Shabnam, Sharmin, Zaccardi, Francesco, Islam, Nazrul, Yates, Tom, Razieh, Cameron, Chudasama, Yogini V., Banerjee, Amitava, Seidu, Samuel, Mamas, Mamas A., Khunti, Kamlesh and Gillies, Clare L. (2025) Hospitalisation and mortality before and during the COVID-19 pandemic in individuals with cardiorenal–metabolic diseases in the UK: a retrospective cohort study. The Lancet Primary Care, 1 (2), [100004]. (doi:10.1016/j.lanprc.2025.100004).
Abstract
Background: health-care access and use were considerably disrupted during the COVID-19 pandemic. This study assessed the sex-specific effect of the pandemic on hospitalisations and mortality among individuals in England with type 2 diabetes, cardiovascular disease, and chronic kidney disease.
Methods: we conducted a retrospective cohort study using the UK Clinical Practice Research Datalink (CPRD) GOLD primary care database in individuals with data linkage available to the Hospital Episode Statistics Admitted Patient Care (HES APC), the Office for National Statistics (ONS) death registry, and the patient-level Index of Multiple Deprivation (IMD) 2019. Individuals were eligible for inclusion if they were registered in CPRD GOLD on the study start date (ie, March 1, 2017); were aged 18 years or older; had up-to-standard registration in CPRD GOLD for at least 1 year before the study start date; and had linkage available to HES APC, ONS, and IMD data. Adults with type 2 diabetes, cardiovascular disease, or chronic kidney disease were identified and followed up for 2 years before (March 1, 2018, to Feb 29, 2020) and 1 year during (March 1, 2020, to Feb 28, 2021) the COVID-19 pandemic. We estimated sex-specific crude incidence rates of all-cause hospitalisations and mortality in both periods. We also estimated sex-stratified, age-adjusted incidence rate ratios (IRRs) for all-cause hospitalisations and mortality during March 1, 2020, to Feb 28, 2021 versus March 1, 2018, to Feb 29, 2020 using Poisson models. Excess deaths were estimated by comparing observed and expected mortality rates.
Findings: among 769 551 eligible individuals, 59 169 (7·7%) had type 2 diabetes, 49 754 (6·5%) had cardiovascular disease, and 39 803 (5·2%) had chronic kidney disease in 2018. From 2018–20 to 2020–21, all-cause hospitalisations declined across all disease cohorts, with the largest reduction observed in female participants with type 2 diabetes (from 568 [95% CI 561–575] to 394 [384–404] events per 1000 person-years; adjusted IRR [aIRR] 0·71 [95% CI 0·69–0·73]). From 2018–20 to 2020–21, all-cause mortality increased in all three cohorts and was highest among male participants (from 62 [95% CI 59–65] to 77 [71–83] events per 1000 person-years; aIRR 1·25 [95% CI 1·14–1·38]) and female participants (from 54 [95% CI 52–57] to 73 [67–79] events per 1000 person-years; aIRR 1·36 [95% CI 1·23–1·49]) with chronic kidney disease. In 2020 in England, there were approximately 24 500, 37 300, and 38 000 excess deaths in individuals with type 2 diabetes, cardiovascular disease, and chronic kidney disease, respectively.
Interpretation: these findings show the effect of COVID-19 on male and female participants with three common chronic conditions in England. Prioritising care for groups at increased risk of severe outcomes and improving resilience are crucial for ensuring continuity of care during future public health crises.
Funding: Health Data Research UK, ONS, and UK Research and Innovation.
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