In an effort to mitigate the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), world leaders implemented a variety of restrictions such as social distancing measures and nationwide lockdowns. Although these non-pharmaceutical interventions (NPIs) reduced viral transmission rates, they also discouraged individuals from seeking certain healthcare services.
Study: Impact of first UK COVID-19 lockdown on hospital admissions: Interrupted time series study of 32 million people. Image Credit: ESB Professional / Shutterstock.com
Background
Previous research conducted in the United Kingdom suggests that the coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on healthcare. However, it remains unclear the extent to which the pandemic impacted healthcare services, as well as whether these effects were temporary or had long-term negative consequences that persisted after lockdown restrictions were lifted.
Furthermore, pre-pandemic healthcare services in the United Kingdom, as well as in other nations throughout the world, were associated with various disparities in their access and quality of care, particularly in the treatment of marginalized communities. As a result, researchers fear that lockdown measures may have worsened these pre-existing inequities that existed within healthcare systems.
In a recent eClinicalMedicine study, researchers use three tracer health disorders including cancer, cardiovascular, and respiratory-related diseases to quantify the impact that COVID-19 lockdowns had on healthcare services throughout the United Kingdom. Moreover, the researchers also assessed whether these effects differed according to socioeconomic status, gender, or ethnicity.
About the study
The OpenSAFELY platform, which was approved by the National Health Service (NHS) England, as well as the EAVE II platform and SAIL Databank, were used to obtain secondary care data from England, Scotland, and Wales, respectively.
Between January 1, 2019, and October 31, 2020, all weekly hospital admissions with a primary diagnosis of cancer, cardiovascular disease, or respiratory disease in England were studied. These same diagnoses were also identified between January 1, 2016, to October 31, 2020, in Scotland and Wales.
Weekly admission rates were stratified by disease, socioeconomic status, sex, ethnicity, and admission type. The researchers were interested in comparing how historical admission rates in these patient populations changed after lockdown restrictions were introduced in the United Kingdom.
Notably, the researchers categorized their data into two distinct follow-up periods. Whereas weeks one through 11 referred to data acquired between January 5, 2020, to March 15, 2020, weeks 12-43 referred to data obtained from March 22, 2020, to October 25, 2020.
Study findings
In general, hospital admission rates in weeks one through 11 in pre-pandemic and pandemic years were similar in England, Scotland, and Wales. However, each of these nations experienced a significant change in the mean rates of admission during weeks 12-43 between pre-pandemic and pandemic years.
These observations were confirmed in the interrupted time series (ITS) analysis, which similarly identified a significant decline in the overall hospital admission rates in England, Scotland, and Wales immediately after the lockdown was implemented in March 2020. As compared to unexpected admission rates, scheduled admissions decreased to a greater extent in England, Scotland, and Wales.
Cancer-related hospital admission rates exhibited the most significant decline in all three nations, which was followed by admissions due to cardiovascular and respiratory diseases. The reduced scheduled admission rates for all three diseases in England, Scotland, and Wales were significantly lower as compared to unscheduled admission rates. Notably, the most significant decline in scheduled admissions was associated with respiratory-related diseases.
Differences in admission rates were comparable between both men and women in all three nations; however, men experienced a slightly greater decline in their admission rates as compared to women. Additionally, individuals in both the least and most deprived socioeconomic statuses also experienced comparable reductions in their hospital admission rates.
In England, scheduled admission rates for Black individuals exhibited the greatest decline, while those of a Mixed ethnicity experienced the greatest reduction in unplanned admissions rates. Asians experienced the smallest decline in overall admission rates.
Non-White individuals in Scotland experienced a significantly larger reduction than White individuals in both planned and unplanned admissions. Limited data were available in Wales regarding patient ethnicity.
When the lockdown restrictions began to ease in the three countries between August and September 2020, hospital admission rates were lower as compared to those reported at the same time in pre-pandemic years.
Implications
The study findings revealed that COVID-19 lockdown restrictions had a significant impact on healthcare-seeking behaviors in England, Scotland, and Wales. More specifically, hospital admission rates related to cancer, cardiovascular-related conditions, and respiratory-related causes significantly declined as compared to the same admission rates reported in pre-pandemic years. This reduction in hospital admission rates was similar in both males and females, as well as across all races and socioeconomic statuses.
Cancer-related admission rates declined to a greater extent than those due to cardiovascular and respiratory diseases across England, Scotland, and Wales. In England and Scotland, some ethnic minorities were affected more than Whites.
Despite the relaxation of lockdown restrictions over the six months following the first lockdown, admission rates for cancer, cardiovascular, and respiratory-related diseases were much lower than pre-pandemic levels, thus indicating a long-term impact on healthcare provisions in these patient populations.
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