Trends in inequalities in avoidable hospitalisations across the COVID-19 pandemic: a cohort study of 23.5 million people in England.

Green, Mark Alan ORCID: 0000-0002-0942-6628, McKee, Martin ORCID: 0000-0002-0121-9683, Massey, Jon ORCID: 0000-0002-2497-4040, Mackenna, Brian, Mehrkar, Amir, Bacon, Seb, Macleod, John, Sheikh, Aziz, Shah, Syed Ahmar ORCID: 0000-0001-5672-0443, OpenSAFELY Consortium
et al (show 2 more authors) (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-.

[thumbnail of bmj_open_accepted.pdf] Text
bmj_open_accepted.pdf - Author Accepted Manuscript

Download (637kB) | Preview


<h4>Objective</h4>To determine whether periods of disruption were associated with increased 'avoidable' hospital admissions and wider social inequalities in England.<h4>Design</h4>Observational repeated cross-sectional study.<h4>Setting</h4>England (January 2019 to March 2022).<h4>Participants</h4>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).<h4>Primary and secondary outcome measures</h4>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.<h4>Results</h4>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).<h4>Conclusions</h4>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: Article
Uncontrolled Keywords: OpenSAFELY Consortium, Longitudinal Health and Wellbeing National Core Study Collaborative, Humans, Hospitalization, Cohort Studies, Cross-Sectional Studies, Communicable Disease Control, England, Pandemics, COVID-19
Divisions: Faculty of Science and Engineering > School of Environmental Sciences
Depositing User: Symplectic Admin
Date Deposited: 08 Dec 2023 09:35
Last Modified: 02 Feb 2024 15:57
DOI: 10.1136/bmjopen-2023-077948
Related URLs: