Green, M. et al. (2024) Trends in inequalities in avoidable hospitalisations across the COVID-19 pandemic: A cohort study of 23.5 million people in England. BMJ Open, 14(1), e077948. (doi: 10.1136/bmjopen-2023-077948) (PMID:38191251)
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Abstract
Objective To determine whether periods of disruption were associated with increased ‘avoidable’ hospital admissions and wider social inequalities in England. Design Observational repeated cross-sectional study. Setting England (January 2019 to March 2022). Participants With the approval of NHS England we used individual-level electronic health records from OpenSAFELY, which covered ~40% of general practices in England (mean monthly population size 23.5 million people). Primary and secondary outcome measures We estimated crude and directly age-standardised rates for potentially preventable unplanned hospital admissions: ambulatory care sensitive conditions and urgent emergency sensitive conditions. We considered how trends in these outcomes varied by three measures of social and spatial inequality: neighbourhood socioeconomic deprivation, ethnicity and geographical region. Results There were large declines in avoidable hospitalisations during the first national lockdown (March to May 2020). Trends increased post-lockdown but never reached 2019 levels. The exception to these trends was for vaccine-preventable ambulatory care sensitive admissions which remained low throughout 2020–2021. While trends were consistent by each measure of inequality, absolute levels of inequalities narrowed across levels of neighbourhood socioeconomic deprivation, Asian ethnicity (compared with white ethnicity) and geographical region (especially in northern regions). Conclusions We found no evidence that periods of healthcare disruption from the COVID-19 pandemic resulted in more avoidable hospitalisations. Falling avoidable hospital admissions has coincided with declining inequalities most strongly by level of deprivation, but also for Asian ethnic groups and northern regions of England.
| Item Type: | Articles |
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| Additional Information: | This work was funded as part of the National Core Studies Longitudinal Health & Wellbeing programme (MC_PC_20030, MC_PC_20059). MAG acknowledges funding for this research from UK Medical Research Council (MR/W021242/1). SVK acknowledges funding from a NRS Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_00022/2) and the Scottish Government Chief Scientist Office (SPHSU17). JM is partly funded by the National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West). |
| Keywords: | COVID-19, avoidable hospitalisations, electronic health records, inequality, health systems, disruption. |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Katikireddi, Professor Vittal and Green, Mr Mark |
| Authors: | Green, M., McKee, M., Massey, J., MacKenna, B., Mehrkar, A., Bacon, S., Macleod, J., Sheikh, A., Shah, S. A., OpenSAFELY Consortium, , LH&W NCS Collaborative, , and Katikireddi, S. V. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU |
| Journal Name: | BMJ Open |
| Publisher: | BMJ Publishing Group |
| ISSN: | 2044-6055 |
| ISSN (Online): | 2044-6055 |
| Published Online: | 08 January 2024 |
| Copyright Holders: | Copyright © 2024 The Authors |
| First Published: | First published in BMJ Open 14(1): e077948 |
| Publisher Policy: | Reproduced under a Creative Commons licence |
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