Pediatric healthcare service utilization after the end of COVID-19 state of emergency in Northern Italy: a 6-year quasi-experimental study using interrupted time-series analysis
BackgroundEvidence exists on the major disruptions in pediatric healthcare services occurred during the COVID-19 pandemic, but what happened when all restrictions were lifted is unclear. This study examined trends in pediatric hospital admission and Emergency Department visit rates during the first...
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Frontiers Media S.A.
2025-08-01
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2025.1575047/full |
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| author | Matteo Puntoni Caterina Caminiti Giuseppe Maglietta Marcello Lanari Giacomo Biasucci Giacomo Biasucci Agnese Suppiej Federico Marchetti Alessandro De Fanti Fabio Caramelli Lorenzo Iughetti Chiara Ghizzi Enrico Valletta Gianluca Vergine Marcello Stella Beatrice Campana Valentina Fainardi Valentina Fainardi Michela Deolmi Susanna Esposito Susanna Esposito Emilia-Romagna Paediatric COVID-19 Network |
| author_facet | Matteo Puntoni Caterina Caminiti Giuseppe Maglietta Marcello Lanari Giacomo Biasucci Giacomo Biasucci Agnese Suppiej Federico Marchetti Alessandro De Fanti Fabio Caramelli Lorenzo Iughetti Chiara Ghizzi Enrico Valletta Gianluca Vergine Marcello Stella Beatrice Campana Valentina Fainardi Valentina Fainardi Michela Deolmi Susanna Esposito Susanna Esposito Emilia-Romagna Paediatric COVID-19 Network |
| author_sort | Matteo Puntoni |
| collection | DOAJ |
| description | BackgroundEvidence exists on the major disruptions in pediatric healthcare services occurred during the COVID-19 pandemic, but what happened when all restrictions were lifted is unclear. This study examined trends in pediatric hospital admission and Emergency Department visit rates during the first 12 months following the end of the state of emergency in Italy, compared to pre-pandemic levels.MethodsWe conducted a multicenter, retrospective, quasi-experimental before after study including 11 North Italian hospitals. Using electronic health records from March 2017 to March 2023, we compared standardized rates recorded during 1 year following the end of the emergency with the situation before the pandemic, using interrupted time series. We examined trends overall and for individual diagnostic categories that had exhibited the largest impact in our previous studies concerning data up to March 2022.ResultsA total of 104,083 hospitalizations and 858,762 Pediatric Emergency Department visits were analyzed. Compared to the 3 years before the outbreak, post-emergency hospitalization rates increased by 23% (Standardized Hospitalization Rate Ratio 1.23, 95% CI 1.20–1.25), whereas Pediatric Emergency Department visits after a sharp decrease returned to pre-pandemic rates (Standardized Incidence Rate Ratio 0.98, 95% CI 0.96–1.00). Mental health-related hospitalizations exhibited the largest increase, peaking in the first months of the post-pandemic year (level change, Hospitalization Rate Ratio (HRR)2.57, 95%CI 1.61–4.12), then decreasing slightly in the last months but still maintaining much higher than pre-pandemic values. Notably, hospitalization rates in adolescent girls (12–17 years) increased almost 4-fold (level change, HRR 3.72, 95%CI 2.02–6.85, p < 0.001), whereas the increase was not significant for boys in the same age group (level change, HRR 1.42, 95%CI 0.65–3.11, p = 0.378). Respiratory diseases, after drastically declining during the two pandemic years, experienced steadily increasing monthly trends, finally stabilizing in the post-pandemic year at pre-pandemic levels.ConclusionThe COVID-19 pandemic has had long-term consequences on pediatric healthcare utilization. Data from this and future studies can guide the development of proactive policies aiming to mitigate healthcare disruptions and ensure access to essential pediatric services in the event of future health crises, with special consideration to vulnerable populations. The persistent rise in hospital admissions for mental health disorders, particularly teenage girls, make this field a challenging, absolute priority for public health. |
| format | Article |
| id | doaj-art-3c2e91fbb79a49b8936cae99671cf29b |
| institution | Kabale University |
| issn | 2296-2565 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Public Health |
| spelling | doaj-art-3c2e91fbb79a49b8936cae99671cf29b2025-08-21T05:27:08ZengFrontiers Media S.A.Frontiers in Public Health2296-25652025-08-011310.3389/fpubh.2025.15750471575047Pediatric healthcare service utilization after the end of COVID-19 state of emergency in Northern Italy: a 6-year quasi-experimental study using interrupted time-series analysisMatteo Puntoni0Caterina Caminiti1Giuseppe Maglietta2Marcello Lanari3Giacomo Biasucci4Giacomo Biasucci5Agnese Suppiej6Federico Marchetti7Alessandro De Fanti8Fabio Caramelli9Lorenzo Iughetti10Chiara Ghizzi11Enrico Valletta12Gianluca Vergine13Marcello Stella14Beatrice Campana15Valentina Fainardi16Valentina Fainardi17Michela Deolmi18Susanna Esposito19Susanna Esposito20Emilia-Romagna Paediatric COVID-19 NetworkClinical and Epidemiological Research Unit, University-Hospital of Parma, Parma, ItalyClinical and Epidemiological Research Unit, University-Hospital of Parma, Parma, ItalyClinical and Epidemiological Research Unit, University-Hospital of Parma, Parma, ItalyPediatric Emergency Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, ItalyPediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, Piacenza, ItalyDepartment of Medicine and Surgery, University of Parma, Parma, ItalyPediatric Clinic, University of Ferrara, Ferrara, ItalyPediatrics and Neonatology Unit, Ravenna Hospital, AUSL Romagna, Ravenna, ItalyPaediatrics Unit, Santa Maria Nuova