June 21, 2022
2 min read
Although fewer patients visited the emergency department for gastrointestinal bleeding during the pandemic, cases were more severe and disproportionately worse among underrepresented groups, according to a study.
“As was seen in many other conditions, the early pandemic health care shutdown was associated with a concerning, probably nonbiological decrease in presentation of acute, non-COVID illness to hospital,” Michael K. Dougherty, MD, MSCR, study author and adjunct assistant professor of gastroenterology and hepatology at the University of North Carolina School of Medicine, told Healio. “This suggests that people who may have benefitted from health services were not seeking care for some pandemic-related reason (lack of access, fear, etc.).”
In a retrospective study published in Clinical and Experimental Gastroenterology, Dougherty and colleagues used a statewide network of hospitals to compare ED visits for gastrointestinal bleeding (GIB) between March 27 and May 7, 2020, of the pandemic and pre-COVID periods in 2019 and 2020.
According to study results, there were 534 ED visits for GIB during the COVID period compared with 904 in 2019 (incident rate ratio = 0.59; 95% CI, 0.53-0.66). However, a greater proportion of COVID-period ED visits required inpatient admission (73.6% vs 67.8%, P = 0.02) and had severe GIB (19.3% vs 14.9%, P = 0.03). Further, more patients required transfusion (P < 0.001) and presented with shock (P < 0.01) or with critical hemoglobin (P = 0.003) or lactate (P = 0.02) during the COVID period.
In addition, results showed that the percentage of ED visits among underrepresented groups significantly increased from 41.2% in 2019 to 44.4% in the COVID period (P < .01), but race and ethnicity were not significantly associated with GIB presentation or adverse clinical outcomes from GIB during any time period. There was, however, a significant link between minority race or ethnicity and presentation during the COVID period for outcomes of ICU admission and shock from GIB (P < .05).
“While non-Hispanic whites seemed to largely weather this decrease in hospital attendance — with corresponding decreases in the absolute numbers of more severely ill GIB patients presenting to hospital — racial and ethnic minorities on the other hand did not experience any such decrease, and in fact even a slight increase in cases with markers of severe illness (shock, ICU admission, large volume transfusion, etc.),” Dougherty said.
“While the finding of health disparities along racial-ethnic lines should not be surprising, we were surprised to see that in 2019 and earlier 2020, we did not find significantly worse health outcomes in GIBs for minorities in our health system,” he added. “However, it was the COVID pandemic and shutdown that magnified the disparities in our study, which fits with what we also saw with the virus’ effect on different groups during that time when, for a myriad of reasons, minority communities were hit hardest by the pandemic.”