1. Ethnic differences in the indirect effects of the COVID-19 pandemic on clinical monitoring and hospitalisations for non-COVID conditions in England: a population-based, observational cohort study using the OpenSAFELY platformResearch in context
- Author
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Ruth E. Costello, John Tazare, Dominik Piehlmaier, Emily Herrett, Edward P.K. Parker, Bang Zheng, Kathryn E. Mansfield, Alasdair D. Henderson, Helena Carreira, Patrick Bidulka, Angel Y.S. Wong, Charlotte Warren-Gash, Joseph F. Hayes, Jennifer K. Quint, Brian MacKenna, Amir Mehrkar, Rosalind M. Eggo, Srinivasa Vittal Katikireddi, Laurie Tomlinson, Sinéad M. Langan, Rohini Mathur, Nishi Chaturvedi, Chloe Park, Alisia Carnemolla, Dylan Williams, Anika Knueppel, Andy Boyd, Emma L. Turner, Katharine M. Evans, Richard Thomas, Samantha Berman, Stela McLachlan, Matthew Crane, Rebecca Whitehorn, Jacqui Oakley, Diane Foster, Hannah Woodward, Kirsteen C. Campbell, Nicholas Timpson, Alex Kwong, Ana Goncalves Soares, Gareth Griffith, Renin Toms, Louise Jones, Herbert Annie, Ruth Mitchell, Tom Palmer, Jonathan Sterne, Venexia Walker, Lizzie Huntley, Laura Fox, Rachel Denholm, Rochelle Knight, Kate Northstone, Arun Kanagaratnam, Elsie Horne, Harriet Forbes, Teri North, Kurt Taylor, Marwa A.L. Arab, Scott Walker, Jose I.C. Coronado, Arun S. Karthikeyan, George Ploubidis, Bettina Moltrecht, Charlotte Booth, Sam Parsons, Bozena Wielgoszewska, Charis Bridger-Staatz, Claire Steves, Ellen Thompson, Paz Garcia, Nathan Cheetham, Ruth Bowyer, Maxim Freydin, Amy Roberts, Ben Goldacre, Alex Walker, Jess Morley, William Hulme, Linda Nab, Louis Fisher, Colm Andrews, Helen Curtis, Lisa Hopcroft, Amelia Green, Praveetha Patalay, Jane Maddock, Kishan Patel, Jean Stafford, Wels Jacques, Kate Tilling, John Macleod, Eoin McElroy, Anoop Shah, Richard Silverwood, Spiros Denaxas, Robin Flaig, Daniel McCartney, Archie Campbell, Liam Smeeth, Thomas Cowling, Kate Mansfield, Kevin Wang, Kathryn Mansfield, Viyaasan Mahalingasivam, Ian Douglas, Sinead Langan, Sinead Brophy, Michael Parker, Jonathan Kennedy, Rosie McEachan, John Wright, Kathryn Willan, Ellena Badrick, Gillian Santorelli, Tiffany Yang, Bo Hou, Andrew Steptoe, Di Gessa Giorgio, Jingmin Zhu, Paola Zaninotto, Angela Wood, Genevieve Cezard, Samantha Ip, Tom Bolton, Alexia Sampri, Elena Rafeti, Fatima Almaghrabi, Aziz Sheikh, Syed A. Shah, Vittal Katikireddi, Richard Shaw, Olivia Hamilton, Michael Green, Theocharis Kromydas, Daniel Kopasker, Felix Greaves, Robert Willans, Fiona Glen, Steve Sharp, Alun Hughes, Andrew Wong, Lee Hamill Howes, Alicja Rapala, Lidia Nigrelli, Fintan McArdle, Chelsea Beckford, Betty Raman, Richard Dobson, Amos Folarin, Callum Stewart, Yatharth Ranjan, Jd Carpentieri, Laura Sheard, Chao Fang, Sarah Baz, Andy Gibson, John Kellas, Stefan Neubauer, Stefan Piechnik, Elena Lukaschuk, Laura C. Saunders, James M. Wild, Stephen Smith, Peter Jezzard, Elizabeth Tunnicliffe, Zeena-Britt Sanders, Lucy Finnigan, Vanessa Ferreira, Mark Green, Rebecca Rhead, Milla Kibble, Yinghui Wei, Agnieszka Lemanska, Francisco Perez-Reche, Lucy Teece, Edward Parker, Alex J. Walker, Peter Inglesby, Helen J. Curtis, Caroline E. Morton, Jessica Morley, Sebastian C.J. Bacon, George Hickman, Richard Croker, David Evans, Tom Ward, Nicholas J. DeVito, Amelia C.A. Green, Jon Massey, Rebecca M. Smith, William J. Hulme, Simon Davy, Colm D. Andrews, Lisa E.M. Hopcroft, Henry Drysdale, Iain Dillingham, Robin Y. Park, Rose Higgins, Christine Cunningham, Milan Wiedemann, Steven Maude, Orla Macdonald, Ben F.C. Butler-Cole, Thomas O'Dwyer, Catherine L. Stables, Christopher Wood, Andrew D. Brown, Victoria Speed, Lucy Bridges, Andrea L. Schaffer, Caroline E. Walters, Christopher T. Rentsch, Krishnan Bhaskaran, Anna Schultze, Elizabeth J. Williamson, Helen I. McDonald, Laurie A. Tomlinson, Kevin Wing, Richard Grieve, Daniel J. Grint, Ian J. Douglas, Stephen J.W. Evans, Jemma L. Walker, Thomas E. Cowling, Emily L. Herrett, Christopher Bates, Jonathan Cockburn, John Parry, Frank Hester, Sam Harper, Shaun O'Hanlon, Alex Eavis, Richard Jarvis, Dima Avramov, Paul Griffiths, Aaron Fowles, Nasreen Parkes, Brian Nicholson, Rafael Perera, David Harrison, Kamlesh Khunti, Jonathan AC. Sterne, and Jennifer Quint
