Impact of COVID-19 pandemic on incidence of long-term conditions in Wales: a population data linkage study using primary and secondary care health records

Abstract

Background: The COVID-19 pandemic has indirectly impacted health service provisions owing to surge and sustained pressures on the system. The effects of these pressures on the management of long-term or chronic conditions are not fully understood. Aim: To explore the effects of COVID-19 on the recorded incidence of 17 long-term conditions. Design and Setting: An observational retrospective population data linkage study on the population of Wales using primary and secondary care data within the Secure Anonymised Information Linkage (SAIL) Databank. Methods: We presented monthly rates of new diagnosis between 2000 and 2021 for each long-term condition. Incidence rates post-2020 were compared to expected rates predicted using time series modelling of pre-2020 trends. Proportion of annual incidence was presented by socio-demographic factors: age, sex, social deprivation, ethnicity, frailty and learning disability. Results: We included 5,476,012 diagnoses from 2,257,992 individuals. Incidence rates from 2020 to 2021 were lower than mean expected rates across all conditions. The largest relative deficit in incidence was in chronic obstructive pulmonary disease corresponding to 343 (95% CI: 230 to 456) undiagnosed patients per 100,000 population, followed by depression, type 2 diabetes, hypertension, anxiety disorders and asthma. A GP practice of 10,000 patients might have over 400 undiagnosed long-term conditions. No notable differences between socio-demographic profiles of post- and pre- 2020 incidences were observed. Conclusion: There is a potential backlog of undiagnosed patients across multiple long-term conditions. Resources are required to tackle anticipated workload as part of COVID-recovery, particularly in primary care.

Health care utilization and mortality for people with epilepsy during COVID‐19: A population study

“…This could have been due to a reduction in outpatient appointments or a possible increase in unwitnessed seizures. There have also been reductions in the incidences of other diseases during the pandemic 31 . We did not observe a “catch‐up” in epilepsy diagnoses at the end of the pandemic period, although this might take a few years to notice.…”

“…There have also been reductions in the incidences of other diseases during the pandemic. 31 We did not observe a "catch-up" in F I G U R E 2 Deaths per month per 100 000 people with epilepsy: (A) all deaths and (B) deaths associated with epilepsy (AWE). Deaths AWE are deaths in people with epilepsy where epilepsy is mentioned on the death certificate in any position.…”

Investigating the impact of undiagnosed anxiety and depression on health and social care costs and quality of life: cross-sectional study using household health survey data

“…For instance, a study of delayed diagnosis of bipolar disorder in California, USA, found that costs were higher in people who had delayed diagnosis. 22 There has been an increased focus on delayed diagnosis since the pandemic, with studies looking at delayed diagnosis of long-term conditions in primary care in Wales, 23 and delayed cancer diagnoses in the USA. 24 …”

Informing evidence-based policy during the COVID-19 pandemic and recovery period: learning from a national evidence centre

“…1 and discussed below in more detail. These included: 1) stakeholder engagement throughout all processes [10,11]; 2) research question identification and prioritisation [10]; 3) bespoke phased rapid evidence review methodology [12]; 4) rapid primary research [13][14][15]; and 5) knowledge mobilisation [16].…”

“…One study that required the research to be conducted through the medium of Welsh was commissioned to an external research group with appropriate expertise. Three of our completed primary studies were published in peer reviewed journals including the impact of the pandemic on cancer diagnosis in Wales, [13] and the diagnosis of 17 long term conditions including asthma, heart disease and diabetes [14]. Another cohort study showed that higher-risk adult community patients with COVID-19 in Wales treated with anti-viral therapy had a reduced the risk of hospitalisation or death [15].…”