Indirect acute effects of the COVID-19 pandemic on physical and mental health in the UK: a population-based study
Indirect acute effects of the COVID-19 pandemic on physical and mental health in the UK: a population-based study
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DOI：
10.1016/s2589-7500(21)00017-0ac.uk
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发表时间：
2021-04-01
影响因子：
30.8
通讯作者：
Langan, Sinead M.
中科院分区：
文献类型：
--
作者：
Mansfield, Kathryn E.;Mathur, Rohini;Langan, Sinead M.
背景
有人担心英国对新冠疫情的应对可能恶化了身心健康，并减少了卫生服务的使用。然而，问题的规模尚未量化，阻碍了有效缓解措施的制定。我们旨在确定疫情期间急性身心健康状况的全科医疗接触情况发生了什么变化。
方法
利用临床研究实践数据链（CPRD）奥拉姆（涵盖英国13%的人口）2017年至2020年去识别化的电子健康记录，我们计算了选定的急性身心健康状况的每周初级医疗接触情况：焦虑、抑郁、自残（致命和非致命）、严重精神疾病、进食障碍、强迫症、急性酒精相关事件、哮喘加重、慢性阻塞性肺疾病加重、急性心血管事件（脑血管意外、心力衰竭、心肌梗死、短暂性脑缺血发作、不稳定型心绞痛和静脉血栓栓塞）以及糖尿病急症。初级医疗接触包括远程和面对面咨询、出院信中的诊断以及二级医疗转诊，并且通过初级医疗记录中的诊断、症状和处方来确定疾病状况。我们的总体研究人群包括在特定时期内至少有1年在为CPRD奥拉姆提供数据的诊所注册的11岁及以上个体，但分母人群因所分析的疾病状况而异。我们使用中断时间序列分析来正式量化在实施全民限制措施（定义为2020年3月29日）之后与实施之前（定义为2017年1月1日至2020年3月7日）疾病状况的变化，排除了调整至限制措施期间（3月8 - 28日）的数据。
结果
2017年1月1日总体人口包括9863903人，到2020年1月1日增加到10226939人。在实施全民限制措施后，几乎所有疾病状况的初级医疗接触都大幅下降。糖尿病急症（比值比0.35[95%置信区间0.25 - 0.50]）、抑郁（0.53[0.52 - 0.53]）和自残（0.56[0.54 - 0.58]）的接触下降幅度最大。在中断时间序列分析中，除了急性酒精相关事件（0.98[0.89 - 1.10]）外，所有疾病状况都有接触减少的证据（焦虑0.67[0.66 - 0.67]、进食障碍0.62[0.59 - 0.66]、强迫症[0.69[0.64 - 0.74]]、自残0.56[0.54 - 0.58]、严重精神疾病0.80[0.78 - 0.83]、中风0.59[0.56 - 0.62]、短暂性脑缺血发作0.63[0.58 - 0.67]、心力衰竭0.62[0.60 - 0.64]、心肌梗死0.72[0.68 - 0.77]、不稳定型心绞痛0.72[0.60 - 0.87]、静脉血栓栓塞0.94[0.90 - 0.99]以及哮喘加重0.88[0.86 - 0.90]）。到2020年7月，除了不稳定型心绞痛和急性酒精相关事件外，所有疾病状况的接触都未恢复到封锁前的水平。
解释
在实施限制措施后，急性身心疾病的初级医疗接触大幅减少，到2020年7月恢复有限。需要进一步研究以确定这些减少是否反映了疾病频率的变化或错过的治疗机会。在未来的公共卫生规划中，包括进一步的限制措施，保持医疗保健的可及性应是一个关键优先事项。我们所研究的疾病状况足够严重，任何未满足的需求都将对患者以及医疗保健服务产生重大影响。
Methods Using de-identified electronic health records from the Clinical Research Practice Datalink (CPRD) Aurum (covering 13% of the UK population), between 2017 and 2020, we calculated weekly primary care contacts for selected acute physical and mental health conditions: anxiety, depression, self-harm (fatal and non-fatal), severe mental illness, eating disorder, obsessive-compulsive disorder, acute alcohol-related events, asthma exacerbation, chronic obstructive pulmonary disease exacerbation, acute cardiovascular events (cerebrovascular accident, heart failure, myocardial infarction, transient ischaemic attacks, unstable angina, and venous thromboembolism), and diabetic emergency. Primary care contacts included remote and face-to-face consultations, diagnoses from hospital discharge letters, and secondary care referrals, and conditions were identified through primary care records for diagnoses, symptoms, and prescribing. Our overall study population included individuals aged 11 years or older who had at least 1 year of registration with practices contributing to CPRD Aurum in the specified period, but denominator populations varied depending on the condition being analysed. We used an interrupted time-series analysis to formally quantify changes in conditions after the introduction of population-wide restrictions (defined as March 29, 2020) compared with the period before their introduction (defined as Jan 1, 2017 to March 7, 2020), with data excluded for an adjustment-toBackground There are concerns that the response to the COVID-19 pandemic in the UK might have worsened physical and mental health, and reduced use of health services. However, the scale of the problem is unquantified, impeding development of