The Effects of COVID-19 Hospitalizations on Deaths and Hospitalizations from Other Diseases: A Panel Data Analysis Using Brazilian Municipalities

Background: The COVID-19 pandemic in Brazil has brought many challenges, particularly regarding the management of hospital capacity. It generated a new demand for healthcare that added to the preexisting demands, such as neoplasms, cardiovascular diseases and births. In this paper, we estimate the impact of the pandemic on the number of deaths and hospitalizations for other diseases.Methods: We construct a monthly panel data of deaths and hospitalizations for various causes by the municipality of residence and relate them to COVID-19 hospitalizations using regression models that control for municipalities fixed-effects and interactions between State and month fixed-effects. The standard errors are clustered at the municipality level.Findings: Our estimates imply that 100 more hospitalizations by COVID-19 are associated with a reduction of 49 non-COVID-19 hospitalizations and four additional deaths for other reasons (all measured per 100,000 pop.). The effect of ICU COVID-19 hospitalizations on mortality is larger. The groups most affected are the blacks, less-educated and the elderly. Additional deaths occurred both at households and at hospitals. The main causes of additional deaths were neoplasms, mental disorders and diseases related to the nervous, circulatory and endocrine system.Interpretation: The decline in hospitalizations for other causes seems to be related to the overcrowding of hospitals in periods of surge in the COVID-19, alongside with the fall in the demand for care by the citizens who were afraid of COVID-19 infection. These mechanisms affected more strongly the vulnerable groups of the population.Funding: The authors acknowledge funding from the São Paulo Research Foundation (FAPESP): grant number 2019-553-0 (NMF).Declaration of Interest: The authors declare no conflict of interest.