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Impact of COVID-19 lockdown on the incidence and mortality of acute exacerbations of chronic obstructive pulmonary disease: national interrupted time series analyses for Scotland and Wales.
BMC Med. 2021 05 17; 19(1):124.BM

Abstract

BACKGROUND

The COVID-19 pandemic and ensuing national lockdowns have dramatically changed the healthcare landscape. The pandemic's impact on people with chronic obstructive pulmonary disease (COPD) remains poorly understood. We hypothesised that the UK-wide lockdown restrictions were associated with reductions in severe COPD exacerbations. We provide the first national level analyses of the impact of the COVID-19 pandemic and first lockdown on severe COPD exacerbations resulting in emergency hospital admissions and/or leading to death as well as those recorded in primary care or emergency departments.

METHODS

Using data from Public Health Scotland and the Secure Anonymised Information Linkage Databank in Wales, we accessed weekly counts of emergency hospital admissions and deaths due to COPD over the first 30 weeks of 2020 and compared these to the national averages over the preceding 5 years. For both Scotland and Wales, we undertook interrupted time-series analyses to model the impact of instigating lockdown on these outcomes. Using fixed-effect meta-analysis, we derived pooled estimates of the overall changes in trends across the two nations.

RESULTS

Lockdown was associated with 48% pooled reduction in emergency admissions for COPD in both countries (incidence rate ratio, IRR 0.52, 95% CI 0.46 to 0.58), relative to the 5-year averages. There was no statistically significant change in deaths due to COPD (pooled IRR 1.08, 95% CI 0.87 to 1.33). In Wales, lockdown was associated with 39% reduction in primary care consultations for acute exacerbation of COPD (IRR 0.61, 95% CI 0.52 to 0.71) and 46% reduction in COPD-related emergency department attendances (IRR 0.54, 95% CI 0.36 to 0.81).

CONCLUSIONS

The UK-wide lockdown was associated with the most substantial reductions in COPD exacerbations ever seen across Scotland and Wales, with no corresponding increase in COPD deaths. This may have resulted from reduced transmission of respiratory infections, reduced exposure to outdoor air pollution and/or improved COPD self-management.

Authors+Show Affiliations

Population Data Science, Swansea University Medical School, Data Science Building, Singleton Park, Swansea University, Swansea, SA2 8PP, UK. m.a.alsallakh@swansea.ac.uk. Health Data Research UK BREATHE Hub for Respiratory Health, University of Edinburgh, Edinburgh, EH8 9AG, UK. m.a.alsallakh@swansea.ac.uk.Population Data Science, Swansea University Medical School, Data Science Building, Singleton Park, Swansea University, Swansea, SA2 8PP, UK.Health Protection Scotland, Public Health Scotland, Glasgow, UK.Health Data Research UK BREATHE Hub for Respiratory Health, University of Edinburgh, Edinburgh, EH8 9AG, UK. Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK.Population Data Science, Swansea University Medical School, Data Science Building, Singleton Park, Swansea University, Swansea, SA2 8PP, UK.Health Protection Scotland, Public Health Scotland, Glasgow, UK. Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK.Health Data Research UK BREATHE Hub for Respiratory Health, University of Edinburgh, Edinburgh, EH8 9AG, UK. Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK.Population Data Science, Swansea University Medical School, Data Science Building, Singleton Park, Swansea University, Swansea, SA2 8PP, UK. Health Data Research UK BREATHE Hub for Respiratory Health, University of Edinburgh, Edinburgh, EH8 9AG, UK.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33993870

