Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Dec 7, 2024
Date Accepted: May 5, 2025
Trends in Avoidable Hospitalizations Before and During the COVID-19 Pandemic: A Retrospective Study Using Administrative Data from Beijing, China
ABSTRACT
Background:
The rate of avoidable hospitalizations (AHs) reflects the quality of primary care. However, it is rarely evaluated in the setting of China's healthcare system; studies examining its changes befor and during the COVID-19 pandemic were also limited.
Objective:
This study aims to describe trends of AH in Beijing, China in the pre-pandemic (2016 to 2019) and pandemic (2020 to 2021) periods, and examine associate factors on AH rates.
Methods:
We examined hospital discharge data of Beijing residents between January 1st, 2016, and December 31st, 2021. We identified AH cases from all discharge cases and calculated the rate of AH each year, adjusting for population structure change. We performed regression analyses to explore associated factors of AH rates, with COVID-19 outbreak, healthcare resources and socioeconomic characteristics as main explanatory variables.
Results:
Before the pandemic, age-sex standardized rate of AH per 100,000 population in Beijing rose from 514.7 (95% CI 511.4-517.9) in 2016 to 552.8 (95% CI 549.4-556.1) in 2019. During the pandemic, the AH rate per 100,000 population declined to 331.2 (95% CI 328.6-333.8) in 2020. The AH rate rebounded to 465.1 (95% CI 462.1-468.1) in 2021 but did not recover to the pre-pandemic level. Regression analysis shows that newly confirmed COVID-19 cases was associated with a significant decline in AH rate. As for other factors, a larger density of primary physicians was associated with a lower AH rate. Moreover, AH rates were associated with population structure and the level of economic development.
Conclusions:
The AH rate in Beijing exhibits a consistently upward trend before the pandemic and a higher level compared to developed countries. These characteristics suggests an overuse in tertiary care compared to primary care, and calls for changes in Beijing's hospital-centred delivery system. In addition, the association between the AH rate and factors such as pandemic shocks and socioeconomic variables suggests that AH rates should be interpreted with appropriate controls.
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