Waves of COVID-19 transmission during the pandemic were usually followed by lockdowns and other interventions. Both likely affected lifestyle and health choices. Additionally, focusing NHS resources on the care of COVID-19 patients probably led to a decrease in screening, diagnosis, and treatment of many common conditions.
The aim of this study is to examine the trends of diagnosis and treatment of acute and chronic diseases in primary care, as well as the rates of post-COVID related conditions over time during the pandemic. We also aim to understand how waves of COVID-19 and lockdowns impacted the uptake of medicines commonly used to treat common chronic conditions. We will replicate these analyses separately in similar data from other European countries, from North America, and from Asia, to assess the effect of COVID-19 management and public health policies on different health systems.
This study will lead to a better understanding of the impact of COVID-19 waves and related policies on the health system, and the assessment of the most affected populations may lead to improvements or developments of new health polices to diminish the impact of COVID-19 on these diseases.
The aim is to understand whether healthcare utilisation, incidence of different acute care and chronic conditions, as well as post-COVID related conditions, were affected by COVID-19 transmission and public health restrictions; and whether rates have subsequently normalised to pre-pandemic levels.
Study Design: Cohort Study
Population: All patients registered in CPRD GOLD between 01.01.2018 to the latest date of data capture with ≥1 year prior history will be eligible. Data mapped to the Observational Medical Outcomes Partnership Common Data Model (OMOP) will be used to enable replication across other international databases.
Variables: The following conditions will be considered:
1.Acute care conditions: COVID-19, infectious diseases other than COVID-19, traumatic injuries, and cardiovascular and thromboembolic disease.
2.Diagnoses of chronic conditions: diabetes, cancer, dementia, autoimmune diseases, hypertension, hypercholesterolemia, mental health conditions.
3.Diagnoses of post-COVID conditions: post-acute COVID-19 symptoms, post-acute COVID-19 cardiac and thromboembolic complications.
4.Procedures (diagnostic or therapeutic) for the above diseases
5.Medicines/treatments for the above diseases
Analyses:
We will estimate monthly and quarterly incidence rates of new diagnoses for 1-3, of procedures used (4), and of related treatments (5) from January 2018 until January 2024, overall and stratified by age and sex. Secondly, we will fit interrupted time series and ARIMA models to study the impact of COVID-19 waves and public health restrictions on all the study outcomes. These analyses will be replicated separately internationally using other European, North American, and Asian datasets to study the impact of different public health policies.
Primary Outcomes:
1.Diagnoses of acute care conditions: COVID-19, other infectious diseases (influenza, pneumonia, urinary tract infection, sexually transmitted diseases, HIV), traumatic injuries (any fracture, hip fracture), thromboembolic disease (deep vein thrombosis, pulmonary embolism), and cardiovascular diseases (thromboembolic events, ischaemic heart disease, cerebrovascular disease).
2.Diagnoses of chronic conditions: type 1 diabetes, type 2 diabetes, cancer, autoimmune diseases (rheumatoid arthritis, systemic lupus, celiac disease, inflammatory bowel disease, multiple sclerosis), hypertension, hypercholesterolemia, dementia, mental health conditions (depression, general anxiety disorder).
3.Diagnoses of post-COVID conditions: post-acute COVID-19 symptoms according to the WHO definition, post-acute COVID-19 cardiac and thromboembolic complications.
Secondary Outcomes:
4.Procedures for the diagnosis or management of the above diseases.
5.Medicines for the treatment of any of the above diseases.
6.Healthcare utilization: screening appointments, diagnostic tests, GP consultations
Daniel Prieto-Alhambra - Chief Investigator - University of Oxford
Kim López-Güell - Corresponding Applicant - University of Oxford
Antonella Delmestri - Collaborator - University of Oxford
Junqing Xie - Collaborator - University of Oxford
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient