. Lancet Digit Health. 2021;3(4):e205–6.
pubmed: 33612431
pmcid: 7906654
doi: 10.1016/S2589-7500(21)00024-8
Tossou Y. Effect of COVID-19 on demand for healthcare in Togo. Heal Econ Rev. 2021;11(1):36.
doi: 10.1186/s13561-021-00335-x
Rosenbaum L. The untold toll — the Pandemic’s effects on patients without Covid-19. N Engl J Med. 2020;382(24):2368–71.
pubmed: 32302076
doi: 10.1056/NEJMms2009984
World Health Organization. Pulse survey on continuity of essential health services during the COVID-19 pandemic interim report. In: 27 August 2020. https://www.who.int/publications/i/item/WHO-2019-nCoV-EHS_continuity-survey-2020.1 .
Cuschieri S, Borg D, Agius S, Scherb H, Grech V. COVID-19 and vaccination induced changes in hospital activity in Malta, Q1 2020 to Q1 2021: a population-based study. J Egypt Public Health Assoc. 2022;97(1):7.
pubmed: 35133544
pmcid: 8825920
doi: 10.1186/s42506-021-00101-1
Abdi M. Coronavirus disease 2019 (COVID-19) outbreak in Iran: actions and problems. Infect Control Hosp Epidemiol. 2020;41(6):754–5.
pubmed: 32192541
doi: 10.1017/ice.2020.86
Takian A, Aarabi SS, Semnani F, Rayati Damavandi A. Preparedness for future pandemics: lessons learned from the COVID-19 pandemic in Iran. Int J Public Health. 2022;67.
Official Website of the President of the Islamic Republic of Iran. Available online: http://www.president.ir (accessed on 21 March 2020).
Blandenier E, Habibi Z, Kousi T, Sestito P, Flahault A, Rozanova L. Initial COVID-19 outbreak: an epidemiological and socioeconomic case review of Iran. Int J Environ Res Public Health. 2020;17(24):9593.
pubmed: 33371485
pmcid: 7767487
doi: 10.3390/ijerph17249593
Timothy Roberton EDC, Chou VB, Stegmuller AR, Jackson BD, Tam Y, Sawadogo-Lewis T, Walker N. Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study. Emergency Nutrition Network (ENN); 2020.
Tavakkoli M, Karim A, Fischer FB, Monzon Llamas L, Raoofi A, Zafar S, et al. From public health policy to impact for COVID-19: a multi-country case study in Switzerland, Spain, Iran and Pakistan. International Journal of Public Health. 2022;67.
Khankeh H, Farrokhi M, Roudini J, Pourvakhshoori N, Ahmadi S, Abbasabadi-Arab M, Bajerge NM, Farzinnia B, Kolivand P, Delshad V, et al. Challenges to manage pandemic of coronavirus disease (COVID-19) in Iran with a special situation: a qualitative multi-method study. BMC Public Health. 2021;21(1):1919.
pubmed: 34686165
pmcid: 8532398
doi: 10.1186/s12889-021-11973-5
Takian A, Raoofi A, Kazempour-Ardebili S. COVID-19 battle during the toughest sanctions against Iran. Lancet. 2020;395(10229):1035–6.
pubmed: 32199073
pmcid: 7138170
doi: 10.1016/S0140-6736(20)30668-1
Akbari Sari A, Rezaei S, Homaie Rad E, Dehghanian N, Chavehpour Y. Regional disparity in physical resources in the health sector in Iran: a comparison of two time periods. Iran J Public Health. 2015;44(6):848–54.
pubmed: 26258098
pmcid: 4524310
Mojiri A, Ahmadi K. Inequality in the distribution of resources in health care system by using the Gini coefficient and Lorenz curve (a case study of Sistan and Baluchestan province over a five-year period). Payesh (Health Monitor) J. 2022;21(3):227–36.