effective mitigations. We aimed to ascertain what has happened to general practice contacts for acute physical and mental health outcomes during the pandemic.Methods Using de-identified electronic health records from the Clinical Research Practice Datalink (CPRD) Aurum (covering 13% of the UK population), between 2017 and 2020, we calculated weekly primary care contacts for selected acute physical and mental health conditions: anxiety, depression, self-harm (fatal and non-fatal), severe mental illness, eating disorder, obsessive-compulsive disorder, acute alcohol-related events, asthma exacerbation, chronic obstructive pulmonary disease exacerbation, acute cardiovascular events (cerebrovascular accident, heart failure, myocardial infarction, transient ischaemic attacks, unstable angina, and venous thromboembolism), and diabetic emergency. Primary care contacts included remote and face-to-face consultations, diagnoses from hospital discharge letters, and secondary care referrals, and conditions were identified through primary care records for diagnoses, symptoms, and prescribing. Our overall study population included individuals aged 11 years or older who had at least 1 year of registration with practices contributing to CPRD Aurum in the specified period, but denominator populations varied depending on the condition being analysed. We used an interrupted time-series analysis to formally quantify changes in conditions after the introduction of population-wide restrictions (defined as March 29, 2020) compared with the period before their introduction (defined as Jan 1, 2017 to March 7, 2020), with data excluded for an adjustment-to restrictions period (March 8-28).Findings The overall population included 9 863 903 individuals on Jan 1, 2017, and increased to 10 226 939 by Jan 1, 2020. Primary care contacts for almost all conditions dropped considerably after the introduction of populationwide restrictions. The largest reductions were observed for contacts for diabetic emergencies (odds ratio 0.35 [95% CI 0.25-0.50]), depression (0.53 [0.52-0.53]), and self-harm (0.56 [0.54-0.58]). In the interrupted time-series analysis, with the exception of acute alcohol-related events (0.98 [0.89-1.10]), there was evidence of a reduction in contacts for all conditions (anxiety 0.67 [0.66-0.67], eating disorders 0.62 [0.59-0.66], obsessive-compulsive disorder [0.69 [0.64-0.74]], self-harm 0.56 [0.54-0.58], severe mental illness 0.80 [0.78-0.83], stroke 0.59 [0.56-0.62], transient ischaemic attack 0.63 [0.58-0.67], heart failure 0.62 [0.60-0.64], myocardial infarction 0.72 [0.68-0.77], unstable angina 0.72 [0.60-0.87], venous thromboembolism 0.94 [0.90-0.99], and asthma exacerbation 0.88 [0.86-0.90]). By July, 2020, except for unstable angina and acute alcohol-related events, contacts for all conditions had not recovered to pre-lockdown levels.Interpretation There were substantial reductions in primary care contacts for acute physical and mental conditions following the introduction of restrictions, with limited recovery by July, 2020. Further research is needed to ascertain whether these reductions reflect changes in disease frequency or missed opportunities for care. Maintaining healthcare access should be a key priority in future public health planning, including further restrictions. The conditions we studied are sufficiently severe that any unmet need will have substantial ramifications for the people with the conditions as well as health-care provision.