Abstract
SummaryBackgroundTo date, research on the indirect impact of the COVID-19 pandemic on the health of the population and the health-care system is scarce. We aimed to investigate the indirect effect of the COVID-19 pandemic on general practice health-care usage, and the subsequent diagnoses of common physical and mental health conditions in a deprived UK population.MethodsWe did a retrospective cohort study using routinely collected primary care data that was recorded in the Salford Integrated Record between Jan 1, 2010, and May 31, 2020. We extracted the weekly number of clinical codes entered into patient records overall, and for six high-level categories: symptoms and observations, diagnoses, prescriptions, operations and procedures, laboratory tests, and other diagnostic procedures. Negative binomial regression models were applied to monthly counts of first diagnoses of common conditions (common mental health problems, cardiovascular and cerebrovascular disease, type 2 diabetes, and cancer), and corresponding first prescriptions of medications indicative of these conditions. We used these models to predict the expected numbers of first diagnoses and first prescriptions between March 1 and May 31, 2020, which were then compared with the observed numbers for the same time period.FindingsBetween March 1 and May 31, 2020, 1073 first diagnoses of common mental health problems were reported compared with 2147 expected cases (95% CI 1821 to 2489) based on preceding years, representing a 50·0% reduction (95% CI 41·1 to 56·9). Compared with expected numbers, 456 fewer diagnoses of circulatory system diseases (43·3% reduction, 95% CI 29·6 to 53·5), and 135 fewer type 2 diabetes diagnoses (49·0% reduction, 23·8 to 63·1) were observed. The number of first prescriptions of associated medications was also lower than expected for the same time period. However, the gap between observed and expected cancer diagnoses (31 fewer; 16·0% reduction, −18·1 to 36·6) during this time period was not statistically significant.InterpretationIn this deprived urban population, diagnoses of common conditions decreased substantially between March and May 2020, suggesting a large number of patients have undiagnosed conditions. A rebound in future workload could be imminent as COVID-19 restrictions ease and patients with undiagnosed conditions or delayed diagnosis present to primary and secondary health-care services. Such services should prioritise the diagnosis and treatment of these patients to mitigate potential indirect harms to protect public health.FundingNational Institute of Health Research.
Highlights
Since the start of the COVID-19 pandemic, many countries have imposed stringent restrictions on the movement and interaction of populations; commonly known as lockdown
The aim of our study was to investigate the indirect impact of the COVID-19 public health emergency on general practice health-care usage, and to assess whether this has led to a reduction in diagnoses, and potentially missed or delayed diagnoses, of common physical and mental health conditions in this deprived urban population
A large reduction in recording of clinical codes was observed after the onset of the COVID-19 emergency
Summary
Since the start of the COVID-19 pandemic, many countries have imposed stringent restrictions on the movement and interaction of populations; commonly known as lockdown. A nationwide lockdown was implemented on March 23, 2020, which required people to stay at home, leaving only for limited purposes (one form of exercise per day, shopping for necessities, any medical need, essential work). The COVID-19 pandemic and associated public health emergency is likely to have affected patients and the health service with regard to non-COVID conditions. People might have been unwilling to attend a health-care facility because of concerns about catching COVID-19, or due to the misconception that the National Health Service (NHS) was only available for patients with COVID-19. Emergency department attendance declined by 25% in the week after lockdown was implemented,[3] and data from the Royal College of General Practitioners surveillance system[4] has shown that weekly reported incidence of asthma, intestinal infectious diseases, upper respiratory tract infections, and acute respiratory tract infections was markedly reduced.
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