Impact of first UK COVID-19 lockdown on hospital admissions in England, Scotland and Wales
May 2022: Research published in eClinical Medicine looks at how the first wave of the COVID-19 pandemic has disrupted healthcare in England, Scotland and Wales.
Impact of first UK COVID-19 lockdown on hospital admissions: Interrupted time series study of 32 million people
Shah, S. A,; Brophy, S.; Kennedy, J.; Fisher, L.; et. al.
eClinicalMedicine (The Lancet Discovery Science)
Published Online 20 May 2022
Available at: https://doi.org/10.1016/j.eclinm.2022.101462
Plain English Summary
On 11 March 2020 the World Health Organization (WHO) declared a global pandemic of coronavirus (SARS-CoV-2). The UK Government announced the first nationwide lockdown on 23 March 2020. Later lockdowns and restrictions varied slightly around the UK.
Some studies have already shown that the pandemic had a big impact on non-COVID-19 hospital care in the short term. In some hospitals, this included as much as a 50% drop in patients, compared to pre-pandemic levels.
We also know from pre-pandemic data that healthcare access varies between people, based on factors like location and ethnicity. Previous pandemics have made these healthcare inequalities worse.
Why did we carry out this work?
We have already shown that from March 2020-2021, overall hospital care in Scotland stayed below levels seen in previous years.
To date, there has not been any research looking at how the pandemic has changed healthcare access:
- In more than one country, at a whole population level
- For people from ethnic minority backgrounds
- For people who live in areas that are more deprived.
We wanted to understand what impact the COVID-19 pandemic has had on hospital-based care in England, Scotland and Wales. We studied the short and medium-term changes after the first lockdown was introduced and eased. We also looked at different types of care and groups of people.
This information can give a clearer picture of which groups and services need the most immediate support.
What data did we use?
We looked at people’s hospital admissions from the week before the first lockdown (16-22 March), until 31 October 2020. We compared this to pre-pandemic data, starting on 1 January 2019 for England, and 1 January 2016 for Scotland and Wales.
We looked at weekly hospital admissions for people with a primary diagnosis of:
- Cancer; including all types of benign and malignant tumour;
- Circulation-related (‘cardiovascular’) conditions; including heart attacks, strokes, chronic heart disease and high blood pressure;
- Breathing-related (‘respiratory’) conditions: including infections in the airways (not COVID-19), chronic lung diseases and pneumonia.
We also separated and compared the results in terms of a person’s sex at birth, ethnicity, admission type and whether they live in a deprived area. Admission types include planned and unplanned trips to hospital. Unplanned admissions are when a person needs unexpected care, rather than being referred to hospital by their GP or a specialist.
The hospital data comes from:
|UK Nation||Name of Dataset||Number of people in dataset||% of population|
|Scotland||EAVE II||5.4 million||99.9%|
|Wales||SAIL Databank||3.1 million||99.9%|
What did we find?
In the first 11 weeks of 2019 and 2020, hospital admission rates were very similar to each other in England, Scotland and Wales. These rates dropped from the point of lockdown in 2020, compared to the same calendar weeks pre-pandemic:
- Overall admissions dropped by 34% in England, 21% in Scotland and 25% in Wales;
- Planned admissions dropped by 47% in England, 35% in Scotland and 37% in Wales;
- Unplanned admissions dropped by 14% in England, 23% in Scotland and 11% in Wales.
There was some recovery in the follow-up period to the end of October 2020. The bigger drop in planned admissions was seen for all care types studied. Cancer-related care saw the biggest drop in overall admissions, followed by cardiovascular and then respiratory care.
The largest drop seen was in planned respiratory-related admissions in Scotland (100%).
Healthcare for different groups
Variations by sex
There was only a slight difference between men and women in terms of a drop in hospital admissions, with a larger drop for men across England, Scotland and Wales.
Variations by ethnicity
In England, Black people experienced the largest drop in planned hospital admissions (63%), compared to the same period pre-pandemic. In England, unplanned admissions dropped the most for people from a Mixed ethnic background (44%). Overall, Asian people were the least affected of those from ethnic minorities in England.
In Scotland, White people experienced much less of a drop in hospital admissions than people of non-White ethnicity (21% compared to 56%). Reliable ethnicity data was not available for Wales.
Variations by location
The drop in unplanned hospital visits was much higher for people living in more deprived areas. Compared to people in the least deprived areas, the drop was 14%, 37% and 15% larger for England, Scotland and Wales respectively.
Why is this important?
This study is, to date, the largest to look at medium-term impacts of the pandemic on hospital-based care. It is also the first to look at these impacts in detail for people from ethnic minorities, or those who live in deprived areas.
The results show that cancer-, cardiovascular- and respiratory-related care all fell during the first lockdown. This care did not recover over the following six months. People from ethnic minorities, and those who live in more deprived areas, were impacted more than other groups.
We suggest that targeted support should be offered for people from socially disadvantaged groups, so that they can access the care they need as early as possible.
This plain English summary was created with the support and feedback of the EAVE II Public Advisory Group (PAG). This particular plain English summary was reviewed by PAG members Carrol L and Sandra J.
To learn more about the PAG, see: Our EAVE II Public Advisory Group (PAG) | The University of Edinburgh