ABSTRACT
Objectives: We compared the number and profile of patients diagnosed with bacterial sexually transmitted infections (STI) before and during the global pandemic. Method(s): Our study used German claims data provided by AOK PLUS from 01/01/2017-30/06/2021. Continuously insured adults with one inpatient and/or outpatient diagnosis of chlamydia (ICD-10 A55/A56), gonorrhea (A54), or syphilis (A51/A53) were included. The number of new STI cases was assessed quarterly from 2018-2021. A window of 180 days was used to detect new infections, as re-infections are possible. Result(s): Overall, 10,222 individuals (11,685 cases) were included. Approximately 60.4% were female, with a mean/median age of 31.9/28.0 years. Only 3.1% received an STI code at baseline. Chlamydia was the most common STI (77.2%), followed by gonorrhea (13.2%) and syphilis (9.6%). Females recorded more chlamydia (67.4%), while males accounted for a higher share of syphilis (76.9%) and gonorrhea (61.3%) cases. Chlamydia patients were younger at diagnosis (mean/median: 29.9/26.0 years) than gonorrhea (38.4/35.0) and syphilis (41.9/40.0) patients. From 2018-2021, the number of new chlamydia and syphilis cases fluctuated. A decrease in new gonorrhea cases was observed beginning in Q2 2020 (median/range: 93/83-110 vs. 118/101-137 in the pre-COVID period). The share of women with gonorrhea diagnoses was disproportionately lower during COVID compared to pre-COVID (median/range: 33.7%/27.4-38.1% vs. 42.6%/37.1-47.1% during pre-COVID). While no difference in age profile was observed for gonorrhea or syphilis, the age of patients with chlamydia during COVID was slightly lower (29.2 vs. 31.0 during pre-COVID). Conclusion(s): Fewer women received gonorrhea diagnoses during the COVID period, and the average age of chlamydia patients dropped. Further research is needed to assess whether these trends are suggestive of under-diagnosis or systematic changes in risk-taking behavior during lockdown. Copyright © 2022
ABSTRACT
Objectives: This study compared the diagnostic setting and treatment of new cases of bacterial sexually transmitted infections (STIs) in Germany from 2018-2020. Method(s): This study utilized German claims data (AOK PLUS) from 01/01/2017-30/06/2021. We included continuously insured adult patients with an inpatient/outpatient chlamydia (ICD-10 A55/A56), gonorrhea (A54), or syphilis (A51/A53) diagnosis from 01/01/2018-31/12/2020. To account for potential re-infection, a 180-day window was used to detect new cases. Diagnostic setting was observed at index and a 6-month follow-up period was used to assess outpatient treatment with prescribed therapies. Result(s): Overall, 8,913 individuals (cases: 10,032, female: 60.3%, mean age: 32.1 years) were included. Most chlamydia (97.4%), gonorrhea (96.3%), and syphilis (96.9%) cases were diagnosed in the outpatient setting. Among STI cases recorded in the outpatient setting (96.9%), the most common diagnosing physicians were gynecologists (54.5%), general practitioners (20.8%), and urologists (11.5%). No changes in relation to diagnosing physician were observed between pre-COVID and COVID-periods. From 2018-2020, the share of syphilis and gonorrhea cases diagnosed in inpatient vs. outpatient settings varied;no difference between pre-COVID and COVID periods was detected. Despite the overall low number of inpatient chlamydia diagnoses, the proportion of new cases reported in hospitals decreased after the pandemic onset (median/range: 1.8%/1.3-2.0% vs. 2.6%/2.1-3.9% during pre-COVID). Syphilis had the lowest treatment rate at 42.2% (penicillin: 27.9%, doxycycline: 13.1%, tetracycline: 0.0%), followed by gonorrhea with 54.9% (ceftriaxone: 16.2%, azithromycin: 39.6%), and chlamydia with 60.5% (doxycycline: 41.0%, azithromycin: 22.8%, levofloxacin: 1.1%). No longitudinal changes in relation to treatment were observed. Conclusion(s): Generally, diagnosis of bacterial STIs is uncommon in the hospital. Nevertheless, the share of chlamydia cases diagnosed in the inpatient setting decreased during COVID, possibly in relation to healthcare resource capacity constraints. Further research is needed to explore potential reasons for this trend and the substantial proportion of patients without treatment. Copyright © 2022
