Ethnic differences in the indirect effects of the COVID-19 pandemic on clinical monitoring and hospitalisations for non-COVID conditions in England: a population-based, observational cohort study using the OpenSAFELY platform.
Ethnic differences in the indirect effects of the COVID-19 pandemic on clinical monitoring and hospitalisations for non-COVID conditions in England: a population-based, observational cohort study using the OpenSAFELY platform.
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DOI：
10.1016/j.eclinm.2023.102077
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发表时间：
2023-07
影响因子：
15.1
通讯作者：
Mathur, Rohini
中科院分区：
文献类型：
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作者：
Costello, Ruth E.;Tazare, John;Piehlmaier, Dominik;Herrett, Emily;Parker, Edward P. K.;Zheng, Bang;Mans, Kathryn E.;Henderson, Alasdair D.;Carreira, Helena;Bidulka, Patrick;Wong, Angel Y. S.;Warren-Gash, Charlotte;Hayes, Joseph F.;Quint, Jennifer K.;MacKenna, Brian;Mehrkar, Amir;Eggo, Rosalind M.;Katikireddi, Srinivasa Vittal;Tomlinson, Laurie;Langan, Sinead M.;Mathur, Rohini
COVID-19大流行扰乱了医疗保健，并可能影响了医疗保健中的种族不平等。我们的目的是描述与大流行相关的干扰对英格兰临床监测和非covid条件下住院人数的种族差异的影响。在这项以人群为基础的观察性队列研究中，我们使用了初级保健电子健康记录数据，并与opensafety中的医院发作统计数据和死亡率数据相关联。opensafety是一个数据分析平台，经英国国民健康服务体系（NHS England）批准创建，旨在解决紧急的COVID-19研究问题。我们纳入了2018年3月1日至2022年4月30日期间在TPP诊所注册的18岁及以上的成年人。我们排除了年龄、性别、地理区域或多重剥夺指数缺失的患者。我们将种族（暴露）分为五类：白人、亚洲人、黑人、其他种族和混血儿。我们使用中断时间序列回归来估计2020年3月23日前后临床监测频率（血压和糖化血红蛋白测量、慢性阻塞性肺疾病和哮喘年度检查）的种族差异。我们使用多变量Cox回归来量化2020年3月23日前后与糖尿病、心血管疾病、呼吸系统疾病和心理健康相关的住院治疗的种族差异。截至2020年1月1日，在全科医生登记的33,510,937人中，19,064,019人是成年人，活着且登记至少3个月，3,010,751人符合排除标准，1,122,912人缺少种族。这导致14,930,356名已知种族的成年人（占样本的92%）：86.6%为白人，7.3%为亚洲人，2.6%为黑人，1.4%为混合种族，2.2%为其他种族。临床监测未发现任何族裔群体恢复到大流行前的水平。除了糖尿病监测外，种族差异在大流行前是明显的，并且保持不变，但在有精神健康状况的人的血压监测中，差异在大流行期间缩小了。对于黑人，大流行期间每月有7例糖尿病酮症酸中毒入院，与白人相比，大流行期间相对种族差异缩小（大流行前风险比（HR）： 0.50, 95%可信区间（CI） 0.41, 0.60，大流行风险比：0.75,95% CI: 0.65, 0.87）。在大流行期间，所有种族的心力衰竭入院人数都有所增加，但白人最高（心力衰竭风险差异：5.4）。相对而言，亚洲（大流行前HR为1.56,95% CI为1.49,1.64，大流行前HR为1.24,95% CI为1.19,1.29）和黑人（大流行前HR为1.41,95% CI为1.30,1.53，大流行前HR为1.16,95% CI为1.09,1.25）与白人相比，心力衰竭入院的种族差异缩小。就其他结果而言，大流行对种族差异的影响微乎其微。我们的研究表明，在大多数情况下，临床监测和住院治疗的种族差异在大流行期间基本保持不变。主要例外是因糖尿病酮症酸中毒和心力衰竭住院，这需要进一步调查以了解原因。COVID-19应对基金（DONAT15912）。
The COVID-19 pandemic disrupted healthcare and may have impacted ethnic inequalities in healthcare. We aimed to describe the impact of pandemic-related disruption on ethnic differences in clinical monitoring and hospital admissions for non-COVID conditions in England. In this population-based, observational cohort study we used primary care electronic health record data with linkage to hospital episode statistics data and mortality data within OpenSAFELY, a data analytics platform created, with approval of NHS England, to address urgent COVID-19 research questions. We included adults aged 18 years and over registered with a TPP practice between March 1, 2018, and April 30, 2022. We excluded those with missing age, sex, geographic region, or Index of Multiple Deprivation. We grouped ethnicity (exposure), into five categories: White, Asian, Black, Other, and Mixed. We used interrupted time-series regression to estimate ethnic differences in clinical monitoring frequency (blood