The Impact of the COVID-19 Pandemic on the Measurement of Routine Cardiometabolic Disease Risk Factors in Primary Care in the Population of England (57 Million People)

Abstract

Background: The COVID-19 pandemic reduced incident prescriptions for preventative cardiovascular disease (CVD) medicines, which could in part be related to reduced risk factor measurements. We examined to what extent the number of measurements of cardiometabolic risk factors (e.g., blood pressure, cholesterol, HbA1c) were impacted by the COVID-19 pandemic, and whether these have recovered to expected levels. 

Methods: Records of risk factor measurements were extracted from the routinely collected, de-identified, individual-level data from primary care - COVID-19 General Practice Extraction Service Data for Pandemic Planning and Research (GDPPR), covering the population of England (about 57 million people) - between April 2019 and April 2023 among people who survived until April 2023. The trends in number of measurements for each risk factor were modelled using generalised additive models, stratified by age, sex, and deprivation, and pandemic-related covariates such as stringency of restriction measures. The counterfactual number of measurements was estimated by removing the effects of restrictions due to the pandemic. Reductions in measurements were estimated by subtracting the counterfactual from the observed numbers of measurements. 

Findings: Between March 2020 and February 2022, each month there were 5.52 (95% CI 4.28-6.77) million fewer risk factor measurements than expected. After February 2022, when all restrictions were lifted, there were still considerably fewer measurements, particularly of body mass index (BMI) and blood pressure (BP), with 0.8 and 1.1 million fewer measurements per month, respectively. Reductions in risk factor measurements were largest in people aged 18-59 years, who had double the reduction in BP and in glycated haemoglobin measurements than did people aged 60 years or above, after all restrictions were removed. 

Interpretation: There has been a substantial reduction in routine measurements of cardiometabolic risk factors following the COVID-19 pandemic. Measurements of BMI, BP, and glycated haemoglobin, particularly among younger people, have yet to recover to pre-pandemic levels. The implications for missed diagnoses and worse prognosis are a concern as they will impact on the prevention of cardiometabolic and other conditions. 

Funding: British Heart Foundation (via BHF Data Science Centre, Health Data Research UK).

Declaration of Interest: MISSING

Ethical Approval: The North East - Newcastle and North Tyneside 2 research ethics committee provided ethical approval for the CVD-COVID-UK research program (REC no. 20/NE/0161) to access, within secure trusted research environments, unconsented, whole-population, de-identified data from EHRs collected as part of patients’ routine healthcare.


NS has consulted for and/or received speaker honoraria from Abbott Laboratories, Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Hanmi Pharmaceuticals, Janssen, Merck Sharp & Dohme, Novartis, Novo Nordisk, Pfizer, Roche Diagnostics, and Sanofi; and received grant support paid to his University from AstraZeneca, Boehringer Ingelheim, Novartis, and Roche Diagnostics outside the submitted work. JV was National Clinical Director for Diabetes and Obesity at NHS England from 2013 to September 2023. JH received research grants from Amgen, British Heart Foundation, Health and Care Research Wales, and speaker honorarium from Amgen. CD is the Treasurer of European Council for Cardiovascular Research, Association of Physicians of Great Britain and Ireland, Council Member of the European Society of Hypertension, and the Vice President of Scottish Heart & Arterial disease Risk Prevention (SHARP). All other authors declared no potential conflicts of interests.

Keywords: public health, primary care, risk factor, Covid-19