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大流行的隐性代价:非 COVID-19 住院患者的超额死亡

The hidden toll of the pandemic: Excess mortality in non-COVID-19 hospital patients
Journal of Health Economics · 2024 · Fetzer, Thiemo、Rauh, Christopher、Schreiner, Clara

中文摘要

季节性传染病可能造成需求与供给压力,从而削弱医疗系统提供高质量照护的能力。这可能对因无关原因就医的患者的健康结果产生负向溢出效应。由于缺乏合适的数据且未开展人群检测,通常无法将这些间接负担与感染患者的直接后果区分开来。然而,本文在综合性公共医疗体系——英国国家医疗服务体系(NHS)——中发现了非 COVID-19 患者超额死亡的稳健经验证据。通过分析 NHS 预测死亡率模型中的预测误差,我们发现,人群中每 42 例 COVID-19 相关死亡,至少对应 1 例因与 COVID-19 无关原因就医的患者的额外超额死亡。我们识别出 COVID-19 压力是大流行期间 NHS 医院中非 COVID-19 超额死亡的关键驱动因素,并刻画了受到不成比例影响的医院人群与医疗状况。我们的发现在塑造对 COVID-19 以及更一般而言其他季节性疾病的更广泛负担的理解方面具有实质性意义,并可为关于最优公共卫生政策的讨论提供参考。

Abstract

Seasonal infectious diseases can cause demand and supply pressures that reduce the ability of healthcare systems to provide high-quality care. This may generate negative spillover effects on the health outcomes of patients seeking medical help for unrelated reasons. Separating these indirect burdens from the direct consequences for infected patients is usually impossible due to a lack of suitable data and an absence of population testing. However, this paper finds robust empirical evidence of excess mortality among non-COVID-19 patients in an integrated public healthcare system: the English National Health Service (NHS). Analysing the forecast error in the NHS’ model for predicted mortality, we find at least one additional excess death among patients who sought medical help for reasons unrelated to COVID-19 for every 42 COVID-19-related deaths in the population. We identify COVID-19 pressures as a key driver of non-COVID-19 excess mortality in NHS hospitals during the pandemic, and characterize the hospital populations and medical conditions that were disproportionately affected. Our findings have substantive relevance in shaping our understanding of the wider burden of COVID-19, and other seasonal diseases more generally, and can contribute to debates on optimal public health policy.
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