Kazemi Karyani A, Kazemi Z, Shaahmadi F, Arefi Z, Ghazanfari S. Determining inequality and trend of geographic accessibility to pediatricians in Iran: 2007-2013. Int J Pediatr. 2015;3(2.1):51–8.
Sotodeh Manesh S, Hedayati Zafarghandi M, Merati Z, Ebrahimzadeh J, Delpasand M. Inequality trends in the distribution of healthcare human resources in eastern Iran. Proc Singapore Healthc. 2021;31:20101058211041176.
Chavehpour Y, Rashidian A, Woldemichael A, Takian A. Inequality in geographical distribution of hospitals and hospital beds in densely populated metropolitan cities of Iran. BMC Health Serv Res. 2019;19(1):614.
pubmed: 31470849
pmcid: 6717334
doi: 10.1186/s12913-019-4443-0
Haghdoost A, Hashemi H, Noori Hekmat S, Haji Aghajani M, Janbabaee GH, Maher A, Javadi AM, Emadi S, Rajabalipour M, Haghighi H, et al. The geographical distribution of hospital beds in Iran in 2016 and the estimation of 2026. Iran J Epidemiol. 2018;13:1–13.
Moynihan R, Johansson M, Maybee A, Lang E, Légaré F. Covid-19: an opportunity to reduce unnecessary healthcare. BMJ. 2020;370:m2752.
pubmed: 32665257
doi: 10.1136/bmj.m2752
Bodilsen J, Nielsen PB, Søgaard M, Dalager-Pedersen M, Speiser LOZ, Yndigegn T, Nielsen H, Larsen TB, Skjøth F. Hospital admission and mortality rates for non-covid diseases in Denmark during covid-19 pandemic: nationwide population based cohort study. BMJ. 2021;373:n1135.
pubmed: 34035000
doi: 10.1136/bmj.n1135
Mansfield KE, Mathur R, Tazare J, Henderson AD, Mulick AR, Carreira H, Matthews AA, Bidulka P, Gayle A, Forbes H, et al. Indirect acute effects of the COVID-19 pandemic on physical and mental health in the UK: a population-based study. Lancet Digit Health. 2021;3(4):e217–30.
pubmed: 33612430
pmcid: 7985613
doi: 10.1016/S2589-7500(21)00017-0
Rennert-May E, Leal J, Thanh NX, Lang E, Dowling S, Manns B, Wasylak T, Ronksley PE. The impact of COVID-19 on hospital admissions and emergency department visits: a population-based study. PLoS One. 2021;16(6):e0252441.
pubmed: 34061888
pmcid: 8168854
doi: 10.1371/journal.pone.0252441
Birkmeyer JD, Barnato A, Birkmeyer N, Bessler R, Skinner J. The impact of the COVID-19 pandemic on hospital admissions in the United States. Health Aff. 2020;39(11):2010–7.
doi: 10.1377/hlthaff.2020.00980
Mulholland RH, Wood R, Stagg HR, Fischbacher C, Villacampa J, Simpson CR, Vasileiou E, McCowan C, Stock SJ, Docherty AB, et al. Impact of COVID-19 on accident and emergency attendances and emergency and planned hospital admissions in Scotland: an interrupted time-series analysis. J R Soc Med. 2020;113(11):444–53.
pubmed: 33012218
pmcid: 7686524
doi: 10.1177/0141076820962447
Cassell K, Zipfel CM, Bansal S, Weinberger DM. Trends in non-COVID-19 hospitalizations prior to and during the COVID-19 pandemic period, United States, 2017-2021. Nat Commun. 2022;13(1):5930.
pubmed: 36209210
pmcid: 9546751
doi: 10.1038/s41467-022-33686-y
Gasch-Illescas A, Calle-Serrano M, Vallejo-Vaz AJ, Praena-Fernández JM, Guerrero JA, Calderón EJ, Pollán M, Medrano FJ. Impact of the first wave of the COVID-19 pandemic on non-COVID inpatient care in southern Spain. Sci Rep. 2023;13(1):1634.
