Decline and uneven recovery from 7 common long-term conditions managed in the Catalan primary care after two pandemic years: an observational retrospective population-based study using primary care electronic health records (preprint)

Background: The incidence of chronic diseases during the COVID-19 pandemic has drastically been reduced worldwide due to disruptions in healthcare systems. The aim of our study is to analyse the trends in the incidence of 7 commonly managed primary care chronic diseases during the last 2 years of the COVID-19 pandemic in Catalonia. Methods We performed an observational retrospective population-based study using data from primary care electronic health records from January 2018 to August 2022 (5.1 million people over 14 years). We divided the study period into two: a pre-pandemic period (before 14 March 2020) and a pandemic period. We performed a segmented regression analysis of daily incidence rates per 100,000 inhabitants of 7 chronic diseases: type 2 diabetes mellitus (T2DM), asthma, chronic obstructive pulmonary disease (COPD), ischemic heart disease (IHD), heart failure (HF), hypertension and hypercholesterolemia. In addition, we compared annual incidence between pandemic years (2020, 2021 and 2022) and 2019. Associated incidence rate ratios (IRR) were also calculated. Finally, we estimated the number of expected diagnoses during the pandemic period using data from 2019 and we compared it with the observed data. Results We analysed 740,820 new chronic diseases’ diagnoses. Daily incidence rates of all 7 chronic diseases were drastically interrupted on 14 March 2020, and a general upward trend was observed during the following months. Reductions in 2020 were around 30% for all conditions except COPD which had greater reductions (IRR: 0.58 [95% CI: 0.57 to 0.6]) and HF with lesser drops (IRR: 0.86 [95% CI: 0.84 to 0.88]). Some of the chronic conditions have returned to pre-pandemic diagnosis levels, except asthma, COPD and IHD. The return to pre-pandemic diagnosis levels compensated for the drops in 2020 for T2DM and HF, but not for hypertension which presented an incomplete recovery. We also observed an excess of hypercholesterolemia diagnoses of 8.5% (95%CI: 1.81–16.15%). Conclusions Although primary care has recovered the pre-pandemic diagnosis levels for some chronic diseases, there are still missing diagnoses of asthma, COPD and IHD that should be addressed.

Increase of scabies infestations during the COVID-19 pandemic in Catalonia (preprint)

During the COVID-19 pandemic, several clinicians in Spain reported an increase in scabies diagnoses. We performed a time-series analysis with data from 2014 to 2022 to quantify this increase. We found an increasing trend during late 2020 and 2021, peaking in March 2022 with an almost 4.5-fold incidence than expected, especially in those aged between 16 and 30 years. Although scabies is more frequent in most socioeconomic deprived areas, the observed rise occurs in all the areas. We recommend increasing surveillance among other countries to detect unexpected increases in scabies outbreaks.

Cancer diagnosis in primary care after second pandemic year in Catalonia: a time-series analysis of primary care electronic health records covering about five million people (preprint)

Background During COVID-19 pandemic, incidence of chronic disease had drastically been reduced due to health care interruptions. The aim of this study is to analyze cancer diagnosis during the two years of the COVID-19 pandemic. Methods Time-series study of malignant neoplasms, using data from the primary care electronic health records from January 2014 to December 2021. We obtained the expected monthly incidence using a temporary regression adjusted by trend and seasonality. We additionally compared cancer incidence in 2019 with those of 2020 and 2021 using the T-Test. We performed analysis globally, by sex and by type of cancer. Results During 2020, the incidence of cancer had reduced by -21% compared to 2019 (p-value <0.05). Greater reductions were observed during lockdown in early 2020 (>40%) and with some types of cancers, especially prostate and skin cancers (−29.6% and -26.9% respectively, p-value<0.05). Lung cancers presented statistically non-significant reductions in both years. Cancer diagnosis returned to expected around March 2021, and incidence in 2021 was similar to that of 2019 (overall difference of 0.21%, p=0.967). However, -11% reduction still was found when comparing pandemic months of 2020-2021 with pre-pandemic months (2019-2020) Conclusions Although primary care cancer diagnostic capacity in 2021 has returned to pre-pandemic levels, missing diagnoses during the last two years have not been fully recovered. Key messages Cancer diagnoses have dramatically dropped during 2020 worldwide. We observe a -21% decline in 2020, but a return to pre-pandemic diagnosis capacity in 2021. A -11% outstanding drop was still found comparing pre-pandemic to pandemic months. Reductions were greater during the lockdown (>40%). Lung and breast cancers presented fewer reductions while prostate and skin cancers had greater drops. Missing diagnoses during the last two years have not been fully recovered

