RESUMEN
ObjectivesTo determine whether clinically extremely vulnerable (CEV) children or children living with a CEV person in Wales were at greater risk of presenting with anxiety or depression in primary or secondary care during the COVID-19 pandemic compared with children in the general population, and to compare patterns of anxiety and depression during the pandemic (23rd March 2020-31st January 2021, referred to as 2020/21) and before the pandemic (March 23rd 2019-January 31st 2020, referred to as 2019/20), between CEV children and the general population. DesignPopulation-based cross-sectional cohort study using anonymised, linked, routinely collected health and administrative data held in the Secure Anonymised Information Linkage Databank. CEV individuals were identified using the COVID-19 Shielded Patient List. SettingPrimary and secondary healthcare settings covering 80% of the population of Wales. ParticipantsChildren aged 2-17 in Wales: CEV (3,769); living with a CEV person (20,033); or neither (415,009). Primary outcome measureFirst record of anxiety or depression in primary or secondary healthcare in 2019/20 and 2020/21, identified using Read and ICD-10 codes. ResultsA Cox regression model adjusted for demographics and history of anxiety or depression revealed that only CEV children were at greater risk of presenting with anxiety or depression during the pandemic compared with the general population (Hazard Ratio=2.27, 95% Confidence Interval=1.94-2.66, p<0.001). Compared with the general population, the risk amongst CEV children was higher in 2020/21 (Risk Ratio 3.04) compared with 2019/20 (Risk Ratio 1.90). In 2020/21, the cumulative incidence of anxiety or depression increased slightly amongst CEV children, but declined amongst the general population. ConclusionsDifferences in the cumulative incidences of recorded anxiety or depression in healthcare between CEV children and the general population were largely driven by a reduction in presentations to healthcare services by children in the general population during the pandemic. Strengths and limitations of this studyO_LIStrengths of this study include its novelty, national focus and clinical relevance; to date this is the first population-based study examining the effects of the COVID-19 pandemic on healthcare use for anxiety or depression amongst clinically extremely vulnerable (CEV) children and children living with a CEV person in Wales C_LIO_LIWe compared 2020/21 data with pre-pandemic 2019/20 data for CEV children and children in the general population, to place the impact of the COVID-19 pandemic in the context of longer-term patterns of healthcare use C_LIO_LIWe used a novel approach and linked multiple datasets to identify a cohort of children living with a CEV person in Wales during the COVID-19 pandemic C_LIO_LIThere was heterogeneity within the Shielded Patient List that was used to create the cohorts of children identified as CEV or living with a CEV person, in terms of the type and severity of individuals underlying conditions; the manner in which people were added to the list; the time point that people were added to the list; and the extent to which people followed the shielding guidance C_LIO_LIRoutinely collected healthcare data does not capture self-reported health, and is likely to underestimate the burden of common mental disorders in the population C_LI
RESUMEN
BackgroundResponse to the early stages of the COVID-19 pandemic resulted in the temporary disruption of cancer screening in the UK, and strong public messaging to stay safe and to protect NHS capacity. Following reintroduction in services, we explored the impact on inequalities in uptake of the Bowel Screening Wales (BSW) programme to identify groups who may benefit from tailored interventions. MethodsRecords within the BSW were linked to electronic health records (EHR) and administrative data within the Secured Anonymised Information Linkage (SAIL) Databank. Ethnic group was obtained from a linked data method available within SAIL. We examined uptake for the first 3 months of invitations (August to October) following the reintroduction of BSW programme in 2020, compared to the same period in the preceding 3 years. Uptake was measured across a 6 month follow-up period. Logistic models were conducted to analyse variations in uptake by sex, age group, income deprivation quintile, urban/rural location, ethnic group, and clinically extremely vulnerable (CEV) status in each period; and to compare uptake within sociodemographic groups between different periods. ResultsUptake during August to October 2020 (period 2020/21; 60.4%) declined compared to the same period in 2019/20 (62.7%) but remained above the 60% Welsh standard. Variation by sex, age, income deprivation, and ethnic groups was observed in all periods studied. Compared to the pre-pandemic period in 2019/20, uptake declined for most demographic groups, except for older individuals (70-74 years) and those in the most income deprived group. Uptake continues to be lower in males, younger individuals, people living in the most income deprived areas and those of Asian and unknown ethnic backgrounds. ConclusionsOur findings are encouraging with overall uptake achieving the 60% Welsh standard during the first three months after the programme restarted in 2020 despite the disruption. Inequalities did not worsen after the programme resumed activities but variations in CRC screening in Wales associated with sex, age, deprivation and ethnicity remain. This needs to be considered in targeting strategies to improve uptake and informed choice in CRC screening to avoid exacerbating disparities in CRC outcomes as screening services recover from the pandemic.
