{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T06:21:03Z","timestamp":1771050063346,"version":"3.50.1"},"reference-count":25,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2024,2,23]],"date-time":"2024-02-23T00:00:00Z","timestamp":1708646400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["This research was supported by the National Institute for Health Research (NIHR) for the Applied Research Collaboration Northwest London (ARC NWL), Grant Award Number NIHR200180. The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."],"award-info":[{"award-number":["This research was supported by the National Institute for Health Research (NIHR) for the Applied Research Collaboration Northwest London (ARC NWL), Grant Award Number NIHR200180. The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Individuals with multimorbidity have an increased likelihood of using unplanned secondary care including emergency department visits and emergency hospitalisations. Those with mental health comorbidities are affected to a greater extent. The Covid-19 pandemic has negatively impacted on psychosocial wellbeing and multimorbidity care, especially among vulnerable older individuals.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Aim<\/jats:title>\n<jats:p>To examine the risk of unplanned hospital admissions among patients aged 65+ with multimorbidity and depression in Northwest London, England, during- and post-Covid-19 lockdown.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Retrospective cross-sectional data analysis with the Discover-NOW database for Northwest London was conducted. The overall sample consisted of 20,165 registered patients aged 65+ with depression. Two time periods were compared to observe the impact of the Covid-19 lockdown on emergency hospital admissions between 23rd March 2020 to 21st June 2021 (period 1) and equivalent-length post-lockdown period from 22<jats:sup>nd<\/jats:sup> June 2021 to 19th September 2022 (period 2). Multivariate logistic regression was conducted on having at least one emergency hospital admission in each period against sociodemographic and multimorbidity-related characteristics.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>The odds of having an emergency hospitalisation were greater in men than women (OR = 1.19 (lockdown); OR = 1.29 (post-lockdown)), and significantly increased with age, higher deprivation, and greater number of comorbidities in both periods across the majority of categories. There was an inconclusive pattern with ethnicity; with a statistically significant protective effect among Asian (OR = 0.66) and Black ethnicities (OR = 0.67) compared to White patients during post-lockdown period only.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The likelihood of unplanned hospitalisation was higher in men than women, and significantly increased with age, higher deprivation, and comorbidities. Despite modest increases in magnitude of risk between lockdown and post-lockdown periods, there is evidence to support proactive case-review by multi-disciplinary teams to avoid unplanned admissions, particularly men with multimorbidity and comorbid depression, patients with higher number of comorbidities and greater deprivation. Further work is needed to determine admission reasons, multimorbidity patterns, and other clinical and lifestyle predictors.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0294639","type":"journal-article","created":{"date-parts":[[2024,2,23]],"date-time":"2024-02-23T18:59:24Z","timestamp":1708714764000},"page":"e0294639","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Predictors of unplanned emergency hospital admissions among patients aged 65+ with multimorbidity and depression in Northwest London during and after the Covid-19 lockdown in England"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4741-5591","authenticated-orcid":true,"given":"Meryem","family":"Cicek","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geva","family":"Greenfield","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dasha","family":"Nicholls","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2357-9858","authenticated-orcid":true,"given":"Azeem","family":"Majeed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2645-6191","authenticated-orcid":true,"given":"Benedict","family":"Hayhoe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,2,23]]},"reference":[{"key":"pone.0294639.ref001","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1016\/j.pmedr.2018.10.008","article-title":"The global burden of multiple chronic conditions: A narrative review.","volume":"12","author":"C Hajat","year":"2018","journal-title":"Prev Med Rep"},{"key":"pone.0294639.ref002","doi-asserted-by":"crossref","first-page":"e489","DOI":"10.1016\/S2666-7568(21)00146-X","article-title":"Inequalities in incident and prevalent multimorbidity in England, 