More information into which conditions are included in ICD-10 chapters can be found here https://icd.codes/icd10cm
The number of elective hospital admissions among CEV people fell sharply during the first lockdown, but some specialties were more protected than others, particularly renal and cancer.
In the case of cancer, there was a shift from elective admissions to emergency admissions (which were in fact higher than in 2019). This may reflect the way that sytems were reorganised during the pandemic.
Emergency admissions, in general, experienced smaller reductions.
Admissions for respiratory disease (the largest disease group within the CEV population) decreased on average by 60% for elective and 35% for emergency.
Chronic conditions are more likely appear during the pre-COVID period (March to July 2019). For example, people with cancer in March 2020 may have been ‘healthy’ during the same period in 2019 and, if their condition was recent, and this would explain a low number of admissions related to cancer.
During the COVID period (March to July 2020), the most common elective admissions were related to cancer (chapter 2), renal [incl. dialysis] (chapter 14), digestive system (chapter 11), blood-related disorders [incl. anaemia] (chapter 3) and musculoskeletal [incl. many rare or autoimmune disorders] (chapter 13).
During the COVID period (March to July 2020), the most common emergency admissions were related to general symptoms and signs [incl. cough or abnormal heartbeat] (chapter 18), respiratory conditions (chapter 10), circulatory [incl. hypertension] (chapter 9), injuries (chapter 19) and digestive system (chapter 11). There is a steep decrease in emergency admissions for respiratory conditions, and an increase in emergency admissions related to cancer. This is explored in more detail in the next section.
| partner | ICD10.chapter | number.events.2019.sdc | number.events.2020.sdc |
|---|---|---|---|
| Average | 2 - Neoplasms | 75,380 | 49,218 |
| Average | 14 - Diseases of the genitourinary system | 19,388 | 17,214 |
| Average | 11 - Diseases of the digestive system | 18,331 | 9,665 |
| Average | 3 - Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism | 8,585 | 4,799 |
| Average | 13 - Diseases of the musculoskeletal system and connective tissue | 9,527 | 3,823 |
| Average | 21 - Factors influencing health status and contact with health services | 6,022 | 2,903 |
| Average | 7 - Diseases of the eye and adnexa | 7,464 | 2,132 |
| Average | 6 - Diseases of the nervous system | 4,411 | 2,121 |
| Average | 18 - Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified | 4,940 | 1,941 |
| Average | 9 - Diseases of the circulatory system | 4,345 | 1,813 |
| Average | 10 - Diseases of the respiratory system | 3,662 | 1,450 |
| Average | 4 - Endocrine, nutritional and metabolic diseases | 2,025 | 1,006 |
| Average | 19 - Injury, poisoning and certain other consequences of external causes | 1,583 | 913 |
| Average | 12 - Diseases of the skin and subcutaneous tissue | 2,124 | 765 |
| Average | 1 - Certain infectious and parasitic diseases | 757 | 270 |
| Average | 17 - Congenital malformations, deformations and chromosomal abnormalities | 513 | 172 |
| Average | 15 - Pregnancy, childbirth and the puerperium | 111 | 103 |
| Average | 5 - Mental, Behavioral and Neurodevelopmental disorders | 143 | 79 |
| Average | 8 - Diseases of the ear and mastoid process | 186 | 14 |
| partner | ICD10.chapter | number.events.2019.sdc | number.events.2020.sdc |
|---|---|---|---|
| Average | 18 - Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified | 11,552 | 8,723 |
| Average | 10 - Diseases of the respiratory system | 13,337 | 8,632 |
| Average | 9 - Diseases of the circulatory system | 7,205 | 6,107 |
| Average | 19 - Injury, poisoning and certain other consequences of external causes | 6,140 | 5,161 |
| Average | 11 - Diseases of the digestive system | 6,007 | 4,817 |
| Average | 2 - Neoplasms | 2,517 | 3,586 |
| Average | 14 - Diseases of the genitourinary system | 4,324 | 3,323 |
| Average | 1 - Certain infectious and parasitic diseases | 3,705 | 2,713 |
| Average | 13 - Diseases of the musculoskeletal system and connective tissue | 3,350 | 2,269 |
| Average | 4 - Endocrine, nutritional and metabolic diseases | 2,177 | 1,955 |
| Average | 3 - Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism | 1,566 | 1,238 |
| Average | 12 - Diseases of the skin and subcutaneous tissue | 1,742 | 1,212 |
| Average | 6 - Diseases of the nervous system | 1,241 | 964 |
| Average | 5 - Mental, Behavioral and Neurodevelopmental disorders | 976 | 862 |
| Average | 21 - Factors influencing health status and contact with health services | 337 | 274 |
| Average | 7 - Diseases of the eye and adnexa | 265 | 194 |
| Average | 15 - Pregnancy, childbirth and the puerperium | 160 | 112 |
| Average | 8 - Diseases of the ear and mastoid process | 222 | 100 |
| Average | 17 - Congenital malformations, deformations and chromosomal abnormalities | 62 | 25 |
Elective admissions related to cancer and the digestive system saw the highest reductions at all locations except Grampian. This was usually followed by admissions for diseases of the eye of musculoskeletal conditions. In both Wales and North West London, reductions for cancer admissions are much larger than for other specialties. In Grampian, the main difference is that elective admissions for cancer were more ‘protected’.
For emergency admissions, the biggest reduction was for respiratory conditions and this was common across partners. This was usually followed by ‘signs and symptoms’ (which is often a ‘catch-all’ category that includes reasons such as unspecified cough or headache). Emergency admissions for cancer were higher during this period compared to the previous year, in all locations except Leeds. In Grampian, there was an increase in emergency admissions for many specialties.
This chart only includes chapters that are in the aggregate top 10 chapters by number of admissions in either: 2019 or 2020, elective or emergency (4 combinations).
On the elective side, there were steep decreases across all specialties. Most of elective care was canceled during this period. Elective admissions for renal/dialysis (chapter 14) and cancer (chapter 2) were the most protected.
On the emergency side, we also saw decreases but they tend to be smaller than those seen in elective care. In the case of cancer, while elective admissions decreased, emergency admissions increased in most places. In Grampian, as seen in other analyses, emergency admissions were generally higher over this period compared to 2019 (particularly for cancer).
Hospital care for respiratory conditions (the largest disease group among CEV patients) fell steeply - these are often chronic conditions that develop over a long time, meaning that there was potentially unmet need for patients with respiratory conditions.