Paper information
- Authors
-
- Mark Russell,
- James Galloway,
- Colm Andrews,
- Brian MacKenna,
- Ben Goldacre,
- Amir Mehrkar,
- Helen Curtis,
- Ben Butler-Cole,
- Tom O'Dwyer,
- Sumera Qureshi,
- Joanna Ledingham,
- Arti Mahto,
- Andrew Rutherford,
- Maryam Adas,
- Edward Alveyn,
- Sam Norton,
- Andrew Cope,
- Katie Bechman
- Citation
- Incidence and management of inflammatory arthritis in England before and during the COVID-19 pandemic: a population-level cohort study using OpenSAFELY. Mark D Russell, James B Galloway, Colm D Andrews, Brian MacKenna, Ben Goldacre, Amir Mehrkar, Helen J Curtis, Ben Butler-Cole, Thomas O’Dwyer, Sumera Qureshi, Joanna M Ledingham, Arti Mahto, Andrew I Rutherford, Maryam A Adas, Edward Alveyn, Sam Norton, Andrew P Cope, Katie Bechman, OpenSAFELY Collaborative doi: https://doi.org/10.1016/S2665-9913(22)00305-8
- Categories
Objective
To use the OpenSAFELY platform to replicate key metrics from a national clinical audit, and assess the impact of COVID-19 on disease incidence and care delivery for inflammatory arthritis (IA) in England.
Design
Population-based cohort study, with the approval of NHS England.
Setting
Primary care and linked hospital outpatient data for more than 17 million people registered with general practices in England that use TPP electronic health record software.
Participants
Adults (18-110 years) with new diagnoses of IA (rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, undifferentiated IA) between 1 April 2019 and 31 March 2022.
Main outcome measures
The following outcomes were explored before and after April 2020: 1) incidence of IA diagnoses; 2) time from primary care referral to first rheumatology assessment; 3) time to first prescription of a disease-modifying anti-rheumatic drug (DMARD) in primary care.
Results
From a reference population of 17,683,500 adults, there were 31,280 incident IA diagnoses between April 2019 and March 2022. The incidence of IA decreased by 20.3% in the year commencing April 2020, relative to the preceding year (5.1 vs. 6.4 diagnoses per 10,000 adults, respectively). For those who presented with IA, the time to first rheumatology assessment was shorter during the pandemic (median 18 days; interquartile range 8 to 35 days) than before (21 days; 9 to 41 days). Overall, the proportion of patients prescribed DMARDs in primary care was comparable during the pandemic to before; however, the choice of medication changed, with fewer people prescribed methotrexate or leflunomide during the pandemic, and more people prescribed sulfasalazine or hydroxychloroquine.
Conclusions
The incidence of IA diagnoses in England decreased markedly during the early COVID-19 pandemic. However, for people who sought medical attention, the impact of the pandemic on service delivery was less marked than might have been anticipated. This study demonstrates that it is feasible to use routinely captured, near real-time data in the secure OpenSAFELY platform to benchmark care quality for long-term conditions on a national scale, without the need for manual data collection.