Impact of the COVID-19 pandemic and a national lockdown on hospitalizations for venous thromboembolism andpulmonary embolism in france

Background : The COVID-19 pandemic and the national lockdown implemented in France have disturbed populations behavior and overwhelmed hospitals. Furthermore, infection to SARS-CoV-2 has been found to be directly associated with an increased risk of pulmonary embolism (PE). Aims : The aims of this study were to analyze time-trends in patients hospitalized for PE in France, to describe the prevalence of a SARSCoV-2 infection over time among these patients and the related inhospital mortality rates. Methods : We used the French national healthcare database. All patients hospitalized with a diagnosis of PE in France between January and September (Weeks 1 -40) of each year from 2017 to 2020 were selected. Weekly incidence rates ratios (IRR) were computed to compare the rates of patients hospitalized between 2020 and 2017-2019.The COVID-19 diagnosis was based on biologic sample or CT scan. Results : During 2020 study period, 35,446 patients were hospitalized with a primary diagnosis of PE and 23,759 with an associated diagnosis of PE. The prevalence of COVID-19 diagnosis was respectively 3.1% and 15.9%, and reached 9.5% and 45.1% during the lockdown (weeks 12-19). As compared with same 2017-2019 weeks, rates of patients hospitalized with a primary diagnosis of PE in 2020 decreased significantly during the first week of the lockdown (-42%). By contrast, rates of patients hospitalized with an associated diagnosis of PE doubled during the lockdown. Adjusted in-hospital death probability was multiplied by 3 among patients hospitalized with an associated diagnosis of PE (OR = 3.1[2.0-4.8] for week 13 of 2020 vs 2017-2019) but remained steady among those hospitalized with a primary diagnosis of PE. Conclusions : Substantial changes in the epidemiology of PE have been found and were partly related to the global massive decrease in hospitalizations, and also directly linked to the increased number of PE with SARS-CoV-2 infections and their higher severity.