ABSTRACT
Objectives: As COVID-19 spread worldwide, indicators of influenza activity in the Northern Hemisphere began to decline by mid-to-late February. In Germany, federal lockdown measures were introduced to contain the outbreak on 22/03/2020 (week 12). We used claims data from AOK PLUS, a regional sickness fund covering around half the population in Saxony and Thuringia (6.2 million inhabitants), to examine the trend of influenza hospitalizations in 2020 compared to 2019. Methods: Using data from 01/01/2019 to 31/05/2020 (weeks 1-22), influenza hospitalizations were identified using ICD-10-GM codes J10-J11. We estimated changes in the number of influenza hospitalizations using a “difference-in-differences” model including variables for age group (<18, 18-44, 45-64, 65-79, 80+), gender, week, year, and outbreak status (interaction variable between year 2020 and week 12 or later). Adjusted incidence rate ratios (aIRRs) were estimated using Poisson regression with heteroskedasticity-robust standard errors. Results: During weeks 1-22, we observed 5,174 influenza hospitalizations in 2019 and 2020. Influenza hospitalizations in 2020 showed similar trends until week 12 and then showed a relative decline compared to 2019. The average number of influenza hospitalizations per week during weeks 12-22 significantly decreased in 2020 compared to 2019 (1.6 vs. 5.2;aIRR: 0.45;95% CI: 0.34-0.59;p<0.001). When stratified by age group, all groups except age 18-44 had a similar decrease in average influenza hospitalizations per week in 2020 compared to 2019, with large relative declines in patients age 80+ (2.2 vs. 5.8;aIRR: 0.36;95% CI: 0.28-0.46;p<0.001) and children <18 (1.8 vs. 8.0;aIRR: 0.38;95% CI 0.32-0.46;p<0.001). Conclusions: The number of influenza hospitalizations saw a relative faster decline in 2020 compared to 2019 after the introduction of federal lockdown measures in Germany, possibly due to the effectiveness of non-pharmaceutical interventions like social distancing and the use of facemasks.
ABSTRACT
Objectives: The COVID-19 pandemic impacted the German health system comprehensively. This study compared overall healthcare resource utilization (HCRU) in the first half of 2020 (COVID-19 lockdown time) with the utilization observed in previous years (2017-2019). Methods: The analysis was based on anonymized claims data of a German sickness fund (AOK PLUS), considering all individuals with at least one insurance day between 01/01/2017-30/06/2020. All hospitalizations, outpatient visits, and prescriptions were observed in the first half of each year. HCRU per 1,000 person-days (PTPD) observed in 2020 was compared with respective numbers of previous years. Results: We observed 3,322,504 insured persons (591,705,100 days) in the first half of 2020, with 0.68 hospitalizations PTPD (8.55% with at least one hospitalization). Hospitalization rates were considerably higher in the previous periods (2019/2018/2017: 0.79/0.80/0.82 inpatient stays PTPD;9.75%/9.95%/10.09% with at least one hospitalization). In the first half of 2020, 67.09% of the insured received at least one prescription of any medication with on average 1,936.87 DDDs PTPD. These numbers were very similar in the pre-years (2019/2018/2017: 68.94%/70.12%/69.93% and 1,925.79/1,949.66/1,982.60 DDDs PTPD). Proportion of patients with prescriptions for antiinfectives particularly decreased (-14.07%;ATC-code J-). Regarding outpatient treatment, with an unchanged overall number of outpatient visits, utilization of laboratory services increased substantially, followed by visits related to COVID-19. Cancer screening visits occurred far less frequently than in previous years (0.90 PTPD in 2020 versus 1.03/1.02/1.01 PTPD in 2019/2018/2017). Conclusions: In the first half of 2020, number of hospitalizations decreased substantially. This might be explained by lockdown measures themselves (postponement of planned inpatient treatments, general underuse of health care or reduction of the so far existent overuse) but might also be due to a lower number of non-COVID infections which as also prescriptions of antiinfectives decreased in this time.
