Impact on emergency and elective hospital-based care in Scotland over the first 12 months of the pandemic: interrupted time-series analysis of national lockdowns

Syed Ahmar Shah; Rachel H Mulholland; Samantha Wilkinson; Srinivasa Vittal Katikireddi; Jiafeng Pan; Ting Shi; Steven Kerr; Uktarsh Agrawal; Igor Rudan; Colin R Simpson; Sarah J Stock; John Macleod; Josephine-LK Murray; Colin McCowan; Lewis Ritchie; Mark Woolhouse; Aziz Sheikh

doi:10.1177/01410768221095239

Impact on emergency and elective hospital-based care in Scotland over the first 12 months of the pandemic: interrupted time-series analysis of national lockdowns

Syed Ahmar Shah^* (Corresponding Author), Rachel H Mulholland, Samantha Wilkinson, Srinivasa Vittal Katikireddi, Jiafeng Pan, Ting Shi, Steven Kerr, Uktarsh Agrawal, Igor Rudan, Colin R Simpson, Sarah J Stock, John Macleod, Josephine-LK Murray, Colin McCowan, Lewis Ritchie, Mark Woolhouse, Aziz Sheikh

^*Corresponding author for this work

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Abstract

ObjectivesCOVID-19 has resulted in the greatest disruption to National Health Service (NHS) care in its over 70-year history. Building on our previous work, we assessed the ongoing impact of pandemic-related disruption on provision of emergency and elective hospital-based care across Scotland over the first year of the pandemic.DesignWe undertook interrupted time-series analyses to evaluate the impact of ongoing pandemic-related disruption on hospital NHS care provision at national level and across demographics and clinical specialties spanning the period 29 March 2020–28 March 2021.SettingScotland, UK.ParticipantsPatients receiving hospital care from NHS Scotland.Main outcome measuresWe used the percentage change of accident and emergency attendances, and emergency and planned hospital admissions during the pandemic compared to the average admission rate for equivalent weeks in 2018–2019.ResultsAs restrictions were gradually lifted in Scotland after the first lockdown, hospital-based admissions increased approaching pre-pandemic levels. Subsequent tightening of restrictions in September 2020 were associated with a change in slope of relative weekly admissions rate: –1.98–2.38, –1.58) in accident and emergency attendance, –1.36–1.68, –1.04) in emergency admissions and –2.31–2.95, –1.66) in planned admissions. A similar pattern was seen across sex, socioeconomic status and most age groups, except children (0–14 years) where accident and emergency attendance, and emergency admissions were persistently low over the study period.ConclusionsWe found substantial disruption to urgent and planned inpatient healthcare provision in hospitals across NHS Scotland. There is the need for urgent policy responses to address continuing unmet health needs and to ensure resilience in the context of future pandemics.

Original language	English
Pages (from-to)	429 - 438
Number of pages	10
Journal	Journal of the Royal Society of Medicine
Volume	115
Issue number	11
Early online date	3 May 2022
DOIs	https://doi.org/10.1177/01410768221095239
Publication status	Published - 1 Nov 2022

Bibliographical note

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This analysis is part of the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) study. EAVE II is funded by the Medical Research Council (MR/R008345/1) with the support of BREATHE – The Health Data Research Hub for Respiratory Health (MC_PC_19004), which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. Additional support has been provided through the Scottish Government DG Health and Social Care. SAS and AS are also supported by the COVID-19 Longitudinal Health and Wellbeing National Core Study, funded by the Medical Research Council (MC_PC_20030). SVK acknowledges funding from a NRS Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_00022/2) and the Scottish Government Chief Scientist Office (SPHSU17). JM is partly funded by the National Institute for Health Research Applied Research Collaboration West (NIHR ARC West).

Data Availability Statement

Data is publicly available on the PHS COVID-19 wider impacts dashboard (https://scotland.shinyapps.io/phs-covid-wider-impact/).

Keywords

population trends
public health
statistics and research methods

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Impact on emergency and elective hospital-based care in Scotland over the first 12 months of the pandemic: interrupted time-series analysis of national lockdowns
Shah, S. A. (Creator), Mulholland, R. H. (Creator), Wilkinson, S. (Creator), Katikireddi, S. V. (Creator), Pan, J. (Creator), Shi, T. (Creator), Kerr, S. (Creator), Agrawal, U. (Creator), Rudan, I. (Creator), Simpson, C. R. (Creator), Stock, S. J. (Creator), Macleod, J. (Creator), Murray, J. (Creator), McCowan, C. (Creator), Ritchie, L. (Creator), Woolhouse, M. (Creator) & Sheikh, A. (Creator), SAGE Journals, 2022
DOI: 10.25384/sage.c.5978936.v1, https://sage.figshare.com/collections/Impact_on_emergency_and_elective_hospital-based_care_in_Scotland_over_the_first_12_months_of_the_pandemic_interrupted_time-series_analysis_of_national_lockdowns/5978936/1
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Cite this

