Ethnic differences in the indirect impacts of the COVID-19 pandemic on clinical monitoring and hospitalisations for non-COVID conditions in England: An observational cohort study using OpenSAFELY
Ethnic differences in the indirect impacts of the COVID-19 pandemic on clinical monitoring and hospitalisations for non-COVID conditions in England: An observational cohort study using OpenSAFELY
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COVID-19 大流行对英格兰非 COVID 疾病临床监测和住院治疗的间接影响的种族差异：使用 OpenSAFELY 进行的一项观察性队列研究
DOI：
10.1101/2023.01.04.23284174
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Costello R
中科院分区：
文献类型：
--
作者：
Costello R
背景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。我们的目的是描述流行病相关的中断对临床监测和住院治疗的种族差异的影响，为非COVID条件在England.MethodsIn这项基于人群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，与医院事件统计数据和OpenSAFELY中的死亡率数据相关联，OpenSAFELY是一个数据分析平台，经NHS英格兰批准创建，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日期间注册TPP实践的18岁及以上成年人。我们排除了年龄、性别、地理区域或多重痴呆指数缺失的患者。我们将种族（暴露）分为五类：白色、亚洲人、黑人、其他和混血。我们使用中断时间序列回归来估计2020年3月23日之前和之后临床监测频率（血压和Hba 1c测量，慢性阻塞性肺疾病和哮喘年度回顾）的种族差异。我们使用多变量考克斯回归来量化2020年3月23日之前和之后与糖尿病，心血管疾病，呼吸系统疾病和精神健康相关的住院治疗的种族差异。751人符合排除标准，1，122，912人缺失种族。这导致14，930，356名已知种族的成年人（占样本的92%）：86.6%为白色，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。任何种族群体的临床监测都没有恢复到大流行前的水平。种族差异在大流行前是明显的，除了糖尿病监测，并保持不变，除了那些有精神健康状况的人的血压监测，在大流行期间差异缩小。对于黑人种族，在大流行期间，每月有7例额外的糖尿病酮症酸中毒住院，与白色种族组相比，大流行期间的相对种族差异缩小（大流行前风险比（HR）：0.50，95%置信区间（CI）：0.41，0.60，大流行HR：0.75，95% CI：0.65，0.87）。在大流行期间，所有种族群体因心力衰竭入院的人数都有所增加，但白色种族的人数最多（心力衰竭风险差异：5.4）。相对而言，亚裔心力衰竭患者的种族差异缩小（大流行前HR 1.56，95% CI 1.49，1.64，大流行HR 1.24，95% CI 1.19，1.29）和黑人种族（大流行前HR 1.41，95% CI：1.30，1.53，大流行HR：1.16，95% CI 1.09，1.25）与白色种族相比。对于其他结果，大流行对种族差异的影响最小。InterpretationOur研究表明，在大流行期间，大多数情况下，临床监测和住院治疗的种族差异基本保持不变。关键的例外是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。FundingLSHTM COVID-19 Response Grant（DONAT 15912）。
BackgroundThe 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.MethodsIn 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.FindingsOf 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.InterpretationOur 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.FundingLSHTM COVID-19 Response Grant (DONAT15912).
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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：
4
作者：
Turner SL;Forbes AB;Karahalios A;Taljaard M;McKenzie JE
通讯作者：
McKenzie JE
影响因子：
5.7
作者：
Chaturvedi, N
通讯作者：
Chaturvedi, N
影响因子：
5.7
作者：
Rashid, Muhammad;Timmis, Adam;Mamas, Mamas
通讯作者：
Mamas, Mamas
DOI：
10.1093/ehjqcco/qcab040
发表时间：
2021-07-21
期刊：
European heart journal. Quality of care & clinical outcomes
影响因子：
--
作者：
Shoaib A;Van Spall HGC;Wu J;Cleland JGF;McDonagh TA;Rashid M;Mohamed MO;Ahmed FZ;Deanfield J;de Belder M;Gale CP;Mamas MA
通讯作者：
Mamas MA