ABSTRACT
Objectives: The presence of COVID-19 was first confirmed in Germany in January 2020 and ICD-10-GM codes for COVID-19 were introduced in February 2020. We used claims data from AOK PLUS, a large regional sickness fund covering around half the population in Saxony and Thuringia (6.2 million inhabitants), to describe the COVID-19 patient population during the beginning of the pandemic. Methods: Using data from 01/01/2020 to 30/06/2020, inpatient and outpatient cases of COVID-19 were identified using ICD-10-GM code U07.1. All inpatient cases with code U07.1 in any position were included. Two-sample t-tests and chi-square tests were used to compare patient populations. Results: A total of 15,596 COVID-19 patients (≈0.25% sickness fund population) were identified (93.4% outpatient, 6.6% inpatient;58.7% female, 41.3% male). The mean age was 44.9 (age <18: 7.2%, 18-44: 45.9%, 45-64: 31.4%, >65: 15.5%). There were 188 in-hospital deaths (18.2%), of which 65 (34.6%) received ICU treatment and 58 (30.9%) received intubation. Of the inpatient cases, there were 148 ICU cases (14.3%, 65 deaths) and 98 intubations (9.5%, 58 deaths). There was a larger proportion of females in outpatient (59.6%) vs. inpatient cases (52.8%, p<0.001). Inpatients were significantly older than outpatients (71.0 vs. 43.0, p<0.001) and in-hospital deaths were significantly older than non-fatal inpatient cases (81.3 vs. 68.7, p<0.001). Mean length of stay was significantly longer for patients in the ICU (25.4 days) vs. normal ward (12.3, p<0.001). Of the inpatient cases, the most frequent main diagnoses associated with COVID-19 were respiratory system diseases (codes J00-J99, 620 cases, 59.9%), of which the most prevalent diagnosis was “Other viral pneumonia” (code J12.8, 435 cases). Conclusions: While our data came from only two regions in Germany, claims data can be used to gain insight on the characteristics and evolution of the COVID-19 population, and to accurately estimate HCRU/costs and mortality.
ABSTRACT
Objectives: It was hypothesized that COVID-19 lockdown measures led to later admission of myocardial infarction (MI) patients to hospitals and, consequently, higher average case severity and mortality. The aim of this study was to compare MI-associated mortality between COVID-19 lockdown and pre-COVID-19 periods. Methods: We used German claims data from continuously insured adults hospitalized with a MI (ICD-10 I21), and compared 30-days mortality for cases in March-May 2020 (first COVID lockdown in Germany) with March to May in 2017-2019. Multivariable logistic regression models were conducted to test for differences in mortality between pre-COVID and COVID months while controlling for patients’ age, sex, previous MIs (2-years baseline), and cardiovascular comorbidities. Results: In 2020, we observed 758/612/712 MIs in March/April/May, which was fewer MIs than the average for the same months between 2017-2019 (March: 901;April: 716;May: 853). Over the observational years, there was a shift towards younger patients (average age 2017: 77;2020: 74), and the proportion of women decreased (2017: 42.54%;2020: 39.19%). The length of the index-hospitalization was significantly lower during the COVID-19 pandemic (March-May 2017-2019: 9.19 days;March-May 2020: 8.11 days;p<0.001). Furthermore, the number of deceased patients was lower during the COVID lockdown period (March 2017-2019: 16.53% vs. March 2020: 14.12%;April: 17.19% vs. 16.99%;May: 16.72% vs. 13.48%). However, regression models showed no significant difference between COVID and pre-COVID months except for May (OR [COVID vs. pre-COVID]: 0.73, p=0.014). Conclusions: Even if we cannot rule out the possibility of a higher MI-related mortality during COVID lockdown periods in non-hospitalized MI patients, we cannot confirm the hypothesis that hospitalized patients generally showed a higher mortality due to later admission to hospitals and thus more higher case severity at time of hospital admission.