Time trends in new diagnoses of 19 long-term conditions: a population-level cohort study in England using OpenSAFELY

ObjectivesTo evaluate temporal changes in the incidence and prevalence of 19 long-term conditions in England, quantifying the impact of the COVID-19 pandemic on diagnosis rates by disease, age group, sex, socioeconomic status, and ethnicity. DesignObservational cohort study. SettingPrimary care and hospital admission data, with the approval of NHS England. Participants27,132,190 individuals registered with general practices in England contributing data to the OpenSAFELY-TPP platform. Main outcomes measuresTemporal trends in age and sex-standardised incidence and prevalence were evaluated for 19 long-term conditions between April 1, 2016, and November 30, 2024. Differences between expected and observed incidence rates after the onset of the COVID-19 pandemic were compared using seasonal autoregressive integrated moving-average models. ResultsBetween March 2020 and November 2024, persistent large deficits in incident diagnoses were evident for depression (738,068 [28.0%] fewer diagnoses than expected; 95% CI 701,452 to 774,685), asthma (150,708 [16.0%] fewer diagnoses; 95% CI 133,300 to 168,117), COPD (84,084 [15.1%] fewer diagnoses; 95% CI 74,342 to 93,827), osteoporosis (78,891 [16.5%] fewer diagnoses; 95% CI 72,804 to 84,978) and psoriasis (56,231 [17.6%] fewer diagnoses; 95% CI 51,054 to 61,407). Conversely, post-pandemic diagnoses of chronic kidney disease (CKD) have increased by 32.7% above expected levels, corresponding to 325,996 additional diagnoses (95% CI 252,212 to 399,779). Dementia diagnoses have rebounded above pre-pandemic levels for individuals of White ethnicity and less deprived socioeconomic quintiles, but remain lower than expected for individuals from other ethnicities and more deprived communities. ConclusionsThere has been a lasting and disproportionate impact of the pandemic on conditions including depression, asthma, COPD and osteoporosis, contrasting a post-pandemic surge in CKD diagnoses. Analyses stratified by ethnicity and socioeconomic status reveal inequity in the recovery from the pandemic, particularly for individuals with dementia. Importantly, this study demonstrates the potential for near real-time monitoring of disease epidemiology using routinely collected health data, informing strategies to enhance case detection and address healthcare disparities. Summary boxO_ST_ABSWhat is already knownC_ST_ABSO_LIEarly in the COVID-19 pandemic, large deficits in newly-recorded diagnoses were reported for a range of long-term conditions, including chronic obstructive pulmonary disease (COPD), depression, asthma and rheumatoid arthritis. C_LIO_LIHowever, no population-level studies have evaluated whether diagnosis rates have subsequently recovered as healthcare services emerge from the pandemic, or compared the impact by disease, age group, sex, socioeconomic status, and ethnicity. C_LI What this study addsO_LILarge deficits in diagnoses remain evident for conditions including depression, COPD, asthma, osteoporosis and psoriasis, contrasting a surge in new diagnoses of chronic kidney disease since 2022. C_LIO_LIDiagnosis rates for dementia have reached pre-pandemic levels for individuals of White ethnicity and those from less deprived socioeconomic communities, but remain lower than expected among individuals from other ethnicities and more deprived communities. C_LIO_LIThis study demonstrates how routinely collected health data can transform monitoring of disease epidemiology in near real-time and highlight healthcare inequity. C_LI