Impact of First UK COVID-19 Lockdown on Hospital Admissions: Interrupted Time Series Study of 32 Million People
Shah SA., Brophy S., Kennedy J., Fisher L., Walker A., Mackenna B., Curtis H., Inglesby P., Davy S., Bacon S., Goldacre B., Group OC., Agrawal U., Moore E., Simpson C., Macleod J., Cooksey R., Sheikh A., Katikireddi SV.
Background: Uncontrolled infection and lockdown measures introduced in response have resulted in an unprecedented challenge for health systems internationally. Whether such disruption 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 exemplar non-COVID-19 conditions in England, Scotland and Wales across diseases, sexes, and socioeconomic and ethnic groups. Methods: 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.Findings: Our combined dataset included 32 million people who contributed over 74 million person-years. Admission rates for all three conditions fell by 34.2% in England, 20.9% in Scotland, and 24.7% 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%, 21.9%, and 19.0% 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% for Whites, but 44.3%, 34.6%, and 25.6% 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.Interpretation: Hospital care for non-COVID diseases fell substantially across England, Scotland, and Wales during the first lockdown, with disruptions persisting for at least six months. The most deprived and minority ethnic groups were impacted more severely. Funding Information: Medical Research Council; Health Data Research UK; Industrial Strategy Challenge Fund; Scottish Government; National Institute for Health Research; Asthma UK-BLF; Wellcome TrustDeclaration of Interests: SVK is co-chair of the Scottish Government’s Expert Reference Group on ethnicity and COVID-19 and is a member of the Scientific Advisory Group on Emergencies subgroup on ethnicity. AS is a member of the Scottish Government Chief Medical Officer’s COVID-19 Advisory Group and its Standing Committee on Pandemics, and NERVTAG’s Risk Stratification Subgroup. All other authors declare no conflict of interest related to this work.Ethics Approval Statement: There were database-specific ethics approvals that allowed the use of the anonymised datasets for the current research study. These approvals were by the Health Research Authority (20/LO/0651) and LSHTM Ethics Board (21863) for OpenSAFELY, South East Scotland Research Ethics Committee 02 (12/SS/0201) and Public Benefit and Privacy Panel Committee of Public Health Scotland (1920-0279) for EAVE-II, and SAIL’s independent Information Governance Review Panel (IGRP) for the SAIL Databank.