Comparative effectiveness and safety of homologous two-dose ChAdOx1 versus heterologous vaccination with ChAdOx1 and BNT162b2: a cohort analysis (preprint)

Small trials have suggested that heterologous vaccination with first-dose ChAdOx1 and second-dose BNT162b2 may generate a better immune response than homologous vaccination with two doses of ChAdOx1. We used linked data from Catalonia (Spain), where those aged <60 who received a first dose of ChAdOx1 could choose between ChAdOx1 and BNT162b2 for their second dose. Comparable cohorts were obtained after exact-matching 14,325/17,849 (80.3%) people receiving heterologous vaccination to 14,325/149,386 (9.6%) receiving homologous vaccination by age, sex, region, and date of second dose. Of these, 238 (1.7%) in the heterologous and 389 (2.7%) in the homologous groups developed COVID-19 between 1st June 2021 and 11th October 2021. The resulting hazard ratio (95% confidence interval) was 0.61 [ 0.52-0.71 ], favouring heterologous vaccination, with a Number Needed to Treat of 94.9 [ 71.8 - 139.8 ]. The two groups had similar testing rates and safety outcomes. Sensitivity and negative control outcome analyses confirmed these findings. In conclusion, we demonstrate that a heterologous vaccination schedule with ChAdOx1 followed by BNT162b2 was more efficacious than and similarly safe to homologous vaccination with two doses of ChAdOx1. Most of the infections in our study occurred when Delta was the predominant SARS-CoV-2 variant in Spain. These data agree with previous phase 2 randomised trials.

Non-differential risk of SARS-CoV-2 infection for members of polling stations on Catalan parliament voting day (preprint)

We aimed to assess the risk of SARS-CoV-2 infection for polling station members during the Catalan elections in February 2021. We compared the incidence 14 days after the elections between a cohort of polling station members (N= 18,304) and a control cohort paired by age, sex and place of residence. A total of 37 COVID-19 cases (0.2%) were confirmed in the members of the polling stations and 43 (0.23%) in the control group (p-value 0.576). Our study suggests that there was no greater risk of infection for the members of the polling stations.

Reduction of respiratory syncytial virus burden of disease observed in primary care diagnosis of children under 5 years old during the COVID-19 pandemic: a time-series analysis using routinely collected data from primary care electronic health records in Catalonia (Spain). (preprint)

Background: Great reductions of respiratory syncytial virus (RSV) in children were observed during the 2020 Southern hemisphere winter. Aim: To describe trends of RSV related disease in children in the Northern hemisphere and to propose a low cost clinical surveillance system based on primary care electronic health records (EHR). Methods: Time series analysis of RSV-related disease and virus laboratory-confirmations in children under 5 years old from 1 September 2009 to 16 January 2021. We collected RSV diagnoses from primary care EHR in Catalonia (Spain). We compared the trend of RSV in the season 2020-2021 with that in the previous seasons. We estimated the expected RSV cases with data from 2009 to 2018 using a time series regression adjusted by seasonality. We used the same method to estimate the expected RSV laboratory-confirmations as a sensitivity analysis. Results: In previous seasons, RSV-related disease peaks in Catalonia during the weeks 52 and 53. However in the 2020-2021 period, we observed a reduction of 87.6% (95% CI: 82.7% to 90.3%) in RSV-related disease from october 2020 compared to the expected. Only 1 RSV case was laboratory-confirmed during the 2020-2021 season until mid-January. Conclusions: We observed a nearly absence of RSV-related disease and laboratory-confirmations during the weeks when RSV usually peaks in Catalonia. The use of primary care EHR could be a low-cost surveillance system to monitorize trends of RSV the coming months.

