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Shielding experienced decline in health care use, and at higher risk of poor mental health, during pandemic

Published: 29 July 2021

A new report, published today by Public Health Wales, identifies marked declines in hospital care during the Coronavirus pandemic amongst those clinically extremely vulnerable (CEV) to severe Coronavirus symptoms and advised to shield; and that this population were at a higher risk of experiencing poorer mental health than the general population from March to September 2020. 

This study was based on more than 127,000 people who were advised to shield in Wales (representing approximately 4 per cent of the population). The CEV population was a very diverse group, with complex health needs. The most common underlying conditions were respiratory (37 per cent), followed by immunosuppression (27 per cent) and cancer (21 per cent).

Reflecting these complex health needs, overall levels of health care use are usually much higher amongst the CEV population than the general population. Yet in 2020, compared to 2019, the greatest declines in emergency health care use were amongst the CEV population;

  • Emergency department attendances decreased by 24 per cent amongst the CEV population and 20 per cent amongst the general population.
  • Emergency hospital admissions decreased by 26 per cent amongst the CEV population and 13 per cent amongst the general population.

There are many complex factors which are likely to contribute to trends in care for the CEV population.  Whilst the CEV population have much greater underlying health needs, COVID-19 disrupted the management of underlying health conditions, but it may also have contributed to patients potentially delaying planned care, if able, to a time when they felt less at risk.

During the pandemic, non-essential planned care was suspended and the impact was evident here. This study also found that planned hospital admissions declined by approximately a third (32%) amongst the CEV and general population, and planned outpatient care by 27% amongst the CEV and 31% amongst the general population.

This study highlighted ongoing health inequalities, with those with the greater health needs less likely to receive the care they need. The inverse care law was evident with higher rates of emergency care amongst the most deprived, in both years amongst the CEV and the general population.

Jiao Song, Principal Statistician for Research and Evaluation in Public Health Wales said:

“This is the first quantitative study examining changes in health care presentation specifically for mental ill health amongst the CEV population. We found that from March to September 2020, 1 in 50 of the CEV population had a clinical record of depression and/or anxiety, and of them nearly 1 in 5 had no previous history of mental ill health.”

The study  ‘COVID-19 in Wales: The impact on levels of health care use and mental health of the clinically extremely vulnerable’ has been led by the Networked Data Lab Wales (NDL Wales), a collaborative programme between Public Health Wales, Digital Health and Care Wales, SAIL Databank and Social Care Wales and funded by the Health Foundation.

Ashley Akbari, Senior Research Manager and Data Scientist and Swansea University, said,

“Working together, sharing and building expertise has been part of our core values and strengths in Wales for a long time, and central to the NDL Wales and the wider NDL collaboration as a whole. Understanding patterns of health care use and needs amongst those  shielding is essential to ensure that any further population interventions of this nature, in the future, learn from the COVID-19 pandemic.”

Alisha Davies, Lead for Networked Data Lab Wales and Head of Research & Development in Public Health Wales said:

“These are important findings to help the health care response supporting those who have been shielding over the past year. Given such a significant change in hospital care and evidence of the inverse care law, insights from this study and others are needed to provide more in depth understanding of the CEV and general populations’ unmet needs. Such information can help inform effective, efficient and equitable delivery of future care, towards protect against a longer-term burden of poor physical and mental health following the pandemic.”