Impact of first UK COVID-19 lockdown on hospital admissions: Interrupted time series study of 32 million people
Uncontrolled infection and lockdown measures introduced in response have resulted in an unprecedented challenge for health systems internationally. Whether such unprecedented impact was due to lockdown itself and recedes when such measures are lifted is unclear. We assessed the short- and medium-ter...
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| Veröffentlicht in: | EClinicalMedicine 2022-07, Vol.49, p.101462, Article 101462 |
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| creator | Shah, Syed Ahmar Brophy, Sinead Kennedy, John Fisher, Louis Walker, Alex Mackenna, Brian Curtis, Helen Inglesby, Peter Davy, Simon Bacon, Seb Goldacre, Ben Agrawal, Utkarsh Moore, Emily Simpson, Colin R Macleod, John Cooksey, Roxane Sheikh, Aziz Katikireddi, Srinivasa Vittal |
| description | Uncontrolled infection and lockdown measures introduced in response have resulted in an unprecedented challenge for health systems internationally. Whether such unprecedented impact was due to lockdown itself and recedes when such measures are lifted is unclear. We assessed the short- and medium-term impacts of the first lockdown measures on hospital care for tracer non-COVID-19 conditions in England, Scotland and Wales across diseases, sexes, and socioeconomic and ethnic groups.
We used OpenSAFELY (for England), EAVEII (Scotland), and SAIL Databank (Wales) to extract weekly hospital admission rates for cancer, cardiovascular and respiratory conditions (excluding COVID-19) from the pre-pandemic period until 25/10/2020 and conducted a controlled interrupted time series analysis. We undertook stratified analyses and assessed admission rates over seven months during which lockdown restrictions were gradually lifted.
Our combined dataset included 32 million people who contributed over 74 million person-years. Admission rates for all three conditions fell by 34.2% (Confidence Interval (CI): -43.0, -25.3) in England, 20.9% (CI: -27.8, -14.1) in Scotland, and 24.7% (CI: -36.7, -12.7) in Wales, with falls across every stratum considered. In all three nations, cancer-related admissions fell the most while respiratory-related admissions fell the least (e.g., rates fell by 40.5% (CI: -47.4, -33.6), 21.9% (CI: -35.4, -8.4), and 19.0% (CI: -30.6, -7.4) in England for cancer, cardiovascular-related, and respiratory-related admissions respectively). Unscheduled admissions rates fell more in the most than the least deprived quintile across all three nations. Some ethnic minority groups experienced greater falls in admissions (e.g., in England, unscheduled admissions fell by 9.5% (CI: -20.2, 1.2) for Whites, but 44.3% (CI: -71.0, -17.6), 34.6% (CI: -63.8, -5.3), and 25.6% (CI: -45.0, -6.3) for Mixed, Other and Black ethnic groups respectively). Despite easing of restrictions, the overall admission rates remained lower in England, Scotland, and Wales by 20.8%, 21.6%, and 22.0%, respectively when compared to the same period (August-September) during the pre-pandemic years. This corresponds to a reduction of 26.2, 23.8 and 30.2 admissions per 100,000 people in England, Scotland, and Wales respectively.
Hospital care for non-COVID diseases fell substantially across England, Scotland, and Wales during the first lockdown, with reductions persisting for at least six months. The m |
| doi_str_mv | 10.1016/j.eclinm.2022.101462 |
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We used OpenSAFELY (for England), EAVEII (Scotland), and SAIL Databank (Wales) to extract weekly hospital admission rates for cancer, cardiovascular and respiratory conditions (excluding COVID-19) from the pre-pandemic period until 25/10/2020 and conducted a controlled interrupted time series analysis. We undertook stratified analyses and assessed admission rates over seven months during which lockdown restrictions were gradually lifted.
