Healthcare in England was affected by the COVID-19 pandemic across the pancreatic cancer pathway: a cohort study using OpenSAFELY-TPP
Healthcare in England was affected by the COVID-19 pandemic across the pancreatic cancer pathway: a cohort study using OpenSAFELY-TPP
复制标题
英国的医疗保健受到整个胰腺癌途径中的 COVID-19 大流行的影响：使用 OpenSAFELY-TPP 的队列研究
DOI：
10.1101/2022.12.02.22283026
复制
发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Lemanska A
中科院分区：
文献类型：
--
作者：
Lemanska A
背景：英国及全球各行业的医疗保健均受到COVID-19疫情的负面影响。我们分析了2015年1月至2023年3月期间为胰腺癌患者提供的医疗服务，以调查COVID-19大流行的影响。方法：在英国NHS的批准下，并从全国代表性的2400万患者（超过40%的英国人口）的OpenSAFELY-TPP数据集中提取，我们对诊断为胰腺癌的人进行了队列研究。我们查询了电子医疗记录，以获得有关胰腺癌途径中医疗服务提供的信息。为估计COVID-19疫情的影响，我们预测了疫情未发生时的医疗服务费率。我们使用广义线性模型和2015年1月至2020年2月的大流行前数据来预测2020年3月至2023年3月的发病率。预测值的95%置信区间被用来估计预测和观察rate.Results之间的差异的显着性：在队列中的胰腺癌和糖尿病的诊断率没有受到大流行。从2015年1月到2023年3月，有26，840人被诊断患有胰腺癌。诊断时的平均年龄为72岁（±11 SD），48%的人为女性，95%为白色种族，40%被诊断为糖尿病。我们发现，在大流行期间，手术切除减少了25-28%。此外，在被诊断为胰腺癌之前，接受体重指数、糖化血红蛋白和肝功能检查的人数分别减少了20%、10%和4%。大流行对接触初级保健的人数没有影响，但接触人数平均增加了1-2人。报告的黄疸减少了28%，但在大流行的12个月内恢复。急诊科就诊、住院和死亡没有受到影响。结论：大流行影响了英格兰胰腺癌通路的医疗保健。可以从具有复原力和恢复迅速的服务中吸取积极的经验教训。癌症患者所经历的医疗保健减少有可能导致更糟糕的结果。目前的努力应侧重于解决癌症患者未得到满足的需求。
Background:Healthcare across all sectors, in the UK and globally, was negatively affected by the COVID-19 pandemic. We analysed healthcare services delivered to people with pancreatic cancer from January 2015 to March 2023 to investigate the effect of the COVID-19 pandemic.Methods:With the approval of NHS England, and drawing from a nationally representative OpenSAFELY-TPP dataset of 24 million patients (over 40% of the English population), we undertook a cohort study of people diagnosed with pancreatic cancer. We queried electronic healthcare records for information on the provision of healthcare services across the pancreatic cancer pathway. To estimate the effect of the COVID-19 pandemic, we predicted the rates of healthcare services if the pandemic had not happened. We used generalised linear models and the pre-pandemic data from January 2015 to February 2020 to predict rates in March 2020 to March 2023. The 95% confidence intervals of the predicted values were used to estimate the significance of the difference between the predicted and observed rates.Results:The rate of pancreatic cancer and diabetes diagnoses in the cohort was not affected by the pandemic. There were 26,840 people diagnosed with pancreatic cancer from January 2015 to March 2023. The mean age at diagnosis was 72 (±11 SD), 48% of people were female, 95% were of White ethnicity, and 40% were diagnosed with diabetes. We found a reduction in surgical resections by 25–28% during the pandemic. In addition, 20%, 10%, and 4% fewer people received body mass index, glycated haemoglobin, and liver function tests, respectively, before they were diagnosed with pancreatic cancer. There was no impact of the pandemic on the number of people making contact with primary care, but the number of contacts increased on average by 1–2 per person amongst those who made contact. Reporting of jaundice decreased by 28%, but recovered within 12 months into the pandemic. Emergency department visits, hospital admissions, and deaths were not affected.Conclusions:The pandemic affected healthcare in England across the pancreatic cancer pathway. Positive lessons could be learnt from the services that were resilient and those that recovered quickly. The reductions in healthcare experienced by people with cancer have the potential to lead to worse outcomes. Current efforts should focus on addressing the unmet needs of people with cancer.