Exploring the levels of variation, inequality and use of physical activity intervention referrals in England primary care from 2017-2020: a retrospective cohort study

Abstract

Objectives: In this study, we explore the use of physical activity intervention referrals in primary care in England and compare their use with the rate of cardiovascular disease (CVD) risk factors in England from 2017 to 2020. We also explore variation and inequalities in referrals to these interventions in England across the study period.

Design: Retrospective cohort study.

Setting: England primary care via the Royal College of General Practitioners Research Surveillance Centre.

Participants: The Royal College of General Practitioners Research Surveillance Centre, a sentinel network across England covering a population of over 15 000 000 registered patients, was used for data analyses covering the 2017-2020 financial years and including patients with long-term conditions indicating CVD risk factors.

Outcome measures: An existing ontology of primary care codes was used to capture physical activity interventions and a new ontology was designed to cover long-term conditions indicating CVD risk factors. Single factor analysis of variance, paired samples t-test and two-tailed, one proportion z-tests were used to determine the significance of our findings.

Results: We observed statistically significant variation in physical activity intervention referrals for people with CVD risk factors from different ethnic groups and age groups across different regions of England as well as a marked decrease during the COVID-19 pandemic. Interestingly, a significant difference was not seen for different socioeconomic groups or sexes. Across all attributes and time periods (with the exception of the 18-39 group, 2017-2019), we observed a statistically significant underuse of physical activity intervention referrals.

Conclusions: Our findings identified statistically significant variation and underuse of physical activity referrals in primary care in England for individuals at risk of CVD for different population subgroups, especially different ethnicities and age groups, across different regions of England and across time, with the COVID-19 pandemic exerting a significant negative impact on referral rates.

Keywords: Cardiovascular Disease; DIABETES & ENDOCRINOLOGY; Health Equity; Health informatics; PREVENTIVE MEDICINE; Primary Care.

Figure 1. Mean referral rates per 10 000 to physical activity interventions (PA-I) for different population subgroups. A. Breakdown by NHS-E regions in England (NE & Yorkshire—North East and Yorkshire; NW—North West; EoE—East of England; Midlands; London; SE—South East; SW—South West and All regions). B. Breakdown by ethnicities (NB: ‘Unknown’ ethnicity indicates that the ethnicity data was not recorded in the CMR). C. Breakdown by Index of Multiple Deprivation quintile (IMD—an indicator of socioeconomic status with IMD1 representing the most deprived quintile and IMD5 representing the least deprived quintile). D. Breakdown by sex. E. Breakdown by age groups.

Figure 2. Estimated percentage of population subgroups with a CVD risk factor who received a physical activity intervention (PA-I) in primary care in England in the 2017 to 2020 financial years (eg, ‘2017’ indicates the 2017–2018 financial year which ran from April 2017 to March 2018). Population subgroups are as described in figure 1. A. Breakdown by NHS-E regions in England. B. Breakdown by ethnicities. C. Breakdown by Index of Multiple Deprivation quintile. D. Breakdown by sex. E. Breakdown by age groups. CVD, cardiovascular disease.