Our combined dataset included 32 million people who contributed over 74 million person-years. Admission rates for all three conditions fell by 34.2% (Confidence Interval (CI): -43.0, -25.3) in England, 20.9% (CI: -27.8, -14.1) in Scotland, and 24.7% (CI: -36.7, -12.7) in Wales, with falls across every stratum considered. In all three nations, cancer-related admissions fell the most while respiratory-related admissions fell the least (e.g., rates fell by 40.5% (CI: -47.4, -33.6), 21.9% (CI: -35.4, -8.4), and 19.0% (CI: -30.6, -7.4) in England for cancer, cardiovascular-related, and respiratory-related admissions respectively). Unscheduled admissions rates fell more in the most than the least deprived quintile across all three nations. Some ethnic minority groups experienced greater falls in admissions (e.g., in England, unscheduled admissions fell by 9.5% (CI: -20.2, 1.2) for Whites, but 44.3% (CI: -71.0, -17.6), 34.6% (CI: -63.8, -5.3), and 25.6% (CI: -45.0, -6.3) for Mixed, Other and Black ethnic groups respectively). Despite easing of restrictions, the overall admission rates remained lower in England, Scotland, and Wales by 20.8%, 21.6%, and 22.0%, respectively when compared to the same period (August-September) during the pre-pandemic years. This corresponds to a reduction of 26.2, 23.8 and 30.2 admissions per 100,000 people in England, Scotland, and Wales respectively.
Hospital care for non-COVID diseases fell substantially across England, Scotland, and Wales during the first lockdown, with reductions persisting for at least six months. The most deprived and minority ethnic groups were impacted more severely.
This work was funded by the Medical Research Council as part of the Lifelong Health and Wellbeing study as part of National Core Studies (MC_PC_20030). SVK acknowledges funding from the Medical Research Council (MC_UU_00022/2), and the Scottish Government Chief Scientist Office (SPHSU17). EAVE II is funded by the Medical Research Council (MR/R008345/1) with the support of BREATHE – The Health Data Research Hub for Respiratory Health (MC_PC_19004), which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. BG has received research funding from the NHS National Institute for Health Research (NIHR), the Wellcome Trust, Health Data Research UK, Asthma UK, the British Lung Foundation, and the Longitudinal Health and Wellbeing strand of the National Core Studies programme.</description><identifier>ISSN: 2589-5370</identifier><identifier>EISSN: 2589-5370</identifier><identifier>DOI: 10.1016/j.eclinm.2022.101462</identifier><identifier>PMID: 35611160</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Covid-19 ; Healthcare Disruption ; Healthcare Inequalities ; Interrupted time series analysis ; Pandemic ; SARS-CoV-2</subject><ispartof>EClinicalMedicine, 2022-07, Vol.49, p.101462, Article 101462</ispartof><rights>2022 The Authors</rights><rights>2022 The Authors.</rights><rights>2022 The Authors 2022</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c529t-584041a17bc305535968a3ca766506701fc8fad2e495c03052af106b5f7afcb73</citedby><cites>FETCH-LOGICAL-c529t-584041a17bc305535968a3ca766506701fc8fad2e495c03052af106b5f7afcb73</cites><orcidid>0000-0001-5181-6120 ; 0000-0001-5672-0443</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9121886/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9121886/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35611160$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shah, Syed Ahmar</creatorcontrib><creatorcontrib>Brophy, Sinead</creatorcontrib><creatorcontrib>Kennedy, John</creatorcontrib><creatorcontrib>Fisher, Louis</creatorcontrib><creatorcontrib>Walker, Alex</creatorcontrib><creatorcontrib>Mackenna, Brian</creatorcontrib><creatorcontrib>Curtis, Helen</creatorcontrib><creatorcontrib>Inglesby, Peter</creatorcontrib><creatorcontrib>Davy, Simon</creatorcontrib><creatorcontrib>Bacon, Seb</creatorcontrib><creatorcontrib>Goldacre, Ben</creatorcontrib><creatorcontrib>Agrawal, Utkarsh</creatorcontrib><creatorcontrib>Moore, Emily</creatorcontrib><creatorcontrib>Simpson, Colin R</creatorcontrib><creatorcontrib>Macleod, John</creatorcontrib><creatorcontrib>Cooksey, Roxane</creatorcontrib><creatorcontrib>Sheikh, Aziz</creatorcontrib><creatorcontrib>Katikireddi, Srinivasa Vittal</creatorcontrib><title>Impact of first UK COVID-19 lockdown on hospital admissions: Interrupted time series study of 32 million people</title><title>EClinicalMedicine</title><addtitle>EClinicalMedicine</addtitle><description>Uncontrolled infection and lockdown measures introduced in response have resulted in an unprecedented challenge for health systems internationally. Whether such unprecedented impact was due to lockdown itself and recedes when such measures are lifted is unclear. We assessed the short- and medium-term impacts of the first lockdown measures on hospital care for tracer non-COVID-19 conditions in England, Scotland and Wales across diseases, sexes, and socioeconomic and ethnic groups.
