Abstract
Objectives
Methods
Results
Conclusions
Résumé
Objectifs
Méthodes
Résultats
Conclusions
Keywords
Mots clés
Introduction
COVID-19 Intervention Timeline in Canada Ottawa: The Canadian Institute for Health Information.
The impact of COVID-19 on access to diabetes care, management, and related complications.
Methods
Study design and setting
Data sources and collation
Population
Study outcomes
- 1.Structure (access to care and context measures): a) total general practitioners/family physician (GP/FP) visits, including in-person and virtual visits; and b) total specialist visits, including in-person and virtual visits.
- 2.Process (processes of diabetes care metrics): a) eye exams, defined as those ≥40 years of age who had a retinal exam within each cohort time-frame; b) glycated hemoglobin (A1C) tests for those 40+ years of age; c) low-density lipoprotein (LDL) test for those 40+ years of age; and d) angiotensin-converting enzyme inhibitor, angiotensin II receptor blocker and statin prescriptions filled within each cohort for those ≥65 years of age.
- 3.Outcomes (health/utilisation metrics): a) acute complications of diabetes, defined as having at least 1 visit to the ED or hospital admission with diagnosis for the following conditions during each cohort time-frame: hyperglycemia, hypoglycemia or soft tissue infection; and b) chronic complication of diabetes, defined as having at least 1 visit to ED or hospital admission with diagnosis for one of the following during each cohort time-frame: cardiovascular disease, chronic renal disease or amputation.
Statistical analysis
Ethics approval
Results
Reference cohort 1 (March 1, 2019 to August 31, 2019), n (%) | Reference cohort 2 (September 1, 2019 to February 29, 2020), n (%) | Pandemic cohort (March 1, 2020 to August 31, 2020), n (%) | Standardised difference for Reference cohort 1 & Reference cohort 2 | Standardised difference for Pandemic cohort & Reference cohort 1 | Standardised difference for Pandemic cohort & Reference cohort 2 | |
---|---|---|---|---|---|---|
Sex | ||||||
Male | 732,132 (52.5%) | 744,052 (52.6%) | 758,376 (52.5%) | −0.000446 | −0.000472 | −0.000918 |
Female | 661,272 (47.5%) | 671,438 (47.4%) | 685,624 (47.5%) | 0.000446 | 0.000472 | 0.000918 |
Age, years | ||||||
20–29 | 22,811 (1.6%) | 23,435 (1.7%) | 24,277 (1.7%) | -0.001457 | 0.003457 | 0.002000 |
30–39 | 54,891 (4.0%) | 55,569 (4.0%) | 57,034 (4.0%) | 0.000404 | 0.000592 | 0.000995 |
40–49 | 137,472 (9.9%) | 137,882 (9.7%) | 138,568 (9.6%) | 0.002808 | −0.006122 | −0.003314 |
50–59 | 288,312 (20.7%) | 290,229 (20.5%) | 291,843 (20.2%) | 0.003282 | −0.008260 | −0.004978 |
60–69 | 379,395 (27.3%) | 385,453 (27.3%) | 391,820 (27.2%) | −0.000041 | −0.001377 | −0.001419 |
70–79 | 327,293 (23.5%) | 335,979 (23.7%) | 345,476 (24.0%) | -0.003795 | 0.006666 | 0.002871 |
80+ | 183,230 (13.1%) | 186,943 (13.2%) | 194,982 (13.5%) | -0.001689 | 0.010390 | 0.008701 |
Income quintile | ||||||
Q1 (lowest income) | 325,069 (23.3%) | 328,569 (23.2%) | 334,404 (23.2%) | 0.002763 | −0.004047 | −0.001285 |
Q2 | 303,060 (21.7%) | 307,263 (21.7%) | 313,228 (21.7%) | 0.001029 | −0.001405 | −0.000376 |
Q3 | 286,488 (20.6%) | 290,991 (20.6%) | 297,136 (20.6%) | 0.000066 | 0.000420 | 0.000487 |
Q4 | 254,123 (18.2%) | 259,686 (18.3%) | 265,329 (18.4%) | −0.002805 | 0.003543 | 0.000738 |
Q5 (highest income) | 222,669 (16.0%) | 226,868 (16.0%) | 231,738 (16.0%) | −0.001290 | 0.001857 | 0.000567 |
Missing | 1,995 (0.1%) | 2,113 (0.1%) | 2,165 (0.1%) | −0.001597 | 0.001766 | 0.000169 |
