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  • Impact of COVID-19 lockdown on emergency asthma admissions and deaths: national interrupted time series analyses for Scotland and Wales

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Asthma
Original research
Impact of COVID-19 lockdown on emergency asthma admissions and deaths: national interrupted time series analyses for Scotland and Wales
  1. Gwyneth A Davies1,
  2. Mohammad A Alsallakh1,
  3. Shanya Sivakumaran1,
  4. Eleftheria Vasileiou2,
  5. Ronan A Lyons1,
  6. Chris Robertson3,
  7. Aziz Sheikh2
  8. EAVE II Collaborators
    1. 1 Population Data Science, Swansea University Medical School, Swansea, UK
    2. 2 Usher Institute, University of Edinburgh, Edinburgh, UK
    3. 3 Health Protection Scotland, Public Health Scotland, Glasgow, UK
    1. Correspondence to Dr Mohammad A Alsallakh, Swansea University Medical School, Swansea SA2 8PP, UK; M.A.Alsallakh{at}Swansea.ac.uk

    Abstract

    Background The COVID-19 pandemic’s impact on people with asthma is poorly understood. We hypothesised that lockdown restrictions were associated with reductions in severe asthma exacerbations requiring emergency asthma admissions and/or leading to death.

    Methods Using data from Public Health Scotland and the Secure Anonymised Information Linkage Databank in Wales, we compared weekly counts of emergency admissions and deaths due to asthma over the first 18 weeks in 2020 with the national averages over 2015–2019. We modelled the impact of instigating lockdown on these outcomes using interrupted time-series analysis. Using fixed-effect meta-analysis, we derived pooled estimates of the overall changes in trends across the two nations. We also investigated trends in asthma-related primary care prescribing and emergency department (ED) attendances in Wales.

    Results Lockdown was associated with a 36% pooled reduction in emergency admissions for asthma (incidence rate ratio, IRR: 0.64, 95% CI: 0.49 to 0.83, p value 0.001) across both countries. There was no significant change in asthma deaths (pooled IRR: 0.57, 95% CI: 0.17 to 1.94, p value 0.37). ED asthma attendances in Wales declined during lockdown (IRR: 0.85, 95% CI: 0.73 to 0.99, p value 0.03). A large spike of 121% more inhaled corticosteroids and 133% more oral corticosteroid prescriptions was seen in Wales in the week before lockdown.

    Conclusions National lockdowns were associated with substantial reductions in severe asthma exacerbations leading to hospital admission across both Scotland and Wales, with no corresponding increase in asthma deaths.

    • asthma
    • asthma epidemiology
    • COVID-19

    Data availability statement

    The anonymised person-level data used in this study are held by Public Health Scotland (PHS) and the Secure Anonymised Information Linkage (SAIL) Databank and are restricted and not publicly available but can be accessed upon reasonable requests from PHS and SAIL. All proposals to use SAIL are carefully reviewed by an independent Information Governance Review Panel to ensure proper and appropriate use of data (https://www.saildatabank.com/application-process). When approved, access is then provided through the SAIL Gateway, a privacy-protecting safe haven and a secure remote access system.

    This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

    https://bmj.com/coronavirus/usage

    https://doi.org/10.1136/thoraxjnl-2020-216380

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      Data availability statement

      The anonymised person-level data used in this study are held by Public Health Scotland (PHS) and the Secure Anonymised Information Linkage (SAIL) Databank and are restricted and not publicly available but can be accessed upon reasonable requests from PHS and SAIL. All proposals to use SAIL are carefully reviewed by an independent Information Governance Review Panel to ensure proper and appropriate use of data (https://www.saildatabank.com/application-process). When approved, access is then provided through the SAIL Gateway, a privacy-protecting safe haven and a secure remote access system.

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      Footnotes

      • GAD, MAA and SS are joint first authors.

      • Twitter @DrAzizSheikh

      • GAD, MAA and SS contributed equally.

      • Collaborators EAVE II Collaborators: Colin R Simpson, Wellington School of Health, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand and Usher Institute, The University of Edinburgh, Edinburgh, UK, Jim McMenamin, Public Health Scotland, Glasgow, UK, Lewis D Ritchie, Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK, Mark Woolhouse, Usher Institute, The University of Edinburgh, Edinburgh, UK, Helen R Stagg, Usher Institute, The University of Edinburgh, Edinburgh, UK, Diogo Marques, Public Health Scotland, Glasgow, UK, Josie Murray, Public Health Scotland, Glasgow, UK, Sarah Stock, Usher Institute, The University of Edinburgh, Edinburgh, UK, Rachael Wood, Public Health Scotland and University of Edinburgh, UK, Colin McCowan, School of Medicine, University of St Andrews, St Andrews, UK, Utkarsh Agrawal, School of Medicine, University of St Andrews, St Andrews, UK, Annemarie B. Docherty, Usher Institute, The University of Edinburgh, Edinburgh, UK, Rachel H. Mulholland, Usher Institute, The University of Edinburgh, Edinburgh, UK, Emily Moore, Public Health Scotland, Glasgow, UK, James Marple, Royal Infirmary of Edinburgh, Edinburgh, UK, Vicky Hammersley, Usher Institute, The University of Edinburgh, Edinburgh, UK.

      • Contributors AS conceived the study. MAA, CR, AS, GAD and RAL contributed to study design and data interpretation. EV conducted the statistical analysis for Scotland. MAA conducted the statistical analysis for Wales and prepared the Tables and Figures. CR advised on statistical analysis. GAD, SS and MAA drafted the manuscript. GAD and AS commented critically on several drafts of the manuscript. All authors critically reviewed and approved the final version of the manuscript. MAA is corresponding author and guarantor for this work and attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

      • Funding This study was funded by the Medical Research Council (MR/R008345/1) with the support of BREATHE – The Health Data Research Hub for Respiratory Health [MC_PC_19004], which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK.

      • Disclaimer The funders had no role in the study design, data collection and analysis, interpretation of findings, writing of the manuscript, or the decision to submit this manuscript for publication.

      • Competing interests AS reports grants from UKRI during the conduct of the study. RAL reports grants from Health Data Research UK during the conduct of the study. CR reports grants from Medical Research Council and Public Health Scotland during the conduct of the study.

      • Provenance and peer review Not commissioned; externally peer reviewed.

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