Observational studyBMJ open2025
Impact of COVID-19 state of emergency declarations on percutaneous coronary intervention volumes in Japan: a SARIMAX analysis of nationwide DPC database (2018-2021).
Observational study in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo evaluate the impact of Japan's COVID-19 state of emergency declarations on percutaneous coronary intervention (PCI) volumes using Seasonal AutoRegressive Integrated Moving Average with eXogenous variables (SARIMAX) modelling. This model offers methodological advantages by: (1) accounting for trends, seasonal variations and autocorrelation; (2) allowing the introduction of policy intervention periods as binary exogenous variables; and (3) enabling an accurate assessment of healthcare impacts during intermittent declaration phases while accounting for periods of subsidence.
designRetrospective observational study using a SARIMAX model.
setting1377 acute care hospitals participated in Japan's Diagnosis Procedure Combination (DPC) system between April 2018 and December 2021.
participantsAll patients who underwent emergency PCI (n=176 878) or elective PCI (n=272 811) during the study period, identified from a nationwide administrative database.
interventionsThis study analysed the impact of Japan's COVID-19 state of emergency declarations as policy intervention periods, which were implemented during four waves (April to May 2020, January to March 2021, May to June 2021 and July to September 2021). Months where more than half of the days fell within a state of emergency declaration were defined as intervention periods. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome measures were nationwide changes in both emergency and elective PCI volumes during state of emergency periods compared with non-emergency periods, analysed through SARIMAX modelling. Secondary outcomes included regional analyses of changes in both types of PCI volumes across eight geographical regions of Japan and the distribution analysis of medical resources (DPC hospitals, hospital beds, physicians and board-certified cardiologists per million population) in each region.
resultsNationwide, emergency PCI volumes totalled 176 878 and elective PCI volumes 272 811 over the 45-month study period. SARIMAX modelling indicated that the state of emergency declarations were associated with significant reductions in both emergency PCI volumes (-211.4 cases/month, 95% CI -326.9 to -95.9; -5.4%) and elective PCI volumes (-632.4 cases/month, 95% CI -1045.9 to -219.0; -10.4%). Regional analyses showed varied effects, with some areas (eg, Hokkaido, Shikoku, Kyushu) experiencing non-significant volume decreases, potentially reflecting differences in medical resource distribution and capacity.
conclusionsThe COVID-19 state of emergency declarations in Japan were associated with decreased PCI volumes. Applying SARIMAX models to real-world data could allow us to examine the effects of various events on healthcare considering trends, seasonal variation and autocorrelation by incorporating events as exogenous variables.
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