Comorbidities | ||||||
Hypertension | 891,148 (64.0%) | 915,155 (64.7%) | 919,634 (63.7%) | -0.014572 | −0.005581 | −0.020153 |
CHF | 95,980 (6.9%) | 104,058 (7.4%) | 100,198 (6.9%) | -0.018014 | 0.002001 | −0.016013 |
AMI | 66,952 (4.8%) | 65,819 (4.6%) | 64,930 (4.5%) | 0.007304 | −0.014645 | −0.007342 |
COPD | 222,599 (16.0%) | 231,013 (16.3%) | 229,626 (15.9%) | -0.009380 | −0.001998 | −0.011378 |
Asthma | 221,306 (15.9%) | 228,129 (16.1%) | 231,162 (16.0%) | -0.006389 | 0.003443 | −0.002946 |
Dementia | 36,583 (2.6%) | 33,394 (2.4%) | 31,254 (2.2%) | 0.017080 | -0.030158 | −0.013101 |
Other mental health | 303,136 (21.8%) | 306,436 (21.6%) | 300,994 (20.8%) | 0.002579 | -0.022242 | −0.019663 |
Health regions | ||||||
North-West | 25,294 (1.8%) | 25,449 (1.8%) | 25,613 (1.8%) | −0.002709 | 0.005055 | 0.002345 |
North-East | 62,737 (4.5%) | 63,129 (4.5%) | 64,098 (4.4%) | −0.000017 | 0.001618 | 0.001601 |
East | 131,613 (9.4%) | 133,667 (9.4%) | 136,537 (9.5%) | 0.000078 | 0.000343 | 0.000421 |
Central-East | 442,136 (31.7%) | 450,930 (31.9%) | 461,591 (32.0%) | 0.002057 | −0.003073 | −0.001016 |
South-West | 115,446 (8.3%) | 116,816 (8.3%) | 119,156 (8.3%) | 0.001304 | −0.003127 | −0.001823 |
Central-West | 242268( 17.4%) | 246,117 (17.4%) | 251,951 (17.4%) | 0.001180 | −0.001212 | −0.000032 |
Toronto | 289,575 (20.8%) | 294,574 (20.8%) | 298,608 (20.7%) | −0.000712 | −0.002531 | −0.003244 |
Unkown | 84,335 (6.1%) | 84,808 (6.0%) | 86,446 (6.0%) | 0.002565 | −0.002770 | −0.000205 |
Comparisons | Unadjusted RR (95% CI) | Unadjusted p value | Adjusted RR (95% CI) | Adjusted p value | |
---|---|---|---|---|---|
Structure (access to care and context measures) | |||||
GP visit (total) | Pandemic vs RC 1 | 0.88 (0.88–0.88) | <0.0001 | 0.88 (0.88–0.88) | <0.0001 |
Pandemic vs RC 2 | 0.88 (0.88–0.88) | <0.0001 | 0.88 (0.88–0.88) | <0.0001 | |
GP visit (in-person) | Pandemic vs RC 1 | 0.53 (0.53–0.53) | <0.0001 | 0.53 (0.53–0.53) | <0.0001 |
Pandemic vs RC 2 | 0.53 (0.53–0.53) | <0.0001 | 0.53 (0.53–0.53) | <0.0001 | |
GP visit (virtual) | Pandemic vs RC 1 | 36.41 (35.94–36.88) | <0.0001 | 36.42 (35.95–36.89) | <0.0001 |
Pandemic vs RC 2 | 33.52 (33.11–33.94) | <0.0001 | 33.63 (33.21–34.04) | <0.0001 | |
Specialty visit (total) | Pandemic vs RC 1 | 0.87 (0.87–0.87) | <0.0001 | 0.87 (0.87–0.87) | <0.0001 |
Pandemic vs RC 2 | 0.87 (0.87–0.88) | <0.0001 | 0.88 (0.87–0.88) | <0.0001 | |
Specialty visit (in-person) | Pandemic vs RC 1 | 0.87 (0.87–0.88) | <0.0001 | 0.87 (0.87–0.87) | <0.0001 |
Pandemic vs RC 2 | 0.88 (0.88–0.88) | <0.0001 | 0.88 (0.88–0.88) | <0.0001 | |
Specialty visit (virtual) | Pandemic vs RC 1 | 39.23 (38.57–39.91) | <0.0001 | 39.19 (38.53–39.86) | <0.0001 |
Pandemic vs RC 2 | 36.52 (35.93–37.12) | <0.0001 | 36.75 (36.16–37.36) | <0.0001 | |
Process (processes of diabetes care metrics) | |||||
Eye exam | Pandemic vs RC 1 | 0.58 (0.57–0.58) | <0.0001 | 0.57 (0.56–0.57) | <0.0001 |
Pandemic vs RC 2 | 0.60 (0.59–0.60) | <0.0001 | 0.59 (0.59–0.59) | <0.0001 | |
A1C test | Pandemic vs RC 1 | 0.72 (0.71–0.72) | <0.0001 | 0.72 (0.71–0.72) | <0.0001 |
Pandemic vs RC 2 | 0.73 (0.73–0.73) | <0.0001 | 0.73 (0.73–0.73) | <0.0001 | |
LDL test | Pandemic vs RC 1 | 0.69 (0.69–0.69) | <0.0001 | 0.69 (0.69–0.69) | <0.0001 |
Pandemic vs RC 2 | 0.72 (0.72–0.73) | <0.0001 | 0.73 (0.72–0.73) | <0.0001 | |
ACE/ARB | Pandemic vs RC 1 | 0.98 (0.98–0.99) | <0.0001 | 0.98 (0.98–0.99) | <0.0001 |
Pandemic vs RC 2 | 0.99 (0.99–0.99) | <0.0001 | 0.99 (0.99–0.99) | <0.0001 | |
