Long-Term Impact of COVID-19 on Hospital Visits of Rural Residents in Guangdong, China: A Controlled Interrupted Time Series Study

Abstract

To date, there is a lack of comprehensive understanding regarding the effect of coronavirus disease 2019 (COVID-19) on the healthcare-seeking behavior and utilization of health services in rural areas where healthcare resources are scarce. We aimed to quantify the long-term impact of COVID-19 on hospital visits of rural residents in China. We collected data on the hospitalization of all residents covered by national health insurance schemes in a county in southern China from April 2017 to March 2021. We analyzed changes in residents' hospitalization visits in different areas, i.e., within-county, out-of-county but within-city, and out-of-city, via a controlled interrupted time series approach. Subgroup analyses based on gender, age, hospital levels, and ICD-10 classifications for hospital visits were examined. After experiencing a significant decline in hospitalization cases after the COVID-19 outbreak in early 2020, the pattern of rural residents' hospitalization utilization differed markedly by disease classification. Notably, we found that the overall demand for hospitalization utilization of mental and neurological illness among rural residents in China has been suppressed during the pandemic, while the utilization of inpatient services for other common chronic diseases was redistributed across regions. Our findings suggest that in resource-poor areas, focused strategies are urgently needed to ensure that people have access to adequate healthcare services, particularly mental and neurological healthcare, during the COVID-19 pandemic.

Keywords: COVID-19; ICD-10; healthcare-seeking behavior; impact; interrupted time series analysis.

Figure 1

The segmented regression model for a controlled interrupted time series analysis.

Figure 2

Interrupted time series analysis of hospital visits within Yangxi County from April 2017 to March 2019 (orange line) and from April 2019 to March 2021 (blue line). The line is the model fit and the vertical dashed line indicates the intervention (23 January 2020).

Figure 3

Interrupted time series analysis of hospital visits outside Yangxi County but still within Yangjiang City from April 2017 to March 2019 (orange line) and from April 2019 to March 2021 (blue line). The line is the model fit and the vertical dashed line indicates the intervention (23 January 2020).

Figure 4

Interrupted time series analysis of hospital visits outside Yangjiang City from April 2017 to March 2019 (orange line) and from April 2019 to March 2021 (blue line). The line is the model fit and the vertical dashed line indicates the intervention (23 January 2020).

Figure 5

The instantaneous and long-term effect of COVID-19 lockdown on hospital visits within the county for subgroups. A00–B99: certain infectious and parasitic diseases; C00–D48: neoplasms; D50–D89: diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism; E00–E90: endocrine, nutritional, and metabolic diseases; F00–F99: mental and behavioral disorders; G00–G99: diseases of the nervous system; H00–H59: diseases of the eye and adnexa; H60–H95: diseases of the ear and mastoid process; I00–I99: diseases of the circulatory system; J00–J99: diseases of the respiratory system; K00–K93: diseases of the digestive system; L00–L99: diseases of the skin and subcutaneous tissue; M00–M99: diseases of the musculoskeletal system and connective tissue; N00–N99: diseases of the genitourinary system; O00–O99: pregnancy, childbirth, and the puerperium; P00–P96: certain conditions originating in the perinatal period; Q00–Q99: congenital malformation deformations and chromosomal abnormality; R00–R99: symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified; S00–T98: injury, poisoning, and certain other consequences of external causes; Z00–Z99: factors influencing health status and contact with health services; not applicable: not classified.

Figure 6

The instantaneous and long-term effect of COVID-19 lockdown on hospital visits within the city but outside the county for subgroups. A00–B99: certain infectious and parasitic diseases; C00–D48: neoplasms; D50–D89: diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism; E00–E90: endocrine, nutritional, and metabolic diseases; F00–F99: mental and behavioral disorders; G00–G99: diseases of the nervous system; H00–H59: diseases of the eye and adnexa; H60–H95: diseases of the ear and mastoid process; I00–I99: diseases of the circulatory system; J00–J99: diseases of the respiratory system; K00–K93: diseases of the digestive system; L00–L99: diseases of the skin and subcutaneous tissue; M00–M99: diseases of the musculoskeletal system and connective tissue; N00–N99: diseases of the genitourinary system; O00–O99: pregnancy, childbirth, and the puerperium; P00–P96: certain conditions originating in the perinatal period; Q00–Q99: congenital malformation deformations and chromosomal abnormality; R00–R99: symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified; S00–T98: injury, poisoning, and certain other consequences of external causes; Z00–Z99: factors influencing health status and contact with health services; not applicable: not classified.

Figure 7

The instantaneous and long-term effect of COVID-19 lockdown on hospital visits outside the city for subgroups. A00–B99: certain infectious and parasitic diseases; C00–D48: neoplasms; D50–D89: diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism; E00–E90: endocrine, nutritional, and metabolic diseases; F00–F99: mental and behavioral disorders; G00–G99: diseases of the nervous system; H00–H59: diseases of the eye and adnexa; H60–H95: diseases of the ear and mastoid process; I00–I99: diseases of the circulatory system; J00–J99: diseases of the respiratory system; K00–K93: diseases of the digestive system; L00–L99: diseases of the skin and subcutaneous tissue; M00–M99: diseases of the musculoskeletal system and connective tissue; N00–N99: diseases of the genitourinary system; O00–O99: pregnancy, childbirth, and the puerperium; P00–P96: certain conditions originating in the perinatal period; Q00–Q99: congenital malformation deformations and chromosomal abnormality; R00–R99: symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified; S00–T98: injury, poisoning, and certain other consequences of external causes; Z00–Z99: factors influencing health status and contact with health services; not applicable: not classified.