COVID-19 impact on stroke admissions during France's first epidemic peak: an exhaustive, nationwide, observational study

Risser, C.; Tran Ba Loc, P.; Binder-Foucard, F.; Fabacher, T.; Lefevre, H.; Sauvage, C.; Sauleau, E.; Wolff, V.

Background and Purpose: The COVID-19 pandemic continues to have great impacts on the care of non-COVID-19 patients. This was especially true during the first epidemic peak in France, which coincided with the national lockdown (17 March 2020 to 10 May 2020). Patients with serious and urgent disease like stroke may have experienced a degradation of care, or may have been hesitant to seek healthcare during this period. The aim of this study was to identify, on a national level, whether a decrease in stroke admissions occurred in spring 2020, by analyzing the evolution of all stroke admissions in France from January 2019 to June 2020. Methods: We conducted a nationwide cohort study using the French national database of hospital admissions (PMSI) to extract exhaustive data on all hospitalizations in France with at least one stroke diagnosis between 1 January 2019 and 30 June 2020. The primary endpoint was the difference in the slope gradients of stroke hospitalizations between pre-epidemic, epidemic peak and post-epidemic periods. Modeling was carried out using Bayesian techniques. Results: Stroke hospitalizations dropped from 10 March 2020 (slope gradient: -11.70), and began to rise again from 22 March (slope gradient: 2.090) to 7 May. In total, there were 23 873 stroke admissions during the period March-April 2020, compared to 29 263 at the same period in 2019, representing a decrease of 18.42%. The percentage change was -15.63%, -25.19%, -18.62% for ischemic strokes, transient ischemic attacks, and hemorrhagic strokes, respectively. In spatial models of French departments, the incidence of COVID-19 explained the ratio of stroke hospitalizations. Conclusions: Stroke hospitalizations in France experienced a decline during the first lockdown period, which cannot be explained by a sudden change in stroke incidence. This decline is therefore likely to be a direct, or indirect, result of the COVID-19 pandemic.