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To combat the spread of coronavirus, which causes the severe acute respiratory syndrome, world leaders imposed a number of restrictions, including social isolation and national lockdowns (SARS-CoV-2). NPIs decreased viral transfer rates while discouraging people from seeking certain types of healthcare.

Background

Previous UK research indicates that the COVID-19 pandemic had a substantial impact on healthcare. However, it is unclear how much the pandemic affected healthcare services, and whether these impacts were transitory or had long-term negative effects that remained after the lockdown sanctions were lifted.

Disparities in access and quality care, particularly for marginalized communities, have also been linked to pre-pandemic healthcare services in the UK and other countries around the world. According to researchers, lockdown actions may have exacerbated already-existing disparities in healthcare systems.

Researchers used 3 tracer health disorders, including cancer, cardiovascular, and respiratory-related diseases, in a recent clinical medicine study to evaluate the impact of COVID-19 lockdowns on health care across the United Kingdom. The studies have also investigated whether these impacts varied according to gender, socioeconomic status, or ethnicity.

Terms of the research

Secondary care data from England, Scotland, and Wales were collected using the NHS England-approved Open SAFELY platform, the EAVE II platform and SAIL Databank.

All weekly hospitalizations in England with a principal diagnosis of cardiovascular disease, cancer, or respiratory disease were studied. between 1st January 2019, and 31st October 2020. The same diagnoses were discovered in Scotland and Wales between 1st January 2019, and 31st October 2020.

The weekly admittance rates were classified according to socioeconomic status, disease, gender, ethnicity, and admission type. The researchers wanted to see how historical hospitalization rates in these patients changed after the UK imposed lockdown restrictions.

The researchers divided the data set into two distinct follow-up time frames. Data was collected between 5th January 2020 and 15th March  2020 for weeks 1–11, and between 22nd March 2020 and 25th October 2020 for weeks 12-43.

The findings of the study

In general, hospitalization in England, Scotland, and Wales before and after the pandemic were comparable. However, there was a significant difference in mean admission rates between pre-pandemic and pandemic years in each of these countries during weeks 12-43.

An interrupted time series (ITS) analysis discovered a significant drop in overall hospitalisation in England, Scotland, and Wales soon after the lockdown in March 2020. When compared to unexpected hospitalization, scheduled admissions rates fell in England, Scotland, and Wales.

Cancer hospital admissions decreased the most in all 3 nations, followed by the admission rate for respiratory and cardiovascular diseases. Scheduled hospitalization for all 3 diseases was significantly lower in England, Scotland, and Wales when compared to unscheduled hospitalisation. Notably, the greatest decrease in scheduled hospitalization was for respiratory diseases.

The differences in hospitalization between men and women were comparable in all 3 countries; however, men witnessed a slightly increased decline in admission rates than women. In addition, hospital admission rates fell in both of the most and least disadvantaged socioeconomic groups.

Scheduled hospitalization for Black people fell the most in England, while unplanned admission rates for people of the mixed race fell the most. Asians saw the smallest drop in overall hospitalization rates.

When compared to White people, non-White people in Scotland saw a significant decrease in planned and unplanned admissions. In Wales, there was a data shortage on patients ethnic backgrounds.

When the three countries’ lockdown restrictions were lifted between August – September 2020, hospitalization was lower than in pre-pandemic times

Implications

The findings show that the COVID-19 lockdown had a massive effect on healthcare seekers in England, Scotland, and Wales. Hospitalization rates for cancer, cardiovascular disease, and respiratory disease all decreased significantly when compared to pre-pandemic levels. Hospital admissions fell for men and women of all races and socio-economic backgrounds.

Cancer admission rates fell more than those for respiratory illnesses and cardiovascular diseases in England, Scotland, and Wales. Some minority groups suffered more than Whites in England and Scotland.

Despite a six-month relaxation of lockdown, admission rates for cardiovascular, cancer, and respiratory diseases were significantly lower than before the pandemic, indicating a lengthy impact on healthcare provision in these patient groups

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