Shah, S. A., Mulholland, R. H., Wilkinson, S., Katikireddi, S. V., Pan, J., Shi, T., Kerr, S., Agrawal, U., Rudan, I., Simpson, C. R., Stock, S. J., Macleod, J., Murray, J.-LK., McCowan, C., Ritchie, L., Woolhouse, M., & Sheikh, A. (2022). Impact on emergency and elective hospital-based care in Scotland over the first 12 months of the pandemic: interrupted time-series analysis of national lockdowns. Journal of the Royal Society of Medicine, 115(11), 429 - 438. https://doi.org/10.1177/01410768221095239

Impact on emergency and elective hospital-based care in Scotland over the first 12 months of the pandemic: interrupted time-series analysis of national lockdowns. / Shah, Syed Ahmar (Corresponding Author); Mulholland, Rachel H; Wilkinson, Samantha et al.
In: Journal of the Royal Society of Medicine, Vol. 115, No. 11, 01.11.2022, p. 429 - 438.

Research output: Contribution to journal › Article › peer-review

Shah, SA, Mulholland, RH, Wilkinson, S, Katikireddi, SV, Pan, J, Shi, T, Kerr, S, Agrawal, U, Rudan, I, Simpson, CR, Stock, SJ, Macleod, J, Murray, J-LK, McCowan, C, Ritchie, L, Woolhouse, M & Sheikh, A 2022, 'Impact on emergency and elective hospital-based care in Scotland over the first 12 months of the pandemic: interrupted time-series analysis of national lockdowns', Journal of the Royal Society of Medicine, vol. 115, no. 11, pp. 429 - 438. https://doi.org/10.1177/01410768221095239

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abstract = "ObjectivesCOVID-19 has resulted in the greatest disruption to National Health Service (NHS) care in its over 70-year history. Building on our previous work, we assessed the ongoing impact of pandemic-related disruption on provision of emergency and elective hospital-based care across Scotland over the first year of the pandemic.DesignWe undertook interrupted time-series analyses to evaluate the impact of ongoing pandemic-related disruption on hospital NHS care provision at national level and across demographics and clinical specialties spanning the period 29 March 2020–28 March 2021.SettingScotland, UK.ParticipantsPatients receiving hospital care from NHS Scotland.Main outcome measuresWe used the percentage change of accident and emergency attendances, and emergency and planned hospital admissions during the pandemic compared to the average admission rate for equivalent weeks in 2018–2019.ResultsAs restrictions were gradually lifted in Scotland after the first lockdown, hospital-based admissions increased approaching pre-pandemic levels. Subsequent tightening of restrictions in September 2020 were associated with a change in slope of relative weekly admissions rate: –1.98–2.38, –1.58) in accident and emergency attendance, –1.36–1.68, –1.04) in emergency admissions and –2.31–2.95, –1.66) in planned admissions. A similar pattern was seen across sex, socioeconomic status and most age groups, except children (0–14 years) where accident and emergency attendance, and emergency admissions were persistently low over the study period.ConclusionsWe found substantial disruption to urgent and planned inpatient healthcare provision in hospitals across NHS Scotland. There is the need for urgent policy responses to address continuing unmet health needs and to ensure resilience in the context of future pandemics.",

keywords = "population trends, public health, statistics and research methods",

author = "Shah, {Syed Ahmar} and Mulholland, {Rachel H} and Samantha Wilkinson and Katikireddi, {Srinivasa Vittal} and Jiafeng Pan and Ting Shi and Steven Kerr and Uktarsh Agrawal and Igor Rudan and Simpson, {Colin R} and Stock, {Sarah J} and John Macleod and Josephine-LK Murray and Colin McCowan and Lewis Ritchie and Mark Woolhouse and Aziz Sheikh",

note = "The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This analysis is part of the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) study. EAVE II is funded by the Medical Research Council (MR/R008345/1) with the support of BREATHE – The Health Data Research Hub for Respiratory Health (MC_PC_19004), which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. Additional support has been provided through the Scottish Government DG Health and Social Care. SAS and AS are also supported by the COVID-19 Longitudinal Health and Wellbeing National Core Study, funded by the Medical Research Council (MC_PC_20030). SVK acknowledges funding from a NRS Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_00022/2) and the Scottish Government Chief Scientist Office (SPHSU17). JM is partly funded by the National Institute for Health Research Applied Research Collaboration West (NIHR ARC West). ",

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T1 - Impact on emergency and elective hospital-based care in Scotland over the first 12 months of the pandemic

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AU - Shah, Syed Ahmar

AU - Mulholland, Rachel H

AU - Wilkinson, Samantha

AU - Katikireddi, Srinivasa Vittal

AU - Pan, Jiafeng

AU - Shi, Ting

AU - Kerr, Steven

AU - Agrawal, Uktarsh

AU - Rudan, Igor

AU - Simpson, Colin R

AU - Stock, Sarah J

AU - Macleod, John

AU - Murray, Josephine-LK

AU - McCowan, Colin

AU - Ritchie, Lewis

AU - Woolhouse, Mark

AU - Sheikh, Aziz

N1 - The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This analysis is part of the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) study. EAVE II is funded by the Medical Research Council (MR/R008345/1) with the support of BREATHE – The Health Data Research Hub for Respiratory Health (MC_PC_19004), which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. Additional support has been provided through the Scottish Government DG Health and Social Care. SAS and AS are also supported by the COVID-19 Longitudinal Health and Wellbeing National Core Study, funded by the Medical Research Council (MC_PC_20030). SVK acknowledges funding from a NRS Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_00022/2) and the Scottish Government Chief Scientist Office (SPHSU17). JM is partly funded by the National Institute for Health Research Applied Research Collaboration West (NIHR ARC West).

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N2 - ObjectivesCOVID-19 has resulted in the greatest disruption to National Health Service (NHS) care in its over 70-year history. Building on our previous work, we assessed the ongoing impact of pandemic-related disruption on provision of emergency and elective hospital-based care across Scotland over the first year of the pandemic.DesignWe undertook interrupted time-series analyses to evaluate the impact of ongoing pandemic-related disruption on hospital NHS care provision at national level and across demographics and clinical specialties spanning the period 29 March 2020–28 March 2021.SettingScotland, UK.ParticipantsPatients receiving hospital care from NHS Scotland.Main outcome measuresWe used the percentage change of accident and emergency attendances, and emergency and planned hospital admissions during the pandemic compared to the average admission rate for equivalent weeks in 2018–2019.ResultsAs restrictions were gradually lifted in Scotland after the first lockdown, hospital-based admissions increased approaching pre-pandemic levels. Subsequent tightening of restrictions in September 2020 were associated with a change in slope of relative weekly admissions rate: –1.98–2.38, –1.58) in accident and emergency attendance, –1.36–1.68, –1.04) in emergency admissions and –2.31–2.95, –1.66) in planned admissions. A similar pattern was seen across sex, socioeconomic status and most age groups, except children (0–14 years) where accident and emergency attendance, and emergency admissions were persistently low over the study period.ConclusionsWe found substantial disruption to urgent and planned inpatient healthcare provision in hospitals across NHS Scotland. There is the need for urgent policy responses to address continuing unmet health needs and to ensure resilience in the context of future pandemics.

AB - ObjectivesCOVID-19 has resulted in the greatest disruption to National Health Service (NHS) care in its over 70-year history. Building on our previous work, we assessed the ongoing impact of pandemic-related disruption on provision of emergency and elective hospital-based care across Scotland over the first year of the pandemic.DesignWe undertook interrupted time-series analyses to evaluate the impact of ongoing pandemic-related disruption on hospital NHS care provision at national level and across demographics and clinical specialties spanning the period 29 March 2020–28 March 2021.SettingScotland, UK.ParticipantsPatients receiving hospital care from NHS Scotland.Main outcome measuresWe used the percentage change of accident and emergency attendances, and emergency and planned hospital admissions during the pandemic compared to the average admission rate for equivalent weeks in 2018–2019.ResultsAs restrictions were gradually lifted in Scotland after the first lockdown, hospital-based admissions increased approaching pre-pandemic levels. Subsequent tightening of restrictions in September 2020 were associated with a change in slope of relative weekly admissions rate: –1.98–2.38, –1.58) in accident and emergency attendance, –1.36–1.68, –1.04) in emergency admissions and –2.31–2.95, –1.66) in planned admissions. A similar pattern was seen across sex, socioeconomic status and most age groups, except children (0–14 years) where accident and emergency attendance, and emergency admissions were persistently low over the study period.ConclusionsWe found substantial disruption to urgent and planned inpatient healthcare provision in hospitals across NHS Scotland. There is the need for urgent policy responses to address continuing unmet health needs and to ensure resilience in the context of future pandemics.

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KW - public health

KW - statistics and research methods

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Impact on emergency and elective hospital-based care in Scotland over the first 12 months of the pandemic: interrupted time-series analysis of national lockdowns

Abstract

Bibliographical note

Data Availability Statement

Keywords

UN SDGs

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Impact on emergency and elective hospital-based care in Scotland over the first 12 months of the pandemic: interrupted time-series analysis of national lockdowns

Cite this