Statin | Pandemic vs RC 1 | 0.98 (0.98–0.99) | <0.0001 | 0.98 (0.98–0.99) | <0.0001 |
Pandemic vs RC 2 | 0.99 (0.99–0.99) | <0.0001 | 0.99 (0.99–0.99) | <0.0001 | |
Outcomes (health/utilisation metrics) | |||||
Acute complications | Pandemic vs RC 1 | 0.84 (0.83–0.86) | <0.0001 | 0.84 (0.83–0.86) | <0.0001 |
Pandemic vs RC 2 | 0.90 (0.89–0.92) | <0.0001 | 0.92 (0.90–0.93) | <0.0001 | |
Chronic complications | Pandemic vs RC 1 | 0.94 (0.93–0.95) | <0.0001 | 0.91 (0.90–0.93) | <0.0001 |
Pandemic vs RC 2 | 0.92 (0.91–0.93) | <0.0001 | 0.92 (0.91–0.93) | <0.0001 | |
ED complications | Pandemic vs RC 1 | 0.82 (0.80–0.83) | <0.0001 | 0.82 (0.81–0.84) | <0.0001 |
Pandemic vs RC 2 | 0.90 (0.88–0.91) | <0.0001 | 0.90 (0.89–0.92) | <0.0001 | |
Hospital complications | Pandemic vs RC 1 | 0.83 (0.81–0.86) | <0.0001 | 0.84 (0.81–0.86) | <0.0001 |
Pandemic vs RC 2 | 0.86 (0.84–0.88) | <0.0001 | 0.87 (0.85–0.89) | <0.0001 |
Outcome variables | RC 1 (absolute value) | RC 2 (absolute value) | Pandemic cohort (absolute value) | Pandemic vs RC 1, % (95% CI) | Pandemic vs RC 2, % (95% CI) |
---|---|---|---|---|---|
Structure (access to care and context measures) | |||||
GP visit (total) | 77.99% | 77.61% | 66.92% | −11.07 (−11.23 to −10.92) | −10.69 (−10.84 to −10.53) |
GP visit (in-person) | 77.47% | 77.09% | 36.72% | −40.76 (-40.91 to −40.60) | −40.37 (−40.53 to −40.21) |
GP visit (virtual) | 1.26% | 1.37% | 55.65% | 54.39 (54.24 to 54.54) | 54.29 (54.14 to 54.44) |
Specialist visit (total) | 54.74% | 54.19% | 46.75% | −7.99 (−8.17 to −7.81) | −7.44 (−7.62 to −7.26) |
Specialist visit (in-person) | 54.28% | 53.70% | 46.52% | −7.77 (−7.94 to −7.59) | −7.19 (−7.36 to −7.01) |
Specialist visit (virtual) | 0.80% | 0.85% | 35.11% | 34.31 (34.16 to 34.45) | 34.26 (34.11 to 34.40) |
Process (processes of diabetes care metrics) | |||||
Eye exam | 11.08% | 10.60% | 6.09% | −5.00 (−5.09 to −4.91) | −4.51 (−4.60 to −4.43) |
A1C test | 63.34% | 61.68% | 44.38% | −18.96 (−19.12 to −18.80) | −17.30 (−17.46 to −17.15) |
LDL test | 44.96% | 42.55% | 30.01% | −14.95 (−15.09 to −14.80) | −12.54 (−12.69 to −12.40) |
ACE/ARB | 84.40% | 84.12% | 83.10% | −1.30 (−1.46 to −1.13) | −1.02 (−1.18 to −0.85) |
Statin | 84.40% | 84.12% | 83.10% | −1.30 (-1.46 to −1.13) | −1.02 (−1.18 to −0.85) |
Outcomes (health/utilisation metrics) | |||||
Acute complications | 2.14% | 1.98% | 1.81% | −0.33 (−0.38 to −0.29) | −0.17 (−0.21 to −0.12) |
Chronic complications | 1.84% | 1.83% | 1.68% | −0.16 (−0.21 to −0.11) | −0.15 (−0.20 to −0.10) |
ED complications | 2.05% | 1.86% | 1.68% | −0.37 (−0.41 to −0.33) | −0.18 (−0.22 to −0.14) |
Hospital complications | 0.97% | 0.93 | 0.81% | −0.16 (−0.19 to −0.13) | −0.12 (−0.15 to −0.10) |
Discussion
Canadian Institute for Health Information. How COVID-19 affected emergency departments: Canadian Institute for Health Information. 2021. Updated July 8, 2021. https://www.cihi.ca/en/covid-19-resources/impact-of-covid-19-on-canadas-health-care-systems/how-covid-19-affected. Accessed September 20, 2021.
Canadian Institute for Health Information. COVID-19’s effect on hospital care services: Canadian Institute for Health Information. 2021. Updated July 8, 2021. https://www.cihi.ca/en/covid-19-resources/impact-of-covid-19-on-canadas-health-care-systems/covid-19s-effect-on-hospital. Accessed September 20, 2021.
Author Disclosures
Author Contributions
Acknowledgments
Supplementary data
- Supplementary Materials
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