Impacts of the COVID-19 pandemic on deprivation-level differences in cardiovascular hospitalisations: a comparison of England and Denmark using the OpenSAFELY platform and National Registry Data
Jennifer K Quint,
Ben Goldacre,
Henrik Toft Sørensen,
Laurie A Tomlinson,
Srinivasa Vittal Katikireddi,
Rohini Mathur,
Helena Carreira,
Charlotte Warren-Gash,
Lars Pedersen,
Sinéad M Langan,
Kathryn E Mansfield,
Bang Zheng,
Brian MacKenna,
Ruth E Costello,
Joseph F Hayes,
Amir Mehrkar,
Jan P Vandenbroucke,
Sebastian Bacon,
John Tazare,
Viyaasan Mahalingasivam,
Patrick Bidulka,
Alasdair D Henderson,
Dominik Manuel Piehlmaier,
Angel Yun Sum Wong,
The LH&W NCS (or CONVALESCENCE) Collaborative,
The OpenSAFELY Consortium
Affiliations
Jennifer K Quint
8 NHLI, Imperial College London, London, London, UK
Ben Goldacre
11 Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Henrik Toft Sørensen
2 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
Laurie A Tomlinson
1 London School of Hygiene & Tropical Medicine, London, UK
Srinivasa Vittal Katikireddi
9 MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
Rohini Mathur
12 Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
Helena Carreira
1 London School of Hygiene & Tropical Medicine, London, UK
Charlotte Warren-Gash
1 London School of Hygiene & Tropical Medicine, London, UK
Lars Pedersen
2 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
Sinéad M Langan
1 London School of Hygiene & Tropical Medicine, London, UK
Kathryn E Mansfield
1 London School of Hygiene & Tropical Medicine, London, UK
Bang Zheng
1 London School of Hygiene & Tropical Medicine, London, UK
Brian MacKenna
10 NHS England, Redditch, UK
Ruth E Costello
1 London School of Hygiene & Tropical Medicine, London, UK
Joseph F Hayes
7 University College London, London, UK
Amir Mehrkar
11 Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Jan P Vandenbroucke
4 Leiden University, Leiden, Netherlands
Sebastian Bacon
11 Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
John Tazare
1 London School of Hygiene & Tropical Medicine, London, UK
Viyaasan Mahalingasivam
1 London School of Hygiene & Tropical Medicine, London, UK
Patrick Bidulka
1 London School of Hygiene & Tropical Medicine, London, UK
Alasdair D Henderson
3 School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
Dominik Manuel Piehlmaier
5 University of Sussex, Brighton, UK
Angel Yun Sum Wong
1 London School of Hygiene & Tropical Medicine, London, UK
Objectives To examine the impact of the COVID-19 pandemic on deprivation-related inequalities in hospitalisations for cardiovascular disease (CVD) conditions in Denmark and England between March 2018 and December 2021.Design Time-series studies in England and Denmark.Setting With the approval of National Health Service England, we used English primary care electronic health records, linked to secondary care and death registry data through the OpenSAFELY platform and nationwide Danish health registry data.Participants We included adults aged 18 and over without missing age, sex or deprivation information. On 1 March 2020, 16 234 700 people in England and 4 491 336 people in Denmark met the inclusion criteria.Primary outcome measures Hospital admissions with the primary reason for myocardial infarction (MI), ischaemic or haemorrhagic stroke, heart failure and venous thromboembolism (VTE).Results We saw deprivation gradients in monthly CVD hospitalisations in both countries, with differences more pronounced in Denmark. Based on pre-pandemic trends, in England, there were an estimated 2608 fewer admissions than expected for heart failure in the most deprived quintile during the pandemic compared with an estimated 979 fewer admissions in the least deprived quintile. For all other outcomes, there was little variation by deprivation quintile. In Denmark, there were an estimated 1013 fewer admissions than expected over the pandemic for MI in the most deprived quintile compared with 619 in the least deprived quintile. Similar trends were seen for stroke and VTE, though absolute numbers were smaller. Heart failure admissions were similar to pre-pandemic levels with little variation by deprivation quintile.Conclusions Overall, we did not find that the pandemic substantially worsened pre-existing deprivation-related differences in CVD hospitalisations, though there were exceptions in both countries.
