The COVID-19 pandemic revealed dramatic health inequalities patterned by deprivation and ethnicity. People living in the most deprived neighbourhoods in the country and people from ethnic minority communities have borne a vastly disproportionate share of the health impacts of the pandemic. These disproportionate impacts are associated with poor living and working conditions and poorer general levels of health in these groups.
The pandemic occurred as a health shock following a decade of austerity which saw severe and sustained cuts to public sector funding leading to significant cuts to public services. While austerity was being implemented government funding formulas to allocate money to local areas were also changing shifting funding from younger poorer populations living in deprived ethnically diverse urban neighbourhoods to older white populations in more affluent rural areas. The funding and hence service cuts were therefore felt most severely in precisely those areas and communities that were most severely impacted during the pandemic.
This project will describe how health care use has changed in response to these changes over the austerity period with a particular focus on those people living in the most deprived neighbourhoods in the country and those from ethnic minority communities. We will look at how both primary care use and hospital use has changed over this period and how this may have been indicative of erosion of health in particular groups making them more vulnerable to the pandemic when it arrived.
The aim of the study is to produce summary statistics on the trends in use of primary care, secondary care and mortality at a high level, by age, sex, deprivation and ethnicity:
1. Primary care consultation rates and outcomes (referrals, prescribing, tests, immunisation),
2. Accident and emergency visit rates and outcomes (admission, discharge)
3. Outpatient hospital visit rates and outcomes (discharge, referral, etc.)
4. Emergency inpatient admissions and diagnosis
5. Elective inpatient admissions and diagnosis
6. Mortality rates and causes
We will summarise mean and standard errors of the rates of 1-6 above each year between 2010 and 2019 and compare with COVID-19 related hospitalisations and mortality in 2020/2021. We will do this in each combination of age, sex, ethnicity and deprivation group to describe how health care use has changed over time for different groups in the population prior to austerity and to explore whether this is indicative of an erosion of health that was associated with worse outcomes during the pandemic.
Primary care consultation rates – key variables: age; sex; ethnicity; patient-level Index of Multiple Deprivation; outcome of consultation (referral, prescribing, test, immunisation); the presence of pre-existing long-term condition: Cancer, Diabetes, Heart Failure, Coronary Heart Disease, Atrial Fibrillation, Asthma, Chronic Obstructive Pulmonary Disorder, Stroke, Chronic Kidney Disease, Chronic Liver Disease, Depression, Anxiety, Dementia
Accident and emergency visit rates – key variables: age; sex; ethnicity; patient-level Index of Multiple Deprivation; outcome of visit (admission/discharge)
Outpatient hospital admission rates – key variables: age; sex; ethnicity; patient-level Index of Multiple Deprivation; outcome of consultation (admission/discharge)
Inpatient hospital admission rates – key variables: age; sex; ethnicity; patient-level Index of Multiple Deprivation; emergency/elective admission type; diagnosis codes (ICD 10); procedure codes (OPCS); length of stay; HRG (for linking to reference costs)
Mortality rates - key variables: age; sex; ethnicity; patient-level Index of Multiple Deprivation; causes of death (ICD 10)
Miqdad Asaria - Chief Investigator - The Health Foundation
Andrew Campbell - Corresponding Applicant - The Health Foundation
Ann Raymond - Collaborator - The Health Foundation
Laurie Rachet-Jacquet - Collaborator - The Health Foundation
Stephen Rocks - Collaborator - The Health Foundation
Toby Watt - Collaborator - The Health Foundation
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Rural-Urban Classification