Widespread Underdiagnoses of Physical and Mental Health Conditions During the Global COVID-19 Pandemic

Common and serious medical conditions have likely gone undiagnosed during the global coronavirus 2019 (COVID-19) pandemic. These findings, from a retrospective cohort study, were published in Lancet Public Health.

Data from 241,458 individuals included in the Salford Integrated Record database collected between 2010 and May of 2020 were analyzed for this study. The numbers of first diagnoses for common mental health problems, type 2 diabetes, diseases of the circulatory system, and cancer at 47 general practice offices were quantified and compared before and during the global pandemic.

The average age of the patients was 35 (interquartile range [IQR], 21-54) years and 49% were women.

Although all clinical diagnoses have been increasing during the past 10 years, the investigators observed a large decrease of diagnoses after the onset of COVID-19. The decrease of diagnoses between March and May 2020 was similar to the drop of diagnoses observed around the Christmas holiday each year, however the reduction of diagnoses during the pandemic has been maintained for longer than the yearly winter decline.

Decreased diagnoses were observed among all 4 categories of illnesses quantified for this study. The expected and observed numbers of diagnoses between March 1 and May 31, 2020 for common mental problems were 2147 and 1073, respectively. This decline of 50.0% (95% CI, 41.1%-56.9%) was similar to the reduction observed for type 2 diabetes (49.0%; 95% CI, 23.8%-63.1%) and diseases of the circulatory system (43.3%; 95% CI, 29.6%-53.5%) but greater than what was observed for cancer diagnoses (16.0%; 95% CI, -18.1% to 36.6%). However, the decline of cancer diagnoses during the month of May was similar to the other 3 disease categories (44.1%; 95% CI, 22.4%-57.8%).

The number of first prescriptions for drugs commonly used to treat diseases within these 4 categories also declined. Specifically, reductions of selective serotonin reuptake inhibitors (39.1%; 95% CI, 24.3%-49.5%) and metformin (35.7%; 95% CI, 14.1%-49.5%) were observed.

A limitation of this study was that these data come from an area with high levels of deprivation according to The English Indices of Deprivation. The large decline of clinical consultations may have been driven by the inability of these residents to contact their physician through telemedicine, and therefore may not be generalizable to a more affluent area.

These data indicated that many medical conditions have likely gone undetected during the global pandemic. Clinics and hospitals should be prepared for a large backlog of patients with undiagnosed conditions, many of which carry high risk for complications with delayed diagnosis.

Reference

Williams R, Jenkins D A, Ashcroft D M, et al. Diagnosis of physical and mental health conditions in primary care during the COVID-19 pandemic: a retrospective cohort study. Lancet Public Health. 2020;5(10):e543-e550. doi: 10.1016/S2468-2667(20)30201-2.