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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

Frederick K. Ho Orcid Logo, Caroline Dale, Mehrdad A. Mizani Orcid Logo, Thomas Bolton Orcid Logo, Ewan R. Pearson, Jonathan Valabhji, Christian Delles Orcid Logo, Paul Welsh Orcid Logo, Shinya Nakada, Daniel Mackay, Jill P. Pell, Chris Tomlinson Orcid Logo, Steffen E. Petersen Orcid Logo, Benjamin Bray, Mark Ashworth, Kazem Rahimi Orcid Logo, Mamas Mamas, Julian Halcox Orcid Logo, Cathie Sudlow Orcid Logo, Reecha Sofat, Naveed Sattar Orcid Logo, CVD-COVID-UK/COVID-IMPACT Consortium

PLOS Medicine, Volume: 21, Issue: 11, Start page: e1004485

Swansea University Author: Julian Halcox Orcid Logo

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DOI (Published version): 10.1371/journal.pmed.1004485

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 individua...

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Published in: PLOS Medicine
ISSN: 1549-1277 1549-1676
Published: Public Library of Science (PloS) 2024
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URI: https://cronfa.swan.ac.uk/Record/cronfa68356
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Methods and findings: A cohort of individuals aged &#x2265;18 years in England with records in the primary care&#x2014;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 &#x2265;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% (&#x2212;19 per 1,000) overall, in people aged 18 to 39 (&#x2212;23%; &#x2212;18 per 1,000), 60 to 79 (&#x2212;17%; &#x2212;27 per 1,000), and &#x2265;80 (&#x2212;31%; &#x2212;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 (&#x2212;20%; &#x2212;23 per 1,000) from expectation compared to least deprived quintile (&#x2212;13%; &#x2212;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.</abstract><type>Journal Article</type><journal>PLOS Medicine</journal><volume>21</volume><journalNumber>11</journalNumber><paginationStart>e1004485</paginationStart><paginationEnd/><publisher>Public Library of Science (PloS)</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>1549-1277</issnPrint><issnElectronic>1549-1676</issnElectronic><keywords/><publishedDay>26</publishedDay><publishedMonth>11</publishedMonth><publishedYear>2024</publishedYear><publishedDate>2024-11-26</publishedDate><doi>10.1371/journal.pmed.1004485</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm>Another institution paid the OA fee</apcterm><funders>The British Heart Foundation Data Science Centre (grant no. SP/19/3/34678, awarded to Health Data Research (HDR) UK) funded co-development (with NHS England) of the Secure Data Environment service for England, provision of linked datasets, data access, user software licences, computational usage, and data management and wrangling support, with additional contributions from the HDR UK Data and Connectivity component of the UK Government Chief Scientific Adviser&#x2019;s National Core Studies programme to coordinate national COVID-19 priority research. Consortium partner organisations funded the time of contributing data analysts, biostatisticians, epidemiologists, and clinicians. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.</funders><projectreference/><lastEdited>2024-11-27T14:09:02.2381767</lastEdited><Created>2024-11-27T13:52:21.9322230</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Frederick K.</firstname><surname>Ho</surname><orcid>0000-0001-7190-9025</orcid><order>1</order></author><author><firstname>Caroline</firstname><surname>Dale</surname><order>2</order></author><author><firstname>Mehrdad A.</firstname><surname>Mizani</surname><orcid>0000-0002-2441-895X</orcid><order>3</order></author><author><firstname>Thomas</firstname><surname>Bolton</surname><orcid>0000-0002-2998-7975</orcid><order>4</order></author><author><firstname>Ewan R.</firstname><surname>Pearson</surname><order>5</order></author><author><firstname>Jonathan</firstname><surname>Valabhji</surname><order>6</order></author><author><firstname>Christian</firstname><surname>Delles</surname><orcid>0000-0003-2238-2612</orcid><order>7</order></author><author><firstname>Paul</firstname><surname>Welsh</surname><orcid>0000-0002-7970-3643</orcid><order>8</order></author><author><firstname>Shinya</firstname><surname>Nakada</surname><order>9</order></author><author><firstname>Daniel</firstname><surname>Mackay</surname><order>10</order></author><author><firstname>Jill P.