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Impact of the COVID-19 pandemic on non-COVID mortality in continental Portugal
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Resumo(s)
Introdução: A COVID-19 foi declarada uma pandemia global, em março de 2020. Desde então, o mundo tem enfrentado a pressão por ela criada nos sistemas de saúde, que pode, também, afetar os cuidados de doentes não-COVID-19. Este estudo pretende determinar se a pandemia se associa a um aumento da mortalidade não-COVID-19 e, particularmente, daquela por causas naturais, em Portugal Continental.
Métodos: A partir de dados públicos, agregados e anonimizados, comparámos a mortalidade, nos primeiros 12 meses da pandemia, com a sua baseline, a níveis nacional e regional. Correlacionámos, também, a mortalidade com indicadores de utilização dos cuidados de saúde e com fatores que se poderiam associar a diferenças na mortalidade, tais como medidas de saúde pública, casos de COVID-19 e a temperatura média diária.
Resultados: A mortalidade não COVID-19, quer natural nacional, quer regional, por todas as causas, esteve frequentemente acima da baseline e, durante várias semanas, registou-se excesso de mortalidade. Não houve correlação entre as consultas médicas nos cuidados de saúde primários e a mortalidade, com exceção daquelas ao domicílio, no Alentejo e no Centro, as regiões mais envelhecidas do Continente, que aumentaram com a mortalidade. Quanto ao seguimento de doenças crónicas, cirurgias urgentes e urgências triadas como cor de laranja ou amarelas, observou-se uma associação entre a sua diminuição e o aumento da mortalidade.
Conclusões: A pandemia teve impacto na mortalidade, resultando numa diminuição da mortalidade por acidentes de viação e num aumento da mortalidade não-COVID-19, por causas naturais e por todas as causas. Assim, cuidados de saúde que poderiam evitar a morte parecem ter estado comprometidos quando a pressão no sistema era maior e, simultaneamente, a população poderá ter hesitado na procura de cuidados. No entanto, também parece existir um esforço para manter o seguimento dos indivíduos mais frágeis.
Introduction: COVID-19 was declared a global pandemic in March 2020. Since then, the world has been fighting the distress it has imposed on healthcare systems, which may affect the care of non-COVID-19 patients. This study aims to determine whether and to what extent the pandemic is associated with an increase in non-COVID-19 mortality, especially from natural causes, in Continental Portugal. Methods: Using aggregated anonymized data from public databases, we compared mortality during the first 12 months of the pandemic to its baseline, at national and regional levels. Mortality data were also correlated with indicators of the use of health care and with factors possibly be associated with changes in mortality, namely public health measures, COVID-19 cases, and daily mean temperature. Results: National natural-cause and regional all-cause non-COVID-19 mortality were often above their baseline, and during several weeks excess mortality was recorded. There was no correlation between primary care medical appointments and mortality, the exception being Alentejo and Centro, the most elderly regions of Continental Portugal, where at-home medical appointments increased with mortality. As for the follow-up of chronic illnesses, urgent surgeries, and emergency room attendances triaged as orange and yellow, an association between their decrease and the increase in mortality was observed. Conclusions: During its first 12 months, the pandemic impacted mortality, leading to a decrease in mortality from traffic accidents, and an increase in natural- and all-cause non-COVID-19 mortality. Thus, health care that could have prevented death seems to have gotten compromised when the pressure on the system was higher, which was also when people may have been more hesitant to seek health care. However, there might have been an effort to maintain the follow-up of more fragile individuals during those times.
Introduction: COVID-19 was declared a global pandemic in March 2020. Since then, the world has been fighting the distress it has imposed on healthcare systems, which may affect the care of non-COVID-19 patients. This study aims to determine whether and to what extent the pandemic is associated with an increase in non-COVID-19 mortality, especially from natural causes, in Continental Portugal. Methods: Using aggregated anonymized data from public databases, we compared mortality during the first 12 months of the pandemic to its baseline, at national and regional levels. Mortality data were also correlated with indicators of the use of health care and with factors possibly be associated with changes in mortality, namely public health measures, COVID-19 cases, and daily mean temperature. Results: National natural-cause and regional all-cause non-COVID-19 mortality were often above their baseline, and during several weeks excess mortality was recorded. There was no correlation between primary care medical appointments and mortality, the exception being Alentejo and Centro, the most elderly regions of Continental Portugal, where at-home medical appointments increased with mortality. As for the follow-up of chronic illnesses, urgent surgeries, and emergency room attendances triaged as orange and yellow, an association between their decrease and the increase in mortality was observed. Conclusions: During its first 12 months, the pandemic impacted mortality, leading to a decrease in mortality from traffic accidents, and an increase in natural- and all-cause non-COVID-19 mortality. Thus, health care that could have prevented death seems to have gotten compromised when the pressure on the system was higher, which was also when people may have been more hesitant to seek health care. However, there might have been an effort to maintain the follow-up of more fragile individuals during those times.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
COVID-19 Mortalidade não-COVID-19 Excesso de mortalidade Cuidados de saúde Portugal continental