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 platform

Henderson, Alasdair D; Carreira, Helena; Bidulka, Patrick; Warren‐Gash, Charlotte; Hayes, Joseph; Katikireddi, Srinivasa Vittal; Chaturvedi, Nishi; Park, Chloe; Carnemolla, Alisia; Williams, Dylan M; Knueppel, Anika; Boyd, Andy; Turner, Emma L; Evans, Katharine; Thomas, Richard; Berman, Samantha; McLachlan, Stela; Crane, Matthew A; Whitehorn, Rebecca; Oakley, Jacqui; Foster, Diane; Woodward, Hannah L.; Campbell, Kirsteen; Timpson, Nicholas J.; Kwong, Alex S. F.; Soares, Ana Luiza Gonçalves; Griffith, Gareth J; Toms, Renin; Jones, Louise; Annie, Herbert; Mitchell, Ruth; Palmer, Tom; Walker, Venexia; Huntley, L.G.; Fox, Laura; Denholm, Rachel; Knight, Rochelle; Northstone, Kate; Kanagaratnam, Arun; Horne, Elsie; North, Thomas; Taylor, Kenneth B.; Arab, Mohammad; Walker, Sandra; Coronado, José Ignacio Cuitún; Karthikeyan, Arun S; Ploubidis, George B.; Moltrecht, Bettina; Booth, Charlotte; Parsons, Sam; Wielgoszewska, Bożena; Bridger-Staatz, Charis; Steves, Claire J.; Thompson, Ellen J; García, Paz Guerra; Cheetham, Nathan J.; Bowyer, Ruth C E; Фрейдин, Максим Борисович; Roberts, Amy; Curtis, Helen J; Patalay, Praveetha; Maddock, Jane; Patel, Kalpesh; Stafford, Jean; Wels, Jacques; Tilling, Kate; Macleod, John; McElroy, Eoin; Shah, Anoop D; Silverwood, Richard; Denaxas, Spiros; Flaig, Robin; McCartney, Daniel L.; Campbell, Archie; Mansfield, Kate; Wang, Kevin; Douglas, Ian; Brophy, Sinéad; Parker, Michael; Kennedy, Jonathan; McEachan, Rosemary; Wright, John; Willan, Kathryn; Badrick, Ellena; Santorelli, Gillian; Yang, Tiffany; Hou, Bo; Steptoe, Andrew; Am, Di Giorgio; Zhu, Jingmin; Zaninotto, Paola; Wood, Angela; Cézard, Geneviève; Ip, Samantha; Bolton, Tom; Sampri, Alexia; Rafeti, Elena; Almaghrabi, Fatima; Sheikh, Aziz; Shah, Syed Ahmar; Katikireddi, Srinivasa Vittal; Shaw, RJ; Hamilton, Olivia; Green, Michael J.; Kromydas, Theocharis; Kopasker, Daniel; Greaves, Felix; Willans, Robert; Glen, Fiona; Sharp, Steve; Hughes, Alun D.; Wong, Andrew; Howes, Lee; Rapala, Alicja; Nigrelli, Lidia; McArdle, Fiona; Beckford, Chelsea; Raman, Betty; Dobson, Richard; Folarin, Amos; Stewart, Callum; Ranjan, Yatharth; Carpentieri, JD; Sheard, Laura; Fang, Chi; Baz, Sarah Akhtar; Gibson, Andy; Kellas, John; Neubauer, Stefan; Piechnik, Stefan K.; Lukaschuk, Elena; Saunders, Laura; Wild, Jim M.; Smith, Stephen L.; Jezzard, Peter; Tunnicliffe, Elizabeth M; Sanders, Zeena-Britt; Finnigan, Lucy; Ferreira, Vanessa M.; Green, Mark A.; Rhead, Rebecca; Kibble, Milla; Wei, Yinghui; Lemańska, Agnieszka; Pérez‐Reche, Francisco J.; Piehlmaier, Dominik; Teece, Lucy; Walker, Alex J; MacKenna, Brian; Inglesby, Peter; Goldacre, Ben; Morton, Caroline E; Morley, Jessica; Mehrkar, Amir; Bacon, Sebastian; Hickman, George; Croker, Richard; Evans, David; Ward, Tom; DeVito, Nicholas J; Fisher, Louis; Green, Amelia; Massey, Jonathan; Smith, Rebecca; Hulme, William; Davy, Simon; Andrews, Colm; Hopcroft, Lisa; Drysdale, Henry; Dillingham, Iain; Park, Robin Y; Higgins, Rose; Cunningham, Christine M.; Wiedemann, Milan; Nab, Linda; Maude, Steven; Macdonald, Orla; Butler-Cole, Ben; O’Dwyer, Thomas; Stables, Catherine L.; Wood, Christopher; Brown, A.D.; Speed, Victoria; Bridges, Lucy; Schaffer, Andrea L; Walters, Caroline E.; Rentsch, Christopher T; Bhaskaran, Krishnan; Schultze, Anna; Williamson, Elizabeth; McDonald, Helen I; Tomlinson, Laurie; Mathur, Rohini; Eggo, Rosalind M; Wing, Kevin; Wong, Angel; Tazare, John; Grieve, Richard; Grint, Daniel; Langan, Sinéad; Mansfield, Kathryn E.; Evans, Stephen; Smeeth, Liam; Walker, Jemma; Mahalingasivam, Viyaasan; Forbes, Harriet; Cowling, Thomas E; Herrett, Emily; Costello, Ruth; Zheng, Bang; Parker, Edward P K; Bates, Christopher J.; Cockburn, Jonathan; Parry, John; Hester, Frank; Harper, Sam; O’Hanlon, Shaun; Eavis, Alex; Jarvis, Richard; Avramov, Dima; Griffiths, Paul; Fowles, Aaron; Parkes, Nasreen; Nicholson, Brian D; Perera, Rafael; Harrison, David A; Khunti, Kamlesh; Sterne, Jonathan A C; Quint, Jennifer K

doi:10.1016/j.eclinm.2023.102077

Cited by 2 publications

References 43 publications

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COVID pandemic impact on hypertension management in North-East London: an observational cohort study using electronic health records

