Impact of COVID-19 pandemic on incidence of long-term conditions in Wales

A population data linkage study using anonymised primary and secondary care health records in the Secure Anonymised Information Linkage (SAIL) Databank reveals that in 2020 and 2021, fewer people in Wales were being diagnosed with long-term conditions than expected.

Diagnosis rates increased over the 2-year period but for most conditions, they still lagged behind expectations at the end of 2021 implicating a potential backlog of undiagnosed patients who are unlikely to be receiving systematic monitoring and management for their conditions.

The study was led by researchers from Population Data Science at Swansea University Medical School in partnership with the Wales COVID-19 Evidence Centre, Welsh Government, Cardiff University and the Wales Centre for Primary and Emergency Care Research (PRIME Centre Wales).

Among the most affected conditions were chronic obstructive pulmonary disease (COPD) and anxiety disorders corresponding to more than 30 and 80 ‘missing’ diagnoses in a typical general practice of 10,000 patients, respectively.

Such a practice may have over 400 missing diagnoses across the 17 conditions studied. Researchers did not find any notable differences in socio-demographic characteristics of the patients diagnosed pre- and post- pandemic such as age, sex and ethnicity.

A second phase of research will build on this work to investigate the impact of COVID-19 on patterns of healthcare resource use (HRU) for patients with long-term conditions.

Identifying those living with yet undiagnosed long-term conditions will require specific resource allocation to enable healthcare staff time to search records, test and screen risk groups as well as initiatives to advocate patients with potentially relevant symptoms to present to primary care.

The study team conducted a population data linkage study using primary and secondary care data within the Secure Anonymised Information Linkage (SAIL) Databank. They identified 2,257,992 individuals living in Wales diagnosed for the first time with any of 17 long-term conditions between Jan 1, 2000, and Dec 31, 2021.

Comparing diagnosis rates of each condition from 2020 to 2021 to forecasted expectations based on rates from 2015 to 2019, the researchers estimated the difference between the total number of expected and recorded diagnoses over the two-year period.

This research uncovers a potential backlog of undiagnosed patients with multiple long-term conditions in Wales requiring resources to tackle anticipated workload as part of COVID-19 recovery, particularly in primary care.

“This study gives us valuable insight into the wider effects the COVID-19 pandemic has had on people, communities and the NHS in Wales,” said Professor Kieran Walshe, Director of Health and Care Research Wales and Professor of Health Policy and Management. “Research partnerships like this demonstrate not only the huge value of collaboration in research but also the range of benefits offered by making full use of routinely collected data. From April this year, the newly expanded Wales Evidence Centre will deliver on a wider remit, addressing key priority issues in health, public health and social care.”

Adrian Edwards, Wales COVID-19 Evidence Centre Director, said, ‘This is a vital area of research in reducing gaps in health inequality in Wales. We are delighted to have been able to fund and support this research alongside our dedicated collaborating partners at the Population Data Science team, Swansea University. We look forward to continuing our work towards public health improvement and equality into our next phase of work, as we transition into the Health and Care Research Wales Evidence Centre.’

Co-director of SAIL Databank, Professor Ronan Lyons added, “SAIL Databank has been an integral tool for monitoring transmission and the long-term effects of the pandemic since it first emerged. Over the last 15 years, the teams at SAIL and Population Data Science, together with others across public health bodies in Wales, have worked hard to develop our network and capabilities which has enabled us to respond swiftly and effectively to this health crisis. As part of this One Wales collaboration our work is far from over as we continue to monitor and assess COVID-19’s impact across Wales and ensure that we learn from this experience and further enhance our collective resolve and knowledge for future health emergencies.”