pubmed: 36717651
pmcid: 9885064
doi: 10.1038/s41598-023-28831-6
Kang E, Yun J, Hwang S-H, Lee H, Lee JY. The impact of the COVID-19 pandemic in the healthcare utilization in Korea: analysis of a nationwide survey. J Infect Public Health. 2022;15(8):915–21.
pubmed: 35872432
pmcid: 9265238
doi: 10.1016/j.jiph.2022.07.003
Dang A, Thakker R, Li S, Hommel E, Mehta HB, Goodwin JS. Hospitalizations and mortality from non-SARS-CoV-2 causes among Medicare beneficiaries at US hospitals during the SARS-CoV-2 pandemic. JAMA Netw Open. 2022;5(3):e221754.
pubmed: 35262712
pmcid: 8908076
doi: 10.1001/jamanetworkopen.2022.1754
Qi C, Osborne T, Bailey R, Cooper A, Hollinghurst JP, Akbari A, et al. Impact of COVID-19 pandemic on incidence of long-term conditions in Wales: a population data linkage study using primary and secondary care health records. Br J Gen Pract. 2023; https://doi.org/10.3399/BJGP.2022.0353 . Mar:BJGP.2022.0353 Epub 2023 Mar 7.
Santi L, Golinelli D, Tampieri A, Farina G, Greco M, Rosa S, Beleffi M, Biavati B, Campinoti F, Guerrini S, et al. Non-COVID-19 patients in times of pandemic: emergency department visits, hospitalizations and cause-specific mortality in northern Italy. PLoS One. 2021;16(3):e0248995.
pubmed: 33750990
pmcid: 7984614
doi: 10.1371/journal.pone.0248995
Syed AKSA, Motunrayo A, Kehkashan A, Pauline B, Yen-Fu C, Nazratun Nayeem C, Olufunke F, Frances G, Bronwyn H, Peter K, et al. Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of pre-COVID and COVID-19 lockdown stakeholder engagements. BMJ Glob Health. 2020;5(8):e003042.
doi: 10.1136/bmjgh-2020-003042
Stephen S, Daniel Y, AJV D, Emma B, Thaimu B, Sowmya M, Esther M, Maria Lisa O, Divya P, Sorie S, et al. The impact of the COVID-19 pandemic on hospital utilisation in Sierra Leone. BMJ Glob Health. 2021;6(10):e005988.
doi: 10.1136/bmjgh-2021-005988
Nguyen JL, Benigno M, Malhotra D, Khan F, Angulo FJ, Hammond J, Swerdlow DL, Reimbaeva M, Emir B, McLaughlin JM. Pandemic-related declines in hospitalization for non-COVID-19-related illness in the United States from January through July 2020. PLoS One. 2022;17(1):e0262347.
pubmed: 34990489
pmcid: 8735608
doi: 10.1371/journal.pone.0262347
Ana H, Morag M, Alf T, Peter RM. Trends in healthcare utilisation during COVID-19: a longitudinal study from the UK. BMJ Open. 2021;11(7):e048151.
doi: 10.1136/bmjopen-2020-048151
Abdul-Mumin A, Cotache-Condor C, Bimpong KA, Grimm A, Kpiniong MJ, Yakubu RC, et al. Decrease in admissions and change in the diagnostic landscape in a newborn care unit in northern Ghana during the COVID-19 pandemic. Front Pediatr. 2021;9.
Razimoghadam M, Yaseri M, Effatpanah M, Daroudi R. Changes in emergency department visits and mortality during the COVID-19 pandemic: a retrospective analysis of 956 hospitals. Arch Public Health = Arch Belges de Sante Publique. 2024;82(1):5.
doi: 10.1186/s13690-023-01234-9
Kumar A, King R, Morris K, Krishnamurthy K. Non-COVID-19 reasons for hospitalisation among children during the COVID-19 pandemic compared with the pre-pandemic period – a prospective population-based study from Barbados. Karnataka Paediatr J. 2023;38.
