Impacts of mild COVID-19 on elevated use of primary and specialist health care services: A nationwide register study from Norway

  1. Katrine Damgaard Skyrud
  2. Kjersti Helene Hernæs
  3. Kjetil Elias Telle
  4. Karin Magnusson

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Abstract

To explore the temporal impact of mild COVID-19 on need for primary and specialist health care services.

Methods

In all adults (≥20 years) tested for SARS-CoV-2 in Norway March 1 st 2020 to February 1st 2021 (N = 1 401 922), we contrasted the monthly all-cause health care use before and up to 6 months after the test (% relative difference), for patients with a positive test for SARS-CoV-2 (non-hospitalization, i.e. mild COVID-19) and patients with a negative test (no COVID-19).

Results

We found a substantial short-term elevation in primary care use in all age groups, with men generally having a higher relative increase (men 20–44 years: 522%, 95%CI = 509–535, 45–69 years: 439%, 95%CI = 426–452, ≥70 years: 199%, 95%CI = 180–218) than women (20–44 years: 342, 95%CI = 334–350, 45–69 years = 375, 95%CI = 365–385, ≥70 years: 156%, 95%CI = 141–171) at 1 month following positive test. At 2 months, this sex difference was less pronounced, with a (20–44 years: 21%, 95%CI = 13–29, 45–69 years = 38%, 95%CI = 30–46, ≥70 years: 15%, 95%CI = 3–28) increase in primary care use for men, and a (20–44 years: 30%, 95%CI = 24–36, 45–69 years = 57%, 95%CI = 50–64, ≥70 years: 14%, 95%CI = 4–24) increase for women. At 3 months after test, only women aged 45–70 years still had an increased primary care use (14%, 95%CI = 7–20). The increase was due to respiratory- and general/unspecified conditions. We observed no long-term (4–6 months) elevation in primary care use, and no elevation in specialist care use.

Conclusion

Mild COVID-19 gives an elevated need for primary care that vanishes 2–3 months after positive test. Middle-aged women had the most prolonged increased primary care use.

Article activity feed

  1. Version published to 10.1371/journal.pone.0257926
  2. Version published to 10.1101/2021.02.16.21251807v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2021.02.16.21251807: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All analyses were run in STATA MP v.16.
    STATA
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Potential limitations: Some important limitations should be mentioned. First, our organ-wise studies of primary care, outpatient- and inpatient specialist care might include different diagnoses due to the different setups of the ICPC-2 and the ICD-10 system. As an example, the ICPC-2 chapters include separate codes for patient-reported symptoms and signs in addition to doctors’ diagnoses, whereas the ICD-10 chapters mainly include diagnostic codes that are based on clinical and laboratory tests or imaging. Along this line, the ICPC-2 system includes diagnostic codes for cancers in the ICPC-2 chapters that were included in this study, whereas ICD-10 diagnostic codes for cancers have an own chapter that was not included in our study. However, because our main aim was to provide a broad overview of health and health care use after mild and severe COVID-19, and because we could contrast with pre-test patterns and patterns for those with no COVID-19 in the difference-in-differences model, we regard this to be of small relevance to the interpretation of our findings. A second limitation may be the limited test capacity in the beginning of the pandemic. For this reason, we might have missed a large part of the earliest mild COVID-19 cases. Still, only persons with confirmed negative test were included in the comparison group and we expect no over- or underestimation of results for the group having mild COVID-19. It should further be noted that although we defined persons having a po...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  4. Version published to 10.1101/2021.02.16.21251807v1 on medRxiv