We used OpenSAFELY (for England), EAVEII (Scotland), and SAIL Databank (Wales) to extract weekly hospital admission rates for cancer, cardiovascular and respiratory conditions (excluding COVID-19) from the pre-pandemic period until 25/10/2020 and conducted a controlled interrupted time series analysis. We undertook stratified analyses and assessed admission rates over seven months during which lockdown restrictions were gradually lifted.
Our combined dataset included 32 million people who contributed over 74 million person-years. Admission rates for all three conditions fell by 34.2% (Confidence Interval (CI): -43.0, -25.3) in England, 20.9% (CI: -27.8, -14.1) in Scotland, and 24.7% (CI: -36.7, -12.7) in Wales, with falls across every stratum considered. In all three nations, cancer-related admissions fell the most while respiratory-related admissions fell the least (e.g., rates fell by 40.5% (CI: -47.4, -33.6), 21.9% (CI: -35.4, -8.4), and 19.0% (CI: -30.6, -7.4) in England for cancer, cardiovascular-related, and respiratory-related admissions respectively). Unscheduled admissions rates fell more in the most than the least deprived quintile across all three nations. Some ethnic minority groups experienced greater falls in admissions (e.g., in England, unscheduled admissions fell by 9.5% (CI: -20.2, 1.2) for Whites, but 44.3% (CI: -71.0, -17.6), 34.6% (CI: -63.8, -5.3), and 25.6% (CI: -45.0, -6.3) for Mixed, Other and Black ethnic groups respectively). Despite easing of restrictions, the overall admission rates remained lower in England, Scotland, and Wales by 20.8%, 21.6%, and 22.0%, respectively when compared to the same period (August-September) during the pre-pandemic years. This corresponds to a reduction of 26.2, 23.8 and 30.2 admissions per 100,000 people in England, Scotland, and Wales respectively.
Hospital care for non-COVID diseases fell substantially across England, Scotland, and Wales during the first lockdown, with reductions persisting for at least six months. The most deprived and minority ethnic groups were impacted more severely.
This work was funded by the Medical Research Council as part of the Lifelong Health and Wellbeing study as part of National Core Studies (MC_PC_20030). SVK acknowledges funding from the Medical Research Council (MC_UU_00022/2), and the Scottish Government Chief Scientist Office (SPHSU17). EAVE II is funded by the Medical Research Council (MR/R008345/1) with the support of BREATHE – The Health Data Research Hub for Respiratory Health (MC_PC_19004), which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. BG has received research funding from the NHS National Institute for Health Research (NIHR), the Wellcome Trust, Health Data Research UK, Asthma UK, the British Lung Foundation, and the Longitudinal Health and Wellbeing strand of the National Core Studies programme.</description><subject>Covid-19</subject><subject>Healthcare Disruption</subject><subject>Healthcare Inequalities</subject><subject>Interrupted time series analysis</subject><subject>Pandemic</subject><subject>SARS-CoV-2</subject><issn>2589-5370</issn><issn>2589-5370</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp9kU1v1DAQhi0EolXpP0DIRy5Zxk7sJByQ0JaPFZV6oVwtrzOmXhw72E5R_z2JtpRy4eSR5513Ph5CXjLYMGDyzWGDxrswbjhwvn41kj8hp1x0fSXqFp4-ik_Iec4HAODQdL2E5-SkFpIxJuGUxN04aVNotNS6lAu9_kK3V992FxXrqY_mxxB_BRoDvYl5ckV7qofR5exiyG_pLhRMaZ4KDrS4EWnG5DDTXObhbvWsOR2d94uaThgnjy_IM6t9xvP794xcf_zwdfu5urz6tNu-v6yM4H2pRNdAwzRr96YGIWrRy07XRrdSCpAtMGs6qweOTS8MLBKuLQO5F7bV1uzb-oy8O_pO837EwWAoSXs1JTfqdKeidurfTHA36nu8VT3jrOvkYvD63iDFnzPmopa1DXqvA8Y5Ky5lL9bRmkXaHKUmxZwT2oc2DNSKSx3UEZdacakjrqXs1eMRH4r-wPm7Ay6HunWYVDYOg8HBJTRFDdH9v8NvGPKoEg</recordid><startdate>20220701</startdate><enddate>20220701</enddate><creator>Shah, Syed