Gavish R, Levinsky Y, Dizitzer Y, Bilavsky E, Livni G, Pirogovsky A, Scheuerman O, Krause I. The COVID-19 pandemic dramatically reduced admissions of children with and without chronic conditions to general paediatric wards. Acta Paediatr (Oslo, Norway : 1992). 2021;110(7):2212–7.
doi: 10.1111/apa.15792
Degiorgio S, Grech N, Dimech YM, Xuereb J, Grech V. Significant reduction in pediatric, population-based hospital admissions due to COVID-19 in Malta. Turk Arch Pediatr. 2022;57(1):87–92.
pubmed: 35110084
pmcid: 8867502
doi: 10.5152/TurkArchPediatr.2022.21145
David E, Katie LH, Louise Mc G-L, Maximiliane LV, Ruth G, Ruth B. Reductions in hospital care among clinically vulnerable children aged 0–4 years during the COVID-19 pandemic. Arch Dis Child. 2022;107(10):e31.
doi: 10.1136/archdischild-2021-323681
Kruizinga MD, Peeters D, van Veen M, van Houten M, Wieringa J, Noordzij JG, Bekhof J, Tramper-Stranders G, Vet NJ, Driessen GJA. The impact of lockdown on pediatric ED visits and hospital admissions during the COVID19 pandemic: a multicenter analysis and review of the literature. Eur J Pediatr. 2021;180(7):2271–9.
pubmed: 33723971
pmcid: 7959585
doi: 10.1007/s00431-021-04015-0
Bögli J, Güsewell S, Strässle R, Kahlert CR, Albrich WC. Pediatric hospital admissions, case severity, and length of hospital stay during the first 18 months of the COVID-19 pandemic in a tertiary children’s hospital in Switzerland. Infection. 2023;51(2):439–46.
pubmed: 36065045
doi: 10.1007/s15010-022-01911-x
Miron VD, Gunșahin D, Filimon C, Bar G, Craiu M. Pediatric emergencies and hospital admissions in the first six months of the COVID-19 pandemic in a tertiary children’s Hospital in Romania. Children. 2022;9.
Hu N, Nassar N, Shrapnel J, Perkes I, Hodgins M, O'Leary F, et al. The impact of the COVID-19 pandemic on paediatric health service use within one year after the first pandemic outbreak in New South Wales Australia – a time series analysis. Lancet Reg Health – West Pac. 2022;19.
Homaira N, Hu N, Owens L, Chan M, Gray M, Britton PN, Selvadurai H, Lingam R, Jaffe A. Impact of lockdowns on paediatric asthma hospital presentations over three waves of COVID-19 pandemic. Allergy, Asthma Clin Immunol. 2022;18(1):53.
pubmed: 35710455
doi: 10.1186/s13223-022-00691-1
Heidari M, Sayfouri N, Jafari H. Consecutive waves of COVID-19 in Iran: various dimensions and probable causes. Disaster Med Public Health Prep. 2022;17:e136.
pubmed: 35152937
doi: 10.1017/dmp.2022.45
König S, Pellissier V, Hohenstein S, Leiner J, Hindricks G, Meier-Hellmann A, Kuhlen R, Bollmann A. A comparative analysis of in-hospital mortality per disease groups in Germany before and during the COVID-19 pandemic from 2016 to 2020. JAMA Netw Open. 2022;5(2):e2148649.
pubmed: 35166779
pmcid: 8848198
doi: 10.1001/jamanetworkopen.2021.48649
Solomon DA, Sherman AC, Kanjilal S. Influenza in the COVID-19 era. JAMA. 2020;324(13):1342–3.
pubmed: 32797145
doi: 10.1001/jama.2020.14661
So JY, O’Hara NN, Kenaa B, Williams JG, deBorja CL, Slejko JF, Zafari Z, Sokolow M, Zimand P, Deming M, et al. Population decline in COPD admissions during the COVID-19 pandemic associated with lower burden of community respiratory viral infections. Am J Med. 2021;134(10):1252-1259.e1253.