Hospital, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, ItalyPediatric Intensive Care Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, ItalyPediatrics Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy0Paediatrics Unit, Maggiore Hospital, Bologna, Italy1Pediatric Unit, G.B. Morgagni—L. Pierantoni Hospital, AUSL Romagna, Forlì, Italy2Pediatric Clinic, Rimini Hospital, AUSL Romagna, Rimini, Italy3Pediatric Unit, AUSL Romagna, Cesena, ItalyDepartment of Medicine and Surgery, University of Parma, Parma, ItalyDepartment of Medicine and Surgery, University of Parma, Parma, Italy4Pediatric Clinic, University-Hospital of Parma, Parma, Italy4Pediatric Clinic, University-Hospital of Parma, Parma, ItalyDepartment of Medicine and Surgery, University of Parma, Parma, Italy4Pediatric Clinic, University-Hospital of Parma, Parma, ItalyBackgroundEvidence exists on the major disruptions in pediatric healthcare services occurred during the COVID-19 pandemic, but what happened when all restrictions were lifted is unclear. This study examined trends in pediatric hospital admission and Emergency Department visit rates during the first 12 months following the end of the state of emergency in Italy, compared to pre-pandemic levels.MethodsWe conducted a multicenter, retrospective, quasi-experimental before after study including 11 North Italian hospitals. Using electronic health records from March 2017 to March 2023, we compared standardized rates recorded during 1 year following the end of the emergency with the situation before the pandemic, using interrupted time series. We examined trends overall and for individual diagnostic categories that had exhibited the largest impact in our previous studies concerning data up to March 2022.ResultsA total of 104,083 hospitalizations and 858,762 Pediatric Emergency Department visits were analyzed. Compared to the 3 years before the outbreak, post-emergency hospitalization rates increased by 23% (Standardized Hospitalization Rate Ratio 1.23, 95% CI 1.20–1.25), whereas Pediatric Emergency Department visits after a sharp decrease returned to pre-pandemic rates (Standardized Incidence Rate Ratio 0.98, 95% CI 0.96–1.00). Mental health-related hospitalizations exhibited the largest increase, peaking in the first months of the post-pandemic year (level change, Hospitalization Rate Ratio (HRR)2.57, 95%CI 1.61–4.12), then decreasing slightly in the last months but still maintaining much higher than pre-pandemic values. Notably, hospitalization rates in adolescent girls (12–17 years) increased almost 4-fold (level change, HRR 3.72, 95%CI 2.02–6.85, p < 0.001), whereas the increase was not significant for boys in the same age group (level change, HRR 1.42, 95%CI 0.65–3.11, p = 0.378). Respiratory diseases, after drastically declining during the two pandemic years, experienced steadily increasing monthly trends, finally stabilizing in the post-pandemic year at pre-pandemic levels.ConclusionThe COVID-19 pandemic has had long-term consequences on pediatric healthcare utilization. Data from this and future studies can guide the development of proactive policies aiming to mitigate healthcare disruptions and ensure access to essential pediatric services in the event of future health crises, with special consideration to vulnerable populations. The persistent rise in hospital admissions for mental health disorders, particularly teenage girls, make this field a challenging, absolute priority for public health.https://www.frontiersin.org/articles/10.3389/fpubh.2025.1575047/fullhealthcare service utilizationpost-emergencypost-pandemic effectspediatric hospitalizationspediatric emergency departmentmental disorders |
| spellingShingle | Matteo Puntoni Caterina Caminiti Giuseppe Maglietta Marcello Lanari Giacomo Biasucci Giacomo Biasucci Agnese Suppiej Federico Marchetti Alessandro De Fanti Fabio Caramelli Lorenzo Iughetti Chiara Ghizzi Enrico Valletta Gianluca Vergine Marcello Stella Beatrice Campana Valentina Fainardi Valentina Fainardi Michela Deolmi Susanna Esposito Susanna Esposito Emilia-Romagna Paediatric COVID-19 Network Pediatric healthcare service utilization after the end of COVID-19 state of emergency in Northern Italy: a 6-year quasi-experimental study using interrupted time-series analysis Frontiers in Public Health healthcare service utilization post-emergency post-pandemic effects pediatric hospitalizations pediatric emergency department mental disorders |
| title | Pediatric healthcare service utilization after the end of COVID-19 state of emergency in Northern Italy: a 6-year quasi-experimental study using interrupted time-series analysis |
| title_full | Pediatric healthcare service utilization after the end of COVID-19 state of emergency in Northern Italy: a 6-year quasi-experimental study using interrupted time-series analysis |
| title_fullStr | Pediatric healthcare service utilization after the end of COVID-19 state of emergency in Northern Italy: a 6-year quasi-experimental study using interrupted time-series analysis |
| title_full_unstemmed | Pediatric healthcare service utilization after the end of COVID-19 state of emergency in Northern Italy: a 6-year quasi-experimental study using interrupted time-series analysis |
| title_short | Pediatric healthcare service utilization after the end of COVID-19 state of emergency in Northern Italy: a 6-year quasi-experimental study using interrupted time-series analysis |
| title_sort | pediatric healthcare service utilization after the end of covid 19 state of emergency in northern italy a 6 year quasi experimental study using interrupted time series analysis |
| topic | healthcare service utilization post-emergency post-pandemic effects pediatric hospitalizations pediatric emergency department mental disorders |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2025.1575047/full |
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