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Ethnic differences ,Pandemic ,Healthcare utilisation ,Medicine (General) ,R5-920 - Abstract
Summary: Background: The COVID-19 pandemic disrupted healthcare and may have impacted ethnic inequalities in healthcare. We aimed to describe the impact of pandemic-related disruption on ethnic differences in clinical monitoring and hospital admissions for non-COVID conditions in England. Methods: In this population-based, observational cohort study we used primary care electronic health record data with linkage to hospital episode statistics data and mortality data within OpenSAFELY, a data analytics platform created, with approval of NHS England, to address urgent COVID-19 research questions. We included adults aged 18 years and over registered with a TPP practice between March 1, 2018, and April 30, 2022. We excluded those with missing age, sex, geographic region, or Index of Multiple Deprivation. We grouped ethnicity (exposure), into five categories: White, Asian, Black, Other, and Mixed. We used interrupted time-series regression to estimate ethnic differences in clinical monitoring frequency (blood pressure and Hba1c measurements, chronic obstructive pulmonary disease and asthma annual reviews) before and after March 23, 2020. We used multivariable Cox regression to quantify ethnic differences in hospitalisations related to diabetes, cardiovascular disease, respiratory disease, and mental health before and after March 23, 2020. Findings: Of 33,510,937 registered with a GP as of 1st January 2020, 19,064,019 were adults, alive and registered for at least 3 months, 3,010,751 met the exclusion criteria and 1,122,912 were missing ethnicity. This resulted in 14,930,356 adults with known ethnicity (92% of sample): 86.6% were White, 7.3% Asian, 2.6% Black, 1.4% Mixed ethnicity, and 2.2% Other ethnicities. Clinical monitoring did not return to pre-pandemic levels for any ethnic group. Ethnic differences were apparent pre-pandemic, except for diabetes monitoring, and remained unchanged, except for blood pressure monitoring in those with mental health conditions where differences narrowed during the pandemic. For those of Black ethnicity, there were seven additional admissions for diabetic ketoacidosis per month during the pandemic, and relative ethnic differences narrowed during the pandemic compared to the White ethnic group (Pre-pandemic hazard ratio (HR): 0.50, 95% confidence interval (CI) 0.41, 0.60, Pandemic HR: 0.75, 95% CI: 0.65, 0.87). There was increased admissions for heart failure during the pandemic for all ethnic groups, though highest in those of White ethnicity (heart failure risk difference: 5.4). Relatively, ethnic differences narrowed for heart failure admission in those of Asian (Pre-pandemic HR 1.56, 95% CI 1.49, 1.64, Pandemic HR 1.24, 95% CI 1.19, 1.29) and Black ethnicity (Pre-pandemic HR 1.41, 95% CI: 1.30, 1.53, Pandemic HR: 1.16, 95% CI 1.09, 1.25) compared with White ethnicity. For other outcomes the pandemic had minimal impact on ethnic differences. Interpretation: Our study suggests that ethnic differences in clinical monitoring and hospitalisations remained largely unchanged during the pandemic for most conditions. Key exceptions were hospitalisations for diabetic ketoacidosis and heart failure, which warrant further investigation to understand the causes. Funding: LSHTM COVID-19 Response Grant (DONAT15912).
- Published
- 2023
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