pubmed: 34126098
pmcid: 8196237
doi: 10.1016/j.amjmed.2021.05.008
Li L, Hang D, Dong H, Yuan-Yuan C, Bo-Heng L, Ze-Lin Y, Zhou Y, Chun-Quan O, Peng-Zhe Q. Temporal dynamic in the impact of COVID- 19 outbreak on cause-specific mortality in Guangzhou, China. BMC Public Health. 2021;21(1):883.
pubmed: 33964914
pmcid: 8105693
doi: 10.1186/s12889-021-10771-3
Lazarian G, Quinquenel A, Bellal M, Siavellis J, Jacquy C, Re D, Merabet F, Mekinian A, Braun T, Damaj G, et al. Autoimmune haemolytic anaemia associated with COVID-19 infection. Br J Haematol. 2020;190(1):29–31.
pubmed: 32374906
pmcid: 7267601
doi: 10.1111/bjh.16794
Ko Ko M, Pedro M-V. Impact of COVID-19 pandemic on cardiovascular diseases hospitalisation, management and mortality in Switzerland. Open Heart. 2023;10(1):e002259.
doi: 10.1136/openhrt-2023-002259
Mafham MM, Spata E, Goldacre R, Gair D, Curnow P, Bray M, Hollings S, Roebuck C, Gale CP, Mamas MA, et al. COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England. Lancet. 2020;396(10248):381–9.
pubmed: 32679111
pmcid: 7429983
doi: 10.1016/S0140-6736(20)31356-8
Bhatt AS, Moscone A, McElrath EE, Varshney AS, Claggett BL, Bhatt DL, Januzzi JL, Butler J, Adler DS, Solomon SD, et al. Fewer hospitalizations for acute cardiovascular conditions during the COVID-19 pandemic. J Am Coll Cardiol. 2020;76(3):280–8.
pubmed: 32470516
pmcid: 7250561
doi: 10.1016/j.jacc.2020.05.038
Xie Y, Xu E, Bowe B, Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med. 2022;28(3):583–90.
pubmed: 35132265
pmcid: 8938267
doi: 10.1038/s41591-022-01689-3
Verveen A, Müller F, Lloyd A, Moss-Morris R, Omland T, Penninx B, Raijmakers RPH, van der Schaaf M, Sandler CX, Stavem K, et al. A research agenda for post-COVID-19 fatigue. J Psychosom Res. 2022;154:110726.
pubmed: 35086054
pmcid: 8786369
doi: 10.1016/j.jpsychores.2022.110726
Ghafari M, Kadivar A, Katzourakis A. Excess deaths associated with the Iranian COVID-19 epidemic: a province-level analysis. Int J Infect Dis. 2021;107:101–15.
pubmed: 33862214
pmcid: 8208896
doi: 10.1016/j.ijid.2021.04.015
Safavi-Naini SAA, Farsi Y, Alali WQ, Solhpour A, Pourhoseingholi MA. Excess all-cause mortality and COVID-19 reported fatality in Iran (April 2013–September 2021): age and sex disaggregated time series analysis. BMC Res Notes. 2022;15(1):130.
pubmed: 35382865
pmcid: 8981187
doi: 10.1186/s13104-022-06018-y
Ebrahimoghli R, Abbasi-Ghahramanloo A, Moradi-Asl E, Adham D. The COVID-19 pandemic’s true death toll in Iran after two years: an interrupted time series analysis of weekly all-cause mortality data. BMC Public Health. 2023;23(1):442.
pubmed: 36882708
pmcid: 9990579
doi: 10.1186/s12889-023-15336-0
Msemburi W, Karlinsky A, Knutson V, Aleshin-Guendel S, Chatterji S, Wakefield J. The WHO estimates of excess mortality associated with the COVID-19 pandemic. Nature. 2023;613(7942):130–7.
pubmed: 36517599
doi: 10.1038/s41586-022-05522-2