Impact of COVID-19 pandemic on recorded incidence of long-term conditions in Wales: a population data linkage study using primary and secondary care health records

Background
The COVID-19 pandemic has impacted the UK health service in many ways and has resulted in backlogs and long waiting lists. The effects of these backlogs on the diagnosis and management of long-term or chronic conditions are not fully understood.

The aim of this study was to explore the effects of the COVID-19 pandemic on 17 long-term health conditions.

Approach
Data on patients living in Wales who were newly diagnosed with one or more Long Term Conditions between 2000 and 2021 were examined. The number of new cases identified between 2020-2021 were compared to expected numbers if the COVID-19 pandemic had not occurred.

Key Findings
Recorded incidence rates from 2020 to 2021 were lower than expected across all long-term conditions except Type 1 diabetes. The largest drop in recorded incidence was in chronic obstructive pulmonary disease (COPD), followed by depression, type 2 diabetes, hypertension, anxiety disorders and asthma. Observed rates continued to lag behind expectations by the end of 2021 for most conditions.

Put simply, this suggests that a GP practice of 10,000 patients might have over 400 patients with undiagnosed long-term conditions.

Policy and Practice Implications
The findings suggest that additional resources will be needed (including time and financial investment) to overcome this backlog as part of the pandemic recovery process. Rectifying this backlog of case identification and likely consequent management deficits requires strategic and operational planning, particularly within primary care organisations.

Condition-specific patient advocacy and charitable organisations may have a “championing” role in encouraging individuals with long term condition symptoms to present to their GP  or to attend ‘health checks’ within the community.

Targeted catch-up initiatives are likely unfeasible due to a lack of socio-demographic characterisation of the missing diagnoses within the reviewed data.

Next Steps
Further research is now underway to identify what specific deficits in condition management, health outcomes and health service impacts have occurred.

A report entitled 'Impact of COVID-19 pandemic on incidence of Long-Term Conditions in Welsh residents: a population linkage study' Qi C, Osborne T, Bailey R, et al (2023) is published in the British Journal of General Practice.

Authors: Cathy Qi, Tim Osborne, Rowena Bailey, Alison Cooper, Joe P Hollinghurst, Ashley Akbari, Ruth Crowder, Holly Peters, Rebecca-Jane Law, Ruth Lewis, Deb Smith, Adrian Edwards and Ronan A Lyons