The impact of the COVID-19 pandemic on emergency department visits in region Stockholm: a population-based study between 2018-2021

Abstract

BACKGROUND: As COVID-19 cases increased, organizational changes were implemented in Emergency Departments (EDs) to manage the expected demand. However, the impact of these changes on ED utilization is not understood. This study aims to examine the pattern of hospital-based all-cause ED visits and ED visits for Emergency Care Sensitive Conditions (ECSC) and external causes of morbidity (e.g., falls, traffic accidents) between 2018 and 2021 and assess the effect of the COVID-19 pandemic on ED care utilization by socio-demographic groups. METHODS: A population-based study including those 18 years and older in region Stockholm (N = 1, 848,271) comparing the utilization of hospital-based ED care obtained from the National Patient Register between 2018 and 2021. The pattern of ED visits was visually assessed, the types of ED visits and socio-demographic composition described, and an interrupted time series analysis was used to assess trend changes between 2018 and 2021. RESULTS: Between 2018 and 2019 the weekly volume of ED visits decreased, followed by a sharp decrease in 2020 and remaining at a reduced level in 2021. ED visits due to external causes followed a similar trend, while the rate of visits for ECSC increased between 2018 and 2019. The trend in ED visits per week decreased by -11.6 (CI: -13.8 to -9.3) between 2018w1-2020w10, a significant level change of -1,175 0.0 ED visits (CI: -1,418.5 to-932.6) compared to 2020w11. ED utilization decreased across socio-demographic groups to various extents although remained lower at the end of 2021 compared to 2018-2019. CONCLUSIONS: The reduced utilization of ED care for ECSCs and across socio-demographic groups may indicate that individuals delayed or avoided seeking necessary care during the COVID-19 pandemic. These findings are important in guiding health policy and resource allocation. Moreover, further research is needed to determine whether this decline is due to seeking alternative care sources or forgoing care altogether. REGISTRATION TRIAL: Not applicable.