University news

The number of important routine health checks taking place since the pandemic has substantially reduced in England, with implications for missed diagnosis and increased health inequalities.

In new research, led by the University of Glasgow and published in PLOS Medicine, researchers looked at the number of routine health measurements taken in general practices – including blood pressure, weights and haemoglobin A1c – taken since the pandemic, and found that while most routine checks had returned to expected levels, the recovery of some measurements were slow, with some parts of society more impacted than others.

In particular, the study found that blood pressure checks may not have returned to expected levels in early 2024, more than four years after the pandemic began. Researchers say the implications of their findings for missed diagnoses, worse prognosis and health inequalities are of concern.

Routine face-to-face health checks are a crucial part of prevention strategies, designed to detect common chronic conditions such as type 2 diabetes and high blood pressure, both of which increase the risk of cardiovascular disease. Most routine measurements are taken at GP or out-patient appointments, and while prior to 2020 these were regularly carried out, repeated lockdowns and social distancing measures meant they had to temporarily cease during the pandemic.

To carry out the research the study team looked at the health records of more than 49 million adults in England from November 2018 to March 2024. Their findings paint a detailed picture of how routine health checks were substantially altered through the course of the pandemic and beyond.

As anticipated, there was sharp drop in all measurements between March 2020 and February 2022, as a result of lockdowns and reduced access to GP services due to social distancing. However, most routine measurements did return to their expected levels between March 2022 and February 2023.

By contrast, blood pressure measurements were still below expected levels between March 2023 to March 2024, down by 16% overall against predicted estimates. Looking in more detail, the researchers found that in people aged 18-39 years-old blood pressure tests were down 23%, in 60-79 year-old by 17%, and in the over 80s by 31%. The data also showed that the recovery of routine blood pressure measurements was also linked to location. The study found that the second most deprived areas had the biggest difference, with tests down 20% on expected numbers, compared with the least deprived areas, which were only down by 13%.

Dr Fred Ho, co-lead author on the paper from the University’s School of Health & Wellbeing, said: “There was a distinct pattern in the recovery of health checks across multiple risk factors. Compared with the trend before Covid-19, people living in the second most deprived area were consistently found to have the slowest recovery. A combination of reasons might be behind this, including a change of clinical needs, workload pressures, and the rise of remote consultation, but will require further investigation”.

Professor Naveed Sattar, Professor of Cardiometabolic Medicine at the University of Glasgow, said: “These data alert us to potential missed opportunities to measure key risk factors for chronic diseases, which are on the rise in the UK in an alarming way. Health care workers need better ways to more efficiently capture and then act upon changes in risks to prevent important diseases. The use of new technologies to capture data and better methods to help empower patients to make important lifestyle changes are needed.”

The study, ‘Routine measurement of cardiometabolic disease risk factors in primary care in England before, during and after the COVID-19 pandemic: A population-based cohort study’ is published in PLOS Medicine. The work was supported by the BHF Data Science Centre led by HDR UK.

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Enquiries: ali.howard@glasgow.ac.uk or elizabeth.mcmeekin@glasgow.ac.uk

First published: 26 November 2024