Ahmar</creator><creator>Brophy, Sinead</creator><creator>Kennedy, John</creator><creator>Fisher, Louis</creator><creator>Walker, Alex</creator><creator>Mackenna, Brian</creator><creator>Curtis, Helen</creator><creator>Inglesby, Peter</creator><creator>Davy, Simon</creator><creator>Bacon, Seb</creator><creator>Goldacre, Ben</creator><creator>Agrawal, Utkarsh</creator><creator>Moore, Emily</creator><creator>Simpson, Colin R</creator><creator>Macleod, John</creator><creator>Cooksey, Roxane</creator><creator>Sheikh, Aziz</creator><creator>Katikireddi, Srinivasa Vittal</creator><general>Elsevier Ltd</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-5181-6120</orcidid><orcidid>https://orcid.org/0000-0001-5672-0443</orcidid></search><sort><creationdate>20220701</creationdate><title>Impact of first UK COVID-19 lockdown on hospital admissions: Interrupted time series study of 32 million people</title><author>Shah, Syed Ahmar ; Brophy, Sinead ; Kennedy, John ; Fisher, Louis ; Walker, Alex ; Mackenna, Brian ; Curtis, Helen ; Inglesby, Peter ; Davy, Simon ; Bacon, Seb ; Goldacre, Ben ; Agrawal, Utkarsh ; Moore, Emily ; Simpson, Colin R ; Macleod, John ; Cooksey, Roxane ; Sheikh, Aziz ; Katikireddi, Srinivasa Vittal</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c529t-584041a17bc305535968a3ca766506701fc8fad2e495c03052af106b5f7afcb73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Covid-19</topic><topic>Healthcare Disruption</topic><topic>Healthcare Inequalities</topic><topic>Interrupted time series analysis</topic><topic>Pandemic</topic><topic>SARS-CoV-2</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shah, Syed Ahmar</creatorcontrib><creatorcontrib>Brophy, Sinead</creatorcontrib><creatorcontrib>Kennedy, John</creatorcontrib><creatorcontrib>Fisher, Louis</creatorcontrib><creatorcontrib>Walker, Alex</creatorcontrib><creatorcontrib>Mackenna, Brian</creatorcontrib><creatorcontrib>Curtis, Helen</creatorcontrib><creatorcontrib>Inglesby, Peter</creatorcontrib><creatorcontrib>Davy, Simon</creatorcontrib><creatorcontrib>Bacon, Seb</creatorcontrib><creatorcontrib>Goldacre, Ben</creatorcontrib><creatorcontrib>Agrawal, Utkarsh</creatorcontrib><creatorcontrib>Moore, Emily</creatorcontrib><creatorcontrib>Simpson, Colin R</creatorcontrib><creatorcontrib>Macleod, John</creatorcontrib><creatorcontrib>Cooksey, Roxane</creatorcontrib><creatorcontrib>Sheikh, Aziz</creatorcontrib><creatorcontrib>Katikireddi, Srinivasa Vittal</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>EClinicalMedicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shah, Syed Ahmar</au><au>Brophy, Sinead</au><au>Kennedy, John</au><au>Fisher, Louis</au><au>Walker, Alex</au><au>Mackenna, Brian</au><au>Curtis, Helen</au><au>Inglesby, Peter</au><au>Davy, Simon</au><au>Bacon, Seb</au><au>Goldacre, Ben</au><au>Agrawal, Utkarsh</au><au>Moore, Emily</au><au>Simpson, Colin R</au><au>Macleod, John</au><au>Cooksey, Roxane</au><au>Sheikh, Aziz</au><au>Katikireddi, Srinivasa Vittal</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of first UK COVID-19 lockdown on hospital admissions: Interrupted time series study of 32 million people</atitle><jtitle>EClinicalMedicine</jtitle><addtitle>EClinicalMedicine</addtitle><date>2022-07-01</date><risdate>2022</risdate><volume>49</volume><spage>101462</spage><pages>101462-</pages><artnum>101462</artnum><issn>2589-5370</issn><eissn>2589-5370</eissn><abstract>Uncontrolled infection and lockdown measures introduced in response have resulted in an unprecedented challenge for health systems internationally. Whether such unprecedented impact was due to lockdown itself and recedes when such measures are lifted is unclear. We assessed the short- and medium-term impacts of the first lockdown measures on hospital care for tracer non-COVID-19 conditions in England, Scotland and Wales across diseases, sexes, and socioeconomic and ethnic groups.