Rison,

Redfern,

Mathur

et al. 2023

Preprint

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BackgroundThe COVID19 pandemic had a major impact on primary care management of long-term conditions such as hypertension. This observational cohort study of adults with hypertension registered in 193 primary care practices in North-East London between January 2019 and October 2022 investigated the impact of the COVID19 pandemic on the treatment and control of blood pressure including demographic and social inequities.Method and findingsIn 224,329 adults with hypertension, the proportion with a blood pressure (BP) recorded within the preceding 1 year fell from a 91% pre-pandemic peak to 62% at the end of the pandemic lock-down phase and improved to 77% by the end of the study. The proportion with controlled hypertension (<80 years old, BP ≤140/90mmHg; 80 or more years old: ≤150/90mmHg) for the same time points was 81%, 50% and 60% respectively. Using ‘blood pressure control’ (which considered only patients with a valid blood pressure recording) as the indicator attenuated the reduction to 83%, 80% and 78% respectively.The study used multivariable logistic analysis at four representative time points (Pre-pandemic: April 2019; Pre lockdown: April 2020; Lockdown: April 2021; Post-lockdown: April 2022) to identify temporal, clinical and demographic influences on blood pressure monitoring and control.Pre-pandemic inequities in the management of hypertension were not significantly altered by the pandemic. Throughout the pandemic phases, in comparison to the White ethnic group, the Black ethnic group was less likely to achieve blood pressure control (ORs 0.81 [95% CI = 0.78 to 0.85, p-value<0.001] to 0.87 [95% CI = 0.84 to 0.91, p-value<0.001]). Conversely, the Asian ethnic group was more likely to have controlled blood pressure (ORs 1.09 [95% CI = 1.05 to 1.14, p-value<0.001] to 1.28 [95% CI = 1.23 to 1.32, p-value<0.001]). Younger, male, more affluent individuals, individuals with unknown or unrecorded ethnicity or those untreated were less likely to have blood pressure controlled to target throughout the study.ConclusionThe COVID pandemic had a greater impact on blood pressure recording than on blood pressure control. Although recording and control have improved, these had not returned to pre-pandemic levels by the end of the study period. Ethnic inequalities in blood pressure control persisted during the pandemic and remain outstanding.

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COVID pandemic impact on hypertension management in North-East London: an observational cohort study using electronic health records

Rison,

Redfern,

Mathur

et al. 2023

Preprint

View full text Add to dashboard Cite

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Routine measurement of cardiometabolic disease risk factors in primary care in England before, during, and after the COVID-19 pandemic: A population-based cohort study

Ho,

Dale,

Mizani

et al. 2024

PLoS Med

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Background This study estimated to what extent the number of measurements of cardiometabolic risk factors (e.g., blood pressure, cholesterol, glycated haemoglobin) were impacted by the COVID-19 pandemic and whether these have recovered to expected levels. Methods and findings A cohort of individuals aged ≥18 years in England with records in the primary care—COVID-19 General Practice Extraction Service Data for Pandemic Planning and Research (GDPPR) were identified. Their records of 12 risk factor measurements were extracted between November 2018 and March 2024. Number of measurements per 1,000 individuals were calculated by age group, sex, ethnicity, and area deprivation quintile. The observed number of measurements were compared to a composite expectation band, derived as the union of the 95% confidence intervals of 2 estimates: (1) a projected trend based on data prior to the COVID-19 pandemic; and (2) an assumed stable trend from before pandemic. Point estimates were calculated as the mid-point of the expectation band. A cohort of 49,303,410 individuals aged ≥18 years were included. There was sharp drop in all measurements in March 2020 to February 2022, but overall recovered to the expected levels during March 2022 to February 2023 except for blood pressure, which had prolonged recovery. In March 2023 to March 2024, blood pressure measurements were below expectation by 16% (−19 per 1,000) overall, in people aged 18 to 39 (−23%; −18 per 1,000), 60 to 79 (−17%; −27 per 1,000), and ≥80 (−31%; −57 per 1,000). There was suggestion that recovery in blood pressure measurements was socioeconomically patterned. The second most deprived quintile had the highest deviation (−20%; −23 per 1,000) from expectation compared to least deprived quintile (−13%; −15 per 1,000). Conclusions There was a substantial reduction in routine measurements of cardiometabolic risk factors following the COVID-19 pandemic, with variable recovery. The implications for missed diagnoses, worse prognosis, and health inequality are a concern.

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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 platform

Cited by 2 publications

References 43 publications

COVID pandemic impact on hypertension management in North-East London: an observational cohort study using electronic health records

COVID pandemic impact on hypertension management in North-East London: an observational cohort study using electronic health records

Routine measurement of cardiometabolic disease risk factors in primary care in England before, during, and after the COVID-19 pandemic: A population-based cohort study

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