Divergences on expected pneumonia cases during the COVID-19 epidemic in Catalonia: A time-series analysis of primary care electronic health records covering about 6 million people. (preprint)

BackgroundPneumonia is one of the complications of COVID-19. Primary care electronic health records (EHR) have shown the utility as a surveillance system. AimTo analyze the trends of pneumonia during two waves of COVID-19 pandemic in order to use it as a clinical surveillance system and an early indicator of severity. MethodsTime series analysis of pneumonia cases, January 2014-December 2020. We collected pneumonia diagnoses from primary care EHR, covering >6 million people in Catalonia (Spain). We compared the trend of pneumonia in the season 2019-2020 with that in the previous years. We estimated the expected pneumonia cases with data from 2014 to 2018 using a time series regression adjusted by seasonality and influenza epidemics. ResultsBetween 4 March and 5 May 2020, 11,704 excess pneumonia cases (95% CI: 9,909 to 13,498) were identified. We observed a second excess pneumonia period from 22 october to 15 november of 1,377 excess cases (95% CI: 665 to 2,089). In contrast, we observed two great periods with reductions of pneumonia cases in children, accounting for 131 days and 3,534 less pneumonia cases (95% CI: 1,005 to 6,064) from March to July; and 54 days and 1,960 less pneumonia cases (95% CI 917 to 3,002) from October to December. ConclusionsDiagnoses of pneumonia from the EHR could be used as an early and low cost surveillance system to monitor the spread of COVID-19.

The impact of the COVID-19 pandemic and related control measures on cancer diagnosis in Catalonia:A time-series analysis of primary care electronic health records covering about 5 million people. (preprint)

ObjectivesCancer care has been disrupted by the response of health systems to the COVID-19 pandemic, especially during lockdowns. The aim of our study is to analyse the impact of the pandemic on the incidence of cancer diagnosed in primary care. DesignTime-series study of malignant neoplasm and diagnostic procedures, using data from the primary care electronic health records from January 2014 to September 2020. SettingPrimary care, Catalonia, Spain ParticipantsPeople older than 14 years and assigned in one of the primary care practices of the Catalan Institute of Health with a new diagnosis of malignant neoplasm. Main outcome measuresWe obtained the monthly expected incidence of malignant neoplasms using a temporary regression, where the response variable was the incidence of cancer from 2014 to 2018 and the adjustment variables were the trend and seasonality of the time series. Excess or lack of malignant neoplasms were defined as the number of observed minus expected cases, globally and stratified by sex, age, type of cancer, and socioeconomic status. ResultsBetween March and September 2020 we observed 8,766 (95% CI: 4,135 to 13,397) less malignant neoplasm diagnoses, representing a reduction of 34% (95% CI: 19.5% to 44.1%) compared to the expected. This underdiagnosis was greater in individuals aged more than 64 years, men, and in some types of cancers (skin, colorectal, prostate). Although the reduction was predominantly focused during the lockdown, expected figures have not yet been reached (40.5% reduction during the lockdown and 24.3% reduction after that). ConclusionsReduction on cancer incidences has been observed during and after the lockdown. Urgent policy interventions are necessary to mitigate the indirect effects of COVID-19 pandemic and related control measures on other diseases and some strategies must be designed in order to reduce the underdiagnosis of cancer. What is already know in this topic- The COVID-19 pandemic and related control measures have significantly affected medical care worldwide, with effects on cancer diagnosis. - Non-COVID elective services (healthcare consultations, services, cancer screening programmes) were suspended and have been associated with a reduction in incidence of cancer. - Skin non-melanoma cancers has been more affected than other type of cancers What this study adds?- Provides data from a primary care perspective in a population about 5 million people. - Underdiagnosis of cancer occurred during the lockdown. However, this reduction extended beyond the end of the lockdown, especially for people older than 64 years, men, and some types of cancer. - Least deprived areas had greater reductions in cancer diagnoses during the lockdown, but after the lockdown the most deprived areas were those with more underdiagnosis.