Impact of First UK COVID-19 Lockdown on Hospital Admissions

Impact of First UK COVID-19 Lockdown on Hospital Admissions: Interrupted Time Series Study of 32 Million People

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How to cite: This preprint assesses hospital admission rates over seven months during which the first COVID-19 lockdown was introduced and then gradually lifted.

Abstract

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.

Results: 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.

Conclusions: 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.