Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2025 Mar 6;20(3):e0316553.
doi: 10.1371/journal.pone.0316553. eCollection 2025.

Healthcare utilization trends in adults with asthma or COPD during the first year of COVID-19 pandemic in comparison to pre-pandemic: A population-based study

Tetyana Kendzerska  1   2   3   4 , Michael Pugliese  1   3 , Douglas Manuel  1   3 , Mohsen Sadatsafavi  5 , Marcus Povitz  6 , Therese A Stukel  3   7   8 , Teresa To  3   8   9 , Shawn D Aaron  1   2   4 , Sunita Mulpuru  1   2 , Melanie Chin  1   2 , Claire E Kendall  1   3   10   11 , Kednapa Thavorn  1   3   4 , Andrea S Gershon  3   7   8   12
Affiliations
Observational Study

Healthcare utilization trends in adults with asthma or COPD during the first year of COVID-19 pandemic in comparison to pre-pandemic: A population-based study

Tetyana Kendzerska et al. PLoS One. .

Abstract

Objectives: To assess how changes in outpatient services during the first year of the COVID-19 pandemic were related to acute healthcare use (emergency department or hospitalizations) for individuals with asthma or chronic obstructive pulmonary disease (COPD).

Methods: We conducted an observational study using health administrative data in Ontario (Canada) from January 2016 to March 2021 on all adults with diagnosed asthma or COPD. We used monthly time series auto-regressive integrated moving-average (ARIMA) and pre-pandemic monthly rates (January 2016 to February 2020) to calculate projected rates (i.e., a pandemic had not occurred) during the pandemic (March 2020 to March 2021), and Quasi-Poisson models with two-way interaction to estimate crude and adjusted rate ratios.

Results: In the first pandemic year, in individuals with asthma or COPD, outpatient visit rates started lower than projected (Mar-May 2020), returned to projected in the middle of the year (Jun-Aug 2020) and then rose to higher than projected between Sep 2020 and Mar 2021: observed rates of 80,293 per 100,000 persons vs. projected 74,192 (95% CI: 68,926-79,868) in individuals with asthma, and 92,651 vs. projected 85,871 (95% CI: 79,975-92,207) in individuals with COPD. Acute care rates remained below projected during the first pandemic year. While pulmonary function test (PFT) rates remained below projected during the first pandemic year, in both populations, a decrease in acute care visits during the pandemic, compared to pre-pandemic, was noted during months with the highest PFT rates (interaction p-values < 0.0001).

Conclusions: Despite asthma and COPD being ambulatory-care sensitive conditions, lower rates of outpatient visits during the beginning of the pandemic were not associated with increased rates of acute care use. Lower PFT rates were associated with higher acute care visit rates, suggesting that access to PFT during pandemic is likely important for individuals with asthma or COPD.

PubMed Disclaimer

Conflict of interest statement

All authors declare they have no potential conflict of interest. Tetyana Kendzerska and Andrea Gershon are supported by the PSI (Physicians' Services Incorporated) foundation Knowledge Translation Fellowship. Teresa To is supported by the Canadian Institutes of Health Research, Tier 1 Canada Research Chair in Asthma. Claire Kendall is supported by a Faculty of Medicine Clinical Chair Award. The funding sponsors had no role in the study design, data collection and analysis, or preparation of the manuscript. No other relationships or activities that could appear to have influenced the submitted work. This does not alter our adherence to PLOS ONE policies on sharing data and materials. Please see the Data Availability & Sharing Statement below for details on data sharing restrictions.

Figures

Fig 1
Fig 1. Observed versus projected monthly outpatient care service rates in adults with asthma per 100,000 persons at-risk:
(A) Primary care visits, and (B) Specialist care visits.
Fig 2
Fig 2. Observed versus projected monthly outpatient care service rates in adults with COPD per 100,000 persons at-risk:
(A) Primary care visits, and (B) Specialist care visits.
Fig 3
Fig 3. Observed versus projected monthly hospital costs and acute care visit rates in adults with asthma per 100,000 persons at-risk:
(A) Hospitalizations, and (B) Emergency department (ED) visits.
Fig 4
Fig 4. Observed versus projected monthly hospital costs and acute care visit rates in adults with COPD per 100,000 people at-risk:
(A) Hospitalizations, and (B) Emergency department (ED) visits.
See this image and copyright information in PMC

References

    1. GBD Chronic Respiratory Disease Collaborators. Prevalence and attributable health burden of chronic respiratory diseases, 1990-2017: a systematic analysis for the global burden of disease study 2017. Lancet Respir Med. 2020;8(6):585–96. doi: 10.1016/S2213-2600(20)30105-3 - DOI - PMC - PubMed
    1. Syamlal G, Bhattacharya A, Dodd KE. Medical expenditures attributed to asthma and chronic obstructive pulmonary disease among workers - United States, 2011-2015. MMWR Morb Mortal Wkly Rep. 2020;69(26):809–14. doi: 10.15585/mmwr.mm6926a1 - DOI - PMC - PubMed
    1. Purdy S, Griffin T, Salisbury C, Sharp D. Ambulatory care sensitive conditions: terminology and disease coding need to be more specific to aid policy makers and clinicians. Public Health. 2009;123(2):169–73. doi: 10.1016/j.puhe.2008.11.001 - DOI - PubMed
    1. Park HJ, Byun MK, Kim T, Rhee CK, Kim K, Kim BY, et al.. Frequent outpatient visits prevent exacerbation of chronic obstructive pulmonary disease. Sci Rep. 2020;10(1):6049. doi: 10.1038/s41598-020-63064-x - DOI - PMC - PubMed
    1. Gupta S. Diagnosing asthma and chronic obstructive pulmonary disease: Importance of pulmonary function testing. Can Fam Physician. 2022;68(6):441–4. doi: 10.46747/cfp.6806441 - DOI - PMC - PubMed

Publication types