The Covid-19 pandemic has left a lasting and disproportionate impact on diagnosis rates for several major health conditions, including depression, asthma, and osteoporosis. According to a recent study by King’s College London, published in the British Medical Journal (BMJ), the rates of these diagnoses have not returned to pre-pandemic levels, with depression being the most severely impacted.
The study, which is the first of its kind to evaluate the recovery of diagnosis rates post-pandemic, utilized anonymized data from over 29 million people in England. It revealed that diagnoses for depression were nearly a third lower than expected, a significant drop compared to trends before the pandemic. Meanwhile, asthma diagnoses were down by 16.4%, chronic obstructive pulmonary disease (COPD) by 15.8%, and osteoporosis by 11.5%.
Disparities in Recovery Across Demographics
The pandemic’s unprecedented disruption to healthcare systems worldwide led to a sharp decline in diagnosis rates for a range of diseases. However, the study highlighted that recovery rates varied significantly across different ethnic and socioeconomic groups. For instance, dementia diagnoses returned to pre-pandemic levels among individuals of white ethnicity and those living in less deprived areas. In contrast, these rates remained lower among other ethnic groups and in more deprived communities.
Co-author Professor Sam Norton, Professor of Medical Statistics at King’s College London, expressed concern over the findings. “The deficits in depression diagnoses were particularly striking and somewhat puzzling,” he noted. “After an initial decrease during the early pandemic, diagnosis rates partially recovered by late 2021 but have declined markedly since 2022. This pattern was most evident among younger adults aged 20 to 39 years, and among individuals of white or mixed ethnicity.”
“This is difficult to reconcile with other indicators of mental health need. Disability benefit claims for mental health conditions have increased substantially over the same period, suggesting these declining diagnosis rates may not reflect improving mental health.”
Underlying Causes and NHS Pressures
The study suggests that the decline in diagnosis rates may be influenced by increasing pressures on the National Health Service (NHS), resulting in longer times for formal diagnoses. Additionally, more individuals might be accessing mental health support without receiving a formal diagnosis of depression. The national drive to expand access to psychological therapies has led to a nearly two-thirds increase in referrals to NHS Talking Therapies services between 2013 and 2024, with self-referrals accounting for almost 70% of all referrals.
Furthermore, pandemic-related disruptions could explain the fall in diagnoses for asthma, COPD, and osteoporosis. Backlogs in diagnostic testing during the pandemic are likely a key factor, and the NHS has identified this area as a priority for improvement.
Unexpected Increase in Chronic Kidney Disease Diagnoses
Interestingly, the study also found that diagnoses for chronic kidney disease (CKD) have increased by 34.8% compared to expected levels. Lead author Dr. Mark Russell, a consultant rheumatologist and epidemiologist at King’s College London, commented on this trend. “The rise in CKD diagnoses may reflect increased testing and greater awareness following guideline changes and the introduction of new treatments,” he explained.
“It is also possible that the pandemic itself has contributed to an increase in CKD, either through the direct effects of Covid-19 infection or through delays in diagnosing related conditions such as diabetes.”
Utilizing Data for Future Healthcare Improvements
The research team employed OpenSAFELY, a highly secure and anonymized NHS data platform, to analyze disease trends for 29 million people between April 2016 and November 2024. Dr. Russell emphasized the importance of these resources, stating, “This study highlights the incredible health data resources available within the NHS and demonstrates how real-time, anonymized data could be used safely and securely, without any individual patient data ever leaving the NHS system, to transform disease monitoring, enabling earlier identification of inequities and informing how care is delivered.”
The OpenSAFELY platform is principally funded by grants from NHS England, the Wellcome Trust, and the Medical Research Council. As the healthcare system continues to grapple with the aftershocks of the pandemic, studies like this offer critical insights into the challenges and opportunities for improving public health outcomes.
