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. 2024 Nov 26;21(11):e1004485.
doi: 10.1371/journal.pmed.1004485. eCollection 2024 Nov.

Routine measurement of cardiometabolic disease risk factors in primary care in England before, during, and after the COVID-19 pandemic: A population-based cohort study

Frederick K Ho  1 , Caroline Dale  2 , Mehrdad A Mizani  3 , Thomas Bolton  3 , Ewan R Pearson  3   4 , Jonathan Valabhji  5 , Christian Delles  6 , Paul Welsh  6 , Shinya Nakada  1 , Daniel Mackay  1 , Jill P Pell  1 , Chris Tomlinson  7 , Steffen E Petersen  3   8 , Benjamin Bray  9 , Mark Ashworth  10 , Kazem Rahimi  11 , Mamas Mamas  12 , Julian Halcox  13 , Cathie Sudlow  4 , Reecha Sofat  2   4 , Naveed Sattar  7 ; CVD-COVID-UK/COVID-IMPACT Consortium
Affiliations

Routine measurement of cardiometabolic disease risk factors in primary care in England before, during, and after the COVID-19 pandemic: A population-based cohort study

Frederick K Ho et al. PLoS Med. .

Abstract

Background: This study estimated to what extent the number of measurements of cardiometabolic risk factors (e.g., blood pressure, cholesterol, glycated haemoglobin) were impacted by the COVID-19 pandemic and whether these have recovered to expected levels.

Methods and findings: A cohort of individuals aged ≥18 years in England with records in the primary care-COVID-19 General Practice Extraction Service Data for Pandemic Planning and Research (GDPPR) were identified. Their records of 12 risk factor measurements were extracted between November 2018 and March 2024. Number of measurements per 1,000 individuals were calculated by age group, sex, ethnicity, and area deprivation quintile. The observed number of measurements were compared to a composite expectation band, derived as the union of the 95% confidence intervals of 2 estimates: (1) a projected trend based on data prior to the COVID-19 pandemic; and (2) an assumed stable trend from before pandemic. Point estimates were calculated as the mid-point of the expectation band. A cohort of 49,303,410 individuals aged ≥18 years were included. There was sharp drop in all measurements in March 2020 to February 2022, but overall recovered to the expected levels during March 2022 to February 2023 except for blood pressure, which had prolonged recovery. In March 2023 to March 2024, blood pressure measurements were below expectation by 16% (-19 per 1,000) overall, in people aged 18 to 39 (-23%; -18 per 1,000), 60 to 79 (-17%; -27 per 1,000), and ≥80 (-31%; -57 per 1,000). There was suggestion that recovery in blood pressure measurements was socioeconomically patterned. The second most deprived quintile had the highest deviation (-20%; -23 per 1,000) from expectation compared to least deprived quintile (-13%; -15 per 1,000).

Conclusions: There was a substantial reduction in routine measurements of cardiometabolic risk factors following the COVID-19 pandemic, with variable recovery. The implications for missed diagnoses, worse prognosis, and health inequality are a concern.

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Conflict of interest statement

NS has consulted for and/or received speaker honoraria from Abbott Laboratories, Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Hanmi Pharmaceuticals, Janssen, Merck Sharp & Dohme, Novartis, Novo Nordisk, Pfizer, Roche Diagnostics, and Sanofi; and received grant support paid to his University from AstraZeneca, Boehringer Ingelheim, Novartis, and Roche Diagnostics outside the submitted work. JV was National Clinical Director for Diabetes and Obesity at NHS England from 2013 to September 2023. JH received research grants from Amgen, British Heart Foundation, Health and Care Research Wales, and speaker honorarium from Amgen. CD is the Treasurer of European Council for Cardiovascular Research, Association of Physicians of Great Britain and Ireland, Council Member of the European Society of Hypertension, and the Vice President of Scottish Heart & Arterial disease Risk Prevention (SHARP). All other authors declared no potential conflicts of interests.

Figures

Fig 1
Fig 1. Monthly number of measurements per 1,000 individuals between November 2018 and March 2024.
Shaded areas are ranges of expected levels, aggregated from the 95% CIs of projected trends based on data between November 2018 and February 2020, and assumed stable trends from February 2020. BMI, body mass index; BP, blood pressure; HbA1c, glycated haemoglobin; LDL, low-density lipoprotein; HDL, high-density lipoprotein; LFT, liver function test; eGFR: estimated glomerular filtration rate.
Fig 2
Fig 2. Estimated % deviations of measurements between November 2018 and March 2024.
Horizontal dashed line indicates on difference from expected level. Shaded areas are composite of 95% confidence intervals. BMI, body mass index; BP, blood pressure; HbA1c, glycated haemoglobin; LDL, low-density lipoprotein; HDL, high-density lipoprotein; LFT, liver function test; eGFR, estimated glomerular filtration rate.
Fig 3
Fig 3. Estimated % deviation in number of measurements by age groups between November 2018 and March 2024.
The % deviation was estimated as observed—expected/expected. Horizontal dashed line indicates on difference from expected level. Shaded areas are composite of 95% confidence intervals. BMI, body mass index; BP, blood pressure; HbA1c, glycated haemoglobin; LDL, low-density lipoprotein; HDL, high-density lipoprotein; LFT, liver function test; eGFR, estimated glomerular filtration rate.
Fig 4
Fig 4. Estimated % deviation in measurement of BP and HbA1c by IMD quintile in March 2023–March 2024.
BP, blood pressure; HbA1c, glycated haemoglobin; IMD, index of multiple deprivation.
See this image and copyright information in PMC

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