Citation

Alsallakh, Mohammad A., et al. "Impact of COVID-19 Lockdown On the Incidence and Mortality of Acute Exacerbations of Chronic Obstructive Pulmonary Disease: National Interrupted Time Series Analyses for Scotland and Wales." BMC Medicine, vol. 19, no. 1, 2021, p. 124.
Alsallakh MA, Sivakumaran S, Kennedy S, et al. Impact of COVID-19 lockdown on the incidence and mortality of acute exacerbations of chronic obstructive pulmonary disease: national interrupted time series analyses for Scotland and Wales. BMC Med. 2021;19(1):124.
Alsallakh, M. A., Sivakumaran, S., Kennedy, S., Vasileiou, E., Lyons, R. A., Robertson, C., Sheikh, A., & Davies, G. A. (2021). Impact of COVID-19 lockdown on the incidence and mortality of acute exacerbations of chronic obstructive pulmonary disease: national interrupted time series analyses for Scotland and Wales. BMC Medicine, 19(1), 124. https://doi.org/10.1186/s12916-021-02000-w
Alsallakh MA, et al. Impact of COVID-19 Lockdown On the Incidence and Mortality of Acute Exacerbations of Chronic Obstructive Pulmonary Disease: National Interrupted Time Series Analyses for Scotland and Wales. BMC Med. 2021 05 17;19(1):124. PubMed PMID: 33993870.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of COVID-19 lockdown on the incidence and mortality of acute exacerbations of chronic obstructive pulmonary disease: national interrupted time series analyses for Scotland and Wales. AU - Alsallakh,Mohammad A, AU - Sivakumaran,Shanya, AU - Kennedy,Sharon, AU - Vasileiou,Eleftheria, AU - Lyons,Ronan A, AU - Robertson,Chris, AU - Sheikh,Aziz, AU - Davies,Gwyneth A, AU - ,, Y1 - 2021/05/17/ PY - 2021/01/12/received PY - 2021/04/30/accepted PY - 2021/5/17/entrez PY - 2021/5/18/pubmed PY - 2021/6/4/medline KW - Acute exacerbation of chronic obstructive pulmonary disease KW - COVID-19 lockdown SP - 124 EP - 124 JF - BMC medicine JO - BMC Med VL - 19 IS - 1 N2 - BACKGROUND: The COVID-19 pandemic and ensuing national lockdowns have dramatically changed the healthcare landscape. The pandemic's impact on people with chronic obstructive pulmonary disease (COPD) remains poorly understood. We hypothesised that the UK-wide lockdown restrictions were associated with reductions in severe COPD exacerbations. We provide the first national level analyses of the impact of the COVID-19 pandemic and first lockdown on severe COPD exacerbations resulting in emergency hospital admissions and/or leading to death as well as those recorded in primary care or emergency departments. METHODS: Using data from Public Health Scotland and the Secure Anonymised Information Linkage Databank in Wales, we accessed weekly counts of emergency hospital admissions and deaths due to COPD over the first 30 weeks of 2020 and compared these to the national averages over the preceding 5 years. For both Scotland and Wales, we undertook interrupted time-series analyses to model the impact of instigating lockdown on these outcomes. Using fixed-effect meta-analysis, we derived pooled estimates of the overall changes in trends across the two nations. RESULTS: Lockdown was associated with 48% pooled reduction in emergency admissions for COPD in both countries (incidence rate ratio, IRR 0.52, 95% CI 0.46 to 0.58), relative to the 5-year averages. There was no statistically significant change in deaths due to COPD (pooled IRR 1.08, 95% CI 0.87 to 1.33). In Wales, lockdown was associated with 39% reduction in primary care consultations for acute exacerbation of COPD (IRR 0.61, 95% CI 0.52 to 0.71) and 46% reduction in COPD-related emergency department attendances (IRR 0.54, 95% CI 0.36 to 0.81). CONCLUSIONS: The UK-wide lockdown was associated with the most substantial reductions in COPD exacerbations ever seen across Scotland and Wales, with no corresponding increase in COPD deaths. This may have resulted from reduced transmission of respiratory infections, reduced exposure to outdoor air pollution and/or improved COPD self-management. SN - 1741-7015 UR - https://www.unboundmedicine.com/medline/citation/33993870/Impact_of_COVID_19_lockdown_on_the_incidence_and_mortality_of_acute_exacerbations_of_chronic_obstructive_pulmonary_disease:_national_interrupted_time_series_analyses_for_Scotland_and_Wales_ L2 - https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-021-02000-w DB - PRIME DP - Unbound Medicine ER -