pressure and Hba1c measurements, chronic obstructive pulmonary disease and asthma annual reviews) before and after March 23, 2020. We used multivariable Cox regression to quantify ethnic differences in hospitalisations related to diabetes, cardiovascular disease, respiratory disease, and mental health before and after March 23, 2020. Of 33,510,937 registered with a GP as of 1st January 2020, 19,064,019 were adults, alive and registered for at least 3 months, 3,010,751 met the exclusion criteria and 1,122,912 were missing ethnicity. This resulted in 14,930,356 adults with known ethnicity (92% of sample): 86.6% were White, 7.3% Asian, 2.6% Black, 1.4% Mixed ethnicity, and 2.2% Other ethnicities. Clinical monitoring did not return to pre-pandemic levels for any ethnic group. Ethnic differences were apparent pre-pandemic, except for diabetes monitoring, and remained unchanged, except for blood pressure monitoring in those with mental health conditions where differences narrowed during the pandemic. For those of Black ethnicity, there were seven additional admissions for diabetic ketoacidosis per month during the pandemic, and relative ethnic differences narrowed during the pandemic compared to the White ethnic group (Pre-pandemic hazard ratio (HR): 0.50, 95% confidence interval (CI) 0.41, 0.60, Pandemic HR: 0.75, 95% CI: 0.65, 0.87). There was increased admissions for heart failure during the pandemic for all ethnic groups, though highest in those of White ethnicity (heart failure risk difference: 5.4). Relatively, ethnic differences narrowed for heart failure admission in those of Asian (Pre-pandemic HR 1.56, 95% CI 1.49, 1.64, Pandemic HR 1.24, 95% CI 1.19, 1.29) and Black ethnicity (Pre-pandemic HR 1.41, 95% CI: 1.30, 1.53, Pandemic HR: 1.16, 95% CI 1.09, 1.25) compared with White ethnicity. For other outcomes the pandemic had minimal impact on ethnic differences. Our study suggests that ethnic differences in clinical monitoring and hospitalisations remained largely unchanged during the pandemic for most conditions. Key exceptions were hospitalisations for diabetic ketoacidosis and heart failure, which warrant further investigation to understand the causes. COVID-19 Response Grant (DONAT15912).
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DOI：
10.1136/bmj.n1135
发表时间：
2021-05-24
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Bodilsen J;Nielsen PB;Søgaard M;Dalager-Pedersen M;Speiser LOZ;Yndigegn T;Nielsen H;Larsen TB;Skjøth F
通讯作者：
Skjøth F
影响因子：
8.3
作者：
Cannata A;Watson SA;Daniel A;Giacca M;Shah AM;McDonagh TA;Scott PA;Bromage DI
通讯作者：
Bromage DI
影响因子：
5.7
作者：
Chaturvedi, N
通讯作者：
Chaturvedi, N
影响因子：
30.8
作者：
Mansfield, Kathryn E.;Mathur, Rohini;Langan, Sinead M.
通讯作者：
Langan, Sinead M.
监测 COVID-19 大流行对英国心血管疾病服务的间接影响。
DOI：
10.1136/heartjnl-2020-317870
发表时间：
2020-12
期刊：
Heart (British Cardiac Society)
影响因子：
--
作者：
Ball S;Banerjee A;Berry C;Boyle JR;Bray B;Bradlow W;Chaudhry A;Crawley R;Danesh J;Denniston A;Falter F;Figueroa JD;Hall C;Hemingway H;Jefferson E;Johnson T;King G;Lee KK;McKean P;Mason S;Mills NL;Pearson E;Pirmohamed M;Poon MTC;Priedon R;Shah A;Sofat R;Sterne JAC;Strachan FE;Sudlow CLM;Szarka Z;Whiteley W;Wyatt M;CVD-COVID-UK Consortium
通讯作者：
CVD-COVID-UK Consortium