Impact of first UK COVID-19 lockdown on hospital admissions: Interrupted time series study of 32 million people.
Impact of first UK COVID-19 lockdown on hospital admissions: Interrupted time series study of 32 million people.
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DOI：
10.1016/j.eclinm.2022.101462
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发表时间：
2022-07
影响因子：
15.1
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中科院分区：
文献类型：
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不受控制的感染和为应对而采取的封锁措施给国际卫生系统带来了前所未有的挑战。目前尚不清楚这种史无前例的影响是否源于封锁本身，并在此类措施解除后消退。我们评估了第一批封锁措施对英格兰、苏格兰和威尔士跟踪非新冠肺炎疾病的医院护理的短期和中期影响，涉及疾病、性别、社会经济和种族群体。我们使用OpenSAFELY(英格兰)、EAVEII(苏格兰)和SAIL数据库(威尔士)提取从大流行前到2020年10月25日期间癌症、心血管和呼吸系统疾病(不包括新冠肺炎)的每周住院率，并进行了受控中断时间序列分析。我们进行了分层分析，并在7个月内评估了入院率，在此期间，封锁限制逐渐取消。我们的综合数据集包括3200万人，他们贡献了超过7400万人年。所有三种情况的录取率在英格兰下降了34.2%(可信区间：-43.0，-25.3)，在苏格兰下降了20.9%(可信区间：-27.8，-14.1)，在威尔士下降了24.7%(可信区间：-36.7，-12.7)，每个阶层的录取率都下降了。在这三个国家中，与癌症相关的入院人数下降最多，而与呼吸相关的入院人数下降最少(例如，在英国，与癌症、心血管相关和与呼吸相关的入院人数分别下降了40.5%(CI：-47.4，-33.6)、21.9%(CI：-35.4，-8.4)和19.0%(CI：-30.6，-7.4))。在这三个国家中，计划外录取率下降幅度最大的都超过了最贫困的五分之一。一些少数族裔群体的入学人数降幅更大(例如，在英格兰，白人的计划外入学人数下降了9.5%(CI：-20.2，1.2)，但混血、其他和黑人族裔的非计划入学人数分别下降了44.3%(CI：-71.0，-17.6)、34.6%(CI：-63.8，-5.3)和25.6%(CI：-45.0，-6.3))。尽管放宽了限制，但英格兰、苏格兰和威尔士的总体入院率与大流行前的同期(8-9月)相比，分别下降了20.8%、21.6%和22.0%。这相当于英格兰、苏格兰和威尔士每10万人的入境人数分别减少了26.2、23.8和30.2人。在第一次封锁期间，英格兰、苏格兰和威尔士的非COVID疾病的医院护理大幅下降，减少持续了至少六个月。最贫困和少数族裔群体受到的影响更严重。这项工作是由医学研究委员会资助的，作为国家核心研究(MC-PC_20030)的一部分，是终身健康和福祉研究的一部分。Svk感谢来自医学研究理事会(MC_UU_00022/2)和苏格兰政府首席科学家办公室(SPHSU17)的资助。Eave II由医学研究理事会(MR/R008345/1)资助，呼吸是呼吸健康的健康数据研究中心(MC_PC_19004)，由英国研究和创新产业战略挑战基金资助，通过英国健康数据研究中心提供。BG已经从NHS国家健康研究所(NIHR)、惠康信托基金、英国健康数据研究公司、哮喘英国公司、英国肺脏基金会以及国家核心研究计划的纵向健康和健康计划获得了研究资金。
Uncontrolled infection and lockdown measures introduced in response have resulted in an unprecedented challenge for health systems internationally. Whether such unprecedented impact 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 tracer non-COVID-19 conditions in England, Scotland and Wales across diseases, sexes, and socioeconomic and ethnic groups. 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. Our combined dataset included 32 million people who contributed over 74 million person-years. Admission rates for all three conditions fell by 34.2% (Confidence Interval (CI): -43.0, -25.3) in England, 20.9% (CI: -27.8, -14.1) in Scotland, and 24.7% (CI: -36.7, -12.7) 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% (CI: -47.4, -33.6), 21.9% (CI: -35.4, -8.4), and 19.0% (CI: -30.6, -7.4) 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% (CI: -20.2, 1.2) for Whites, but 44.3% (CI: -71.0, -17.6), 34.6% (CI: -63.8, -5.3), and 25.6% (CI: -45.0, -6.3) 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. This corresponds to a reduction of 26.2, 23.8 and 30.2 admissions per 100,000 people in England, Scotland, and Wales respectively. Hospital care for non-COVID diseases fell substantially across England, Scotland, and Wales during the first lockdown, with reductions persisting for at least six months. The most deprived and minority ethnic groups were impacted more severely. This work was funded by the Medical Research Council as part of the Lifelong Health and Wellbeing study as part of National Core Studies (MC_PC_20030). SVK acknowledges funding from the Medical Research Council (MC_UU_00022/2), and the Scottish Government Chief Scientist Office (SPHSU17). EAVE II is funded by the Medical Research Council (MR/R008345/1) with the support of BREATHE – The Health Data Research Hub for Respiratory Health (MC_PC_19004), which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. BG has received research funding from the NHS National Institute for Health Research (NIHR), the Wellcome Trust, Health Data Research UK, Asthma UK, the British Lung Foundation, and the Longitudinal Health and Wellbeing strand of the National Core Studies programme.
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影响因子：
10
作者：
Shah SA;Quint JK;Nwaru BI;Sheikh A
通讯作者：
Sheikh A
影响因子：
7.4
作者：
Ebrahim S;Ashworth H;Noah C;Kadambi A;Toumi A;Chhatwal J
通讯作者：
Chhatwal J
影响因子：
8.3
作者：
Banerjee A;Chen S;Pasea L;Lai AG;Katsoulis M;Denaxas S;Nafilyan V;Williams B;Wong WK;Bakhai A;Khunti K;Pillay D;Noursadeghi M;Wu H;Pareek N;Bromage D;McDonagh TA;Byrne J;Teo JTH;Shah AM;Humberstone B;Tang LV;Shah ASV;Rubboli A;Guo Y;Hu Y;Sudlow CLM;Lip GYH;Hemingway H
通讯作者：
Hemingway H
影响因子：
3.8
作者：
Liebensteiner, M. C.;Khosravi, I;Thaler, M.
通讯作者：
Thaler, M.
DOI：
10.1136/bmj-2021-066232
发表时间：
2021-12-07
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
McCartney G;Douglas M;Taulbut M;Katikireddi SV;McKee M
通讯作者：
McKee M