Post by Nadica (She/Her) on Nov 27, 2024 4:18:08 GMT
Routine measurement of cardiometabolic disease risk factors in primary care in England before, during, and after the COVID-19 pandemic: A population-based cohort study - Published Nov 26, 2024
Abstract
Background
This study estimated to what extent the number of measurements of cardiometabolic risk factors (e.g., blood pressure, cholesterol, glycated haemoglobin) were impacted by the COVID-19 pandemic and whether these have recovered to expected levels.
Methods and findings
A cohort of individuals aged ≥18 years in England with records in the primary care—COVID-19 General Practice Extraction Service Data for Pandemic Planning and Research (GDPPR) were identified. Their records of 12 risk factor measurements were extracted between November 2018 and March 2024. Number of measurements per 1,000 individuals were calculated by age group, sex, ethnicity, and area deprivation quintile. The observed number of measurements were compared to a composite expectation band, derived as the union of the 95% confidence intervals of 2 estimates: (1) a projected trend based on data prior to the COVID-19 pandemic; and (2) an assumed stable trend from before pandemic. Point estimates were calculated as the mid-point of the expectation band.
A cohort of 49,303,410 individuals aged ≥18 years were included. There was sharp drop in all measurements in March 2020 to February 2022, but overall recovered to the expected levels during March 2022 to February 2023 except for blood pressure, which had prolonged recovery. In March 2023 to March 2024, blood pressure measurements were below expectation by 16% (−19 per 1,000) overall, in people aged 18 to 39 (−23%; −18 per 1,000), 60 to 79 (−17%; −27 per 1,000), and ≥80 (−31%; −57 per 1,000). There was suggestion that recovery in blood pressure measurements was socioeconomically patterned. The second most deprived quintile had the highest deviation (−20%; −23 per 1,000) from expectation compared to least deprived quintile (−13%; −15 per 1,000).
Conclusions
There was a substantial reduction in routine measurements of cardiometabolic risk factors following the COVID-19 pandemic, with variable recovery. The implications for missed diagnoses, worse prognosis, and health inequality are a concern.
Author summary
Why was this study done?
Studies have shown that the initial COVID-19 restrictions were associated with a sharp drop in cardiometabolic risk factor measurements in primary care.
However, the extent to which recovery has occurred until 2024 and how recovery varies by age, sex, ethnicity, or deprivation, remains unknown.
What did the researchers do and find?
We extracted data from the General Practice Extraction Service Data for Pandemic Planning and Research (GDPPR), which covers 98% general practices in England.
Examining a cohort of over 49 million adults, we found that most of the risk factor measurements recovered to the expected level by 2022 to 2023.
The recovery appeared to be socioeconomically patterned.
What do these findings mean?
The prolonged recovery of blood pressure measurement, consistent with findings from Health Survey for England 2021, could mean missed diagnoses and worse prognosis.
The inequality in measurement recovery could also lead to exacerbated inequality to health outcomes.
It should be noted that a shorter period of retrospective data was used to establish the expected level of measurements, which might be less reliable, and that the deaths that occurred during COVID might have changed the population structure and therefore the need of risk factor measurements.
Abstract
Background
This study estimated to what extent the number of measurements of cardiometabolic risk factors (e.g., blood pressure, cholesterol, glycated haemoglobin) were impacted by the COVID-19 pandemic and whether these have recovered to expected levels.
Methods and findings
A cohort of individuals aged ≥18 years in England with records in the primary care—COVID-19 General Practice Extraction Service Data for Pandemic Planning and Research (GDPPR) were identified. Their records of 12 risk factor measurements were extracted between November 2018 and March 2024. Number of measurements per 1,000 individuals were calculated by age group, sex, ethnicity, and area deprivation quintile. The observed number of measurements were compared to a composite expectation band, derived as the union of the 95% confidence intervals of 2 estimates: (1) a projected trend based on data prior to the COVID-19 pandemic; and (2) an assumed stable trend from before pandemic. Point estimates were calculated as the mid-point of the expectation band.
A cohort of 49,303,410 individuals aged ≥18 years were included. There was sharp drop in all measurements in March 2020 to February 2022, but overall recovered to the expected levels during March 2022 to February 2023 except for blood pressure, which had prolonged recovery. In March 2023 to March 2024, blood pressure measurements were below expectation by 16% (−19 per 1,000) overall, in people aged 18 to 39 (−23%; −18 per 1,000), 60 to 79 (−17%; −27 per 1,000), and ≥80 (−31%; −57 per 1,000). There was suggestion that recovery in blood pressure measurements was socioeconomically patterned. The second most deprived quintile had the highest deviation (−20%; −23 per 1,000) from expectation compared to least deprived quintile (−13%; −15 per 1,000).
Conclusions
There was a substantial reduction in routine measurements of cardiometabolic risk factors following the COVID-19 pandemic, with variable recovery. The implications for missed diagnoses, worse prognosis, and health inequality are a concern.
Author summary
Why was this study done?
Studies have shown that the initial COVID-19 restrictions were associated with a sharp drop in cardiometabolic risk factor measurements in primary care.
However, the extent to which recovery has occurred until 2024 and how recovery varies by age, sex, ethnicity, or deprivation, remains unknown.
What did the researchers do and find?
We extracted data from the General Practice Extraction Service Data for Pandemic Planning and Research (GDPPR), which covers 98% general practices in England.
Examining a cohort of over 49 million adults, we found that most of the risk factor measurements recovered to the expected level by 2022 to 2023.
The recovery appeared to be socioeconomically patterned.
What do these findings mean?
The prolonged recovery of blood pressure measurement, consistent with findings from Health Survey for England 2021, could mean missed diagnoses and worse prognosis.
The inequality in measurement recovery could also lead to exacerbated inequality to health outcomes.
It should be noted that a shorter period of retrospective data was used to establish the expected level of measurements, which might be less reliable, and that the deaths that occurred during COVID might have changed the population structure and therefore the need of risk factor measurements.