</firstname><surname>Pell</surname><order>11</order></author><author><firstname>Chris</firstname><surname>Tomlinson</surname><orcid>0000-0002-0903-5395</orcid><order>12</order></author><author><firstname>Steffen E.</firstname><surname>Petersen</surname><orcid>0000-0003-4622-5160</orcid><order>13</order></author><author><firstname>Benjamin</firstname><surname>Bray</surname><order>14</order></author><author><firstname>Mark</firstname><surname>Ashworth</surname><order>15</order></author><author><firstname>Kazem</firstname><surname>Rahimi</surname><orcid>0000-0002-4807-4610</orcid><order>16</order></author><author><firstname>Mamas</firstname><surname>Mamas</surname><order>17</order></author><author><firstname>Julian</firstname><surname>Halcox</surname><orcid>0000-0001-6926-2947</orcid><order>18</order></author><author><firstname>Cathie</firstname><surname>Sudlow</surname><orcid>0000-0002-7725-7520</orcid><order>19</order></author><author><firstname>Reecha</firstname><surname>Sofat</surname><order>20</order></author><author><firstname>Naveed</firstname><surname>Sattar</surname><orcid>0000-0002-1604-2593</orcid><order>21</order></author><author><firstname>CVD-COVID-UK/COVID-IMPACT</firstname><surname>Consortium</surname><order>22</order></author></authors><documents/><OutputDurs/></rfc1807>
spelling 2024-11-27T14:09:02.2381767 v2 68356 2024-11-27 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 3676f695eeda169d0f8c618adf27c04b 0000-0001-6926-2947 Julian Halcox Julian Halcox true false 2024-11-27 MEDS 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. Journal Article PLOS Medicine 21 11 e1004485 Public Library of Science (PloS) 1549-1277 1549-1676 26 11 2024 2024-11-26 10.1371/journal.pmed.1004485 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee The British Heart Foundation Data Science Centre (grant no. SP/19/3/34678, awarded to Health Data Research (HDR) UK) funded co-development (with NHS England) of the Secure Data Environment service for England, provision of linked datasets, data access, user software licences, computational usage, and data management and wrangling support, with additional contributions from the HDR UK Data and Connectivity component of the UK Government Chief Scientific Adviser’s National Core Studies programme to coordinate national COVID-19 priority research. Consortium partner organisations funded the time of contributing data analysts, biostatisticians, epidemiologists, and clinicians. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. 2024-11-27T14:09:02.2381767 2024-11-27T13:52:21.9322230 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Frederick K. Ho 0000-0001-7190-9025 1 Caroline Dale 2 Mehrdad A. Mizani 0000-0002-2441-895X 3 Thomas Bolton 0000-0002-2998-7975 4 Ewan R. Pearson 5 Jonathan Valabhji 6 Christian Delles 0000-0003-2238-2612 7 Paul Welsh 0000-0002-7970-3643 8 Shinya Nakada 9 Daniel Mackay 10 Jill P. Pell 11 Chris Tomlinson 0000-0002-0903-5395 12 Steffen E. Petersen 0000-0003-4622-5160 13 Benjamin Bray 14 Mark Ashworth 15 Kazem Rahimi 0000-0002-4807-4610 16 Mamas Mamas 17 Julian Halcox 0000-0001-6926-2947 18 Cathie Sudlow 0000-0002-7725-7520 19 Reecha Sofat 20 Naveed Sattar 0000-0002-1604-2593 21 CVD-COVID-UK/COVID-IMPACT Consortium 22
title 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
spellingShingle 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
Julian Halcox
title_short 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_sort 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
author_id_str_mv 3676f695eeda169d0f8c618adf27c04b
author_id_fullname_str_mv 3676f695eeda169d0f8c618adf27c04b_***_Julian Halcox
author Julian Halcox
author2 Frederick K. Ho
Caroline Dale
Mehrdad A. Mizani
Thomas Bolton
Ewan R. Pearson
Jonathan Valabhji
Christian Delles
Paul Welsh
Shinya Nakada
Daniel Mackay
Jill P. Pell
Chris Tomlinson
Steffen E. Petersen
Benjamin Bray
Mark Ashworth
Kazem Rahimi
Mamas Mamas
Julian Halcox
Cathie Sudlow
Reecha Sofat
Naveed Sattar
CVD-COVID-UK/COVID-IMPACT Consortium
format Journal article
container_title PLOS Medicine
container_volume 21
container_issue 11
container_start_page e1004485
publishDate 2024
institution Swansea University
issn 1549-1277
1549-1676
doi_str_mv 10.1371/journal.pmed.1004485
publisher Public Library of Science (PloS)
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 0
active_str 0
description 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.
published_date 2024-11-26T20:36:21Z
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