We used OpenSAFELY (for England), EAVEII (Scotland), and SAIL Databank (Wales) to extract weekly hospital admission rates for cancer, cardiovascular and respiratory conditions (excluding COVID-19) from the pre-pandemic period until 25/10/2020 and conducted a controlled interrupted time series analysis. We undertook stratified analyses and assessed admission rates over seven months during which lockdown restrictions were gradually lifted.
Our combined dataset included 32 million people who contributed over 74 million person-years. Admission rates for all three conditions fell by 34.2% (Confidence Interval (CI): -43.0, -25.3) in England, 20.9% (CI: -27.8, -14.1) in Scotland, and 24.7% (CI: -36.7, -12.7) in Wales, with falls across every stratum considered. In all three nations, cancer-related admissions fell the most while respiratory-related admissions fell the least (e.g., rates fell by 40.5% (CI: -47.4, -33.6), 21.9% (CI: -35.4, -8.4), and 19.0% (CI: -30.6, -7.4) in England for cancer, cardiovascular-related, and respiratory-related admissions respectively). Unscheduled admissions rates fell more in the most than the least deprived quintile across all three nations. Some ethnic minority groups experienced greater falls in admissions (e.g., in England, unscheduled admissions fell by 9.5% (CI: -20.2, 1.2) for Whites, but 44.3% (CI: -71.0, -17.6), 34.6% (CI: -63.8, -5.3), and 25.6% (CI: -45.0, -6.3) for Mixed, Other and Black ethnic groups respectively). Despite easing of restrictions, the overall admission rates remained lower in England, Scotland, and Wales by 20.8%, 21.6%, and 22.0%, respectively when compared to the same period (August-September) during the pre-pandemic years. This corresponds to a reduction of 26.2, 23.8 and 30.2 admissions per 100,000 people in England, Scotland, and Wales respectively.
Hospital care for non-COVID diseases fell substantially across England, Scotland, and Wales during the first lockdown, with reductions persisting for at least six months. The most deprived and minority ethnic groups were impacted more severely.
This work was funded by the Medical Research Council as part of the Lifelong Health and Wellbeing study as part of National Core Studies (MC_PC_20030). SVK acknowledges funding from the Medical Research Council (MC_UU_00022/2), and the Scottish Government Chief Scientist Office (SPHSU17). EAVE II is funded by the Medical Research Council (MR/R008345/1) with the support of BREATHE – The Health Data Research Hub for Respiratory Health (MC_PC_19004), which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. BG has received research funding from the NHS National Institute for Health Research (NIHR), the Wellcome Trust, Health Data Research UK, Asthma UK, the British Lung Foundation, and the Longitudinal Health and Wellbeing strand of the National Core Studies programme.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>35611160</pmid><doi>10.1016/j.eclinm.2022.101462</doi><orcidid>https://orcid.org/0000-0001-5181-6120</orcidid><orcidid>https://orcid.org/0000-0001-5672-0443</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Covid-19 Healthcare Disruption Healthcare Inequalities Interrupted time series analysis Pandemic SARS-CoV-2 |
| title | Impact of first UK COVID-19 lockdown on hospital admissions: Interrupted time series study of 32 million people |
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