Objective To determine whether periods of disruption were associated with increased ‘avoidable’ hospital admissions and wider social inequalities in England. Design Observational repeated cross-sectional study. Setting England (January 2019 to March 2022). Participants With the approval of NHS England we used individual-level electronic health records from OpenSAFELY, which covered ~40% of general practices in England (mean monthly population size 23.5 million people). Primary and secondary outcome measures We estimated crude and directly age-standardised rates for potentially preventable unplanned hospital admissions: ambulatory care sensitive conditions and urgent emergency sensitive conditions. We considered how trends in these outcomes varied by three measures of social and spatial inequality: neighbourhood socioeconomic deprivation, ethnicity and geographical region. Results There were large declines in avoidable hospitalisations during the first national lockdown (March to May 2020). Trends increased post-lockdown but never reached 2019 levels. The exception to these trends was for vaccine-preventable ambulatory care sensitive admissions which remained low throughout 2020–2021. While trends were consistent by each measure of inequality, absolute levels of inequalities narrowed across levels of neighbourhood socioeconomic deprivation, Asian ethnicity (compared with white ethnicity) and geographical region (especially in northern regions). Conclusions We found no evidence that periods of healthcare disruption from the COVID-19 pandemic resulted in more avoidable hospitalisations. Falling avoidable hospital admissions has coincided with declining inequalities most strongly by level of deprivation, but also for Asian ethnic groups and northern regions of England.


This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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Green, M., McKee, M., Massey, J., Mackenna, B., Mehrkar, A., Bacon, S., Macleod, J., Sheikh, A., Shah, S., Katikireddi, S., Study, L. & OpenSAFELY Consortium 2024, 'Trends in inequalities in avoidable hospitalisations across the COVID-19 pandemic: A cohort study of 23.5 million people in England', BMJ Open, 14(1), article no: e077948. https://doi.org/10.1136/bmjopen-2023-077948

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Last updated: 26 January 2024
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