CHANGES IN AVOIDABLE HOSPITALIZATION INDICATORS IN LITHUANIAN MUNICIPALITIES, 2018–2024

Abstract

Objective. The aim of the study was to compare changes and trends in avoidable hospitalization indicators across Lithuanian municipalities from 2018 to 2024, and to assess the impact of the COVID-19 pandemic on these indicators.
Material and methods. A quantitative descriptive study design was employed. The object of the study was avoidable hospitalizations (AH), defined as hospital admissions for ambulatory care sensitive conditions. The study population included Lithuanian residents aged one year and older, both male and female, who were hospitalized for conditions manageable at the outpatient level. Data were sourced from the “Sveidra” information system of the Compulsory Health Insurance Fund for the year 2018–2024, combined with average annual population data disaggregated by age, sex, and administrative territory. Indicators were calculated per 1,000 population by age and sex, both at the national and municipal levels. The study examined changes in frequency indicators, annual percentage changes, average annual percentage change, and the proportion of AH among all hospitalizations for acute care (for patients aged ≥1 year). A linear regression model was aplied to assess indicator trends. To evaluate the impact of the COVID-19 pandemic, AH prevalence and changes were compared between March 2019–February 2020 and March 2020–February 2021. The proportion of AH among all acute care hospitalizations was analysed at the municipal level, and monthly changes and differences were calculated. The t-test was applied to assess statistically significant differences between periods. A statistical significance threshold of α = 0.05 was used.
Results and conclusions. In 2024, the national AH rate in Lithuania was approximately 1.3 times lower compared to 2018. During 2020–2021, AH rates declined primarily due to the COVID-19 pandemic. Although the overall trend suggests a decrease in AH rates, a renewed increase in recorded AH cases has been observed since 2022. While the overall AH rate remained stable between 2023 and 2024 (a 1.1% decrease), more substantial differences were recorded across specific causes, age groups, and regions. In recent years, the most pronounced reduction in AH was found among individuals aged 65 and older; however, when considering the full 2018–2024 period, the greatest improvement was observed in the pediatric population. In 2024, AH due to ear, nose, and throat infections declined significantly among children, although AH due to pneumonia increased several-fold. A statistically significant decrease was observed for pediatric pyelonephritis. Among adults and elderly populations, reductions in AH were noted for congestive heart failure and diabetes mellitus. Conversely, pneumonia-related AH increased among individuals aged 18–64, and pyelonephritis-related AH increased among those aged 65 and older. Trends for other conditions varied. In 2024, the national average AH rate was 20.6 per 1,000 population, with a municipal median of 24.2. The majority of municipalities recorded AH rates above the national average; only 16 municipalities had rates below it. AH rates varied by more than fourfold across municipalities. Comparison of pre-pandemic and post-pandemic periods revealed overall declines in AH rates and acute care hospitalizations, likely due to reduced admissions during lockdowns. In recent years, AH rates have shown an upward trend, although pre-pandemic levels have not yet been fully restored. Despite the overall decreasing trend, the patterns of change in AH indicators by cause, sex, and age group were heterogeneous across municipalities during the 2018–2024 period.