2004\u201319: a population-based, descriptive study","volume":"2","author":"A Head","year":"2021","journal-title":"Lancet Healthy Longev"},{"key":"pone.0294639.ref003","doi-asserted-by":"crossref","first-page":"e245","DOI":"10.3399\/bjgp18X695465","article-title":"The epidemiology of multimorbidity in primary care: a retrospective cohort study.","volume":"68","author":"A Cassell","year":"2018","journal-title":"Br J Gen Pract"},{"key":"pone.0294639.ref004","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/S0140-6736(12)60240-2","article-title":"Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study","volume":"380","author":"K Barnett","year":"2012","journal-title":"The Lancet"},{"key":"pone.0294639.ref005","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1093\/ageing\/afx201","article-title":"Projections of multi-morbidity in the older population in England to 2035: estimates from the Population Ageing and Care Simulation (PACSim) model.","volume":"47","author":"A Kingston","year":"2018","journal-title":"Age Ageing."},{"key":"pone.0294639.ref006","first-page":"100149","article-title":"Associations between physical multimorbidity patterns and common mental health disorders in middle-aged adults: A prospective analysis using data from the UK Biobank","volume":"8","author":"A Ronaldson","year":"2021","journal-title":"Lancet Reg Health\u2014Eur"},{"key":"pone.0294639.ref007","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1016\/S0140-6736(18)32279-7","article-title":"Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990\u20132017: a systematic analysis for the Global Burden of Disease Study 2017","volume":"392","author":"SL James","year":"2018","journal-title":"The Lancet"},{"key":"pone.0294639.ref008","first-page":"1","volume-title":"Long-term conditions and mental health: The cost of co-morbidities.","author":"C Naylor","year":"2012"},{"key":"pone.0294639.ref009","doi-asserted-by":"crossref","first-page":"e39","DOI":"10.3399\/bjgp20X713897","article-title":"Impact of multimorbidity on healthcare costs and utilisation: a systematic review of the UK literature.","volume":"71","author":"M Soley-Bori","year":"2021","journal-title":"Br J Gen Pract J R Coll Gen Pract"},{"key":"pone.0294639.ref010","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.jpsychores.2012.08.018","article-title":"Does depression predict the use of urgent and unscheduled care by people with long term conditions? A systematic review with meta-analysis","volume":"73","author":"C Dickens","year":"2012","journal-title":"J Psychosom Res"},{"key":"pone.0294639.ref011","doi-asserted-by":"crossref","first-page":"E221","DOI":"10.1503\/cmaj.121349","article-title":"The effect of physical multimorbidity, mental health conditions and socioeconomic deprivation on unplanned admissions to hospital: a retrospective cohort study.","volume":"185","author":"RA Payne","year":"2013","journal-title":"Can Med Assoc J"},{"key":"pone.0294639.ref012","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.jpsychores.2014.10.002","article-title":"Depression predicts future emergency hospital admissions in primary care patients with chronic physical illness.","volume":"82","author":"EA Guthrie","year":"2016","journal-title":"J Psychosom Res"},{"key":"pone.0294639.ref013","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1016\/j.jad.2017.10.029","article-title":"The effect of comorbid depression on the use of unscheduled hospital care by people with a long term condition: A retrospective observational study","volume":"227","author":"T Ricketts","year":"2018","journal-title":"J Affect Disord"},{"key":"pone.0294639.ref014","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1002\/ejhf.1112","article-title":"Prognostic value of psychosocial factors for first and recurrent hospitalizations and mortality in heart failure patients: insights from the OPERA-HF study","volume":"20","author":"I Sokoreli","year":"2018","journal-title":"Eur J Heart Fail"},{"key":"pone.0294639.ref015","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.2147\/COPD.S179109","article-title":"Depression predicts emergency care use in people with chronic obstructive pulmonary disease: a large cohort study in primary care","volume":"14","author":"A Blakemore","year":"2019","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"pone.0294639.ref016","first-page":"10","article-title":"Mental health in the UK during the COVID-19 pandemic: cross-sectional analyses from a community cohort study","author":"R Jia","year":"2020","journal-title":"BMJ Open"},{"key":"pone.0294639.ref017","doi-asserted-by":"crossref","first-page":"e124","DOI":"10.1016\/S2468-2667(20)30288-7","article-title":"Effects of the COVID-19 pandemic on primary care-recorded mental illness and self-harm episodes in the UK: a population-based cohort study","volume":"6","author":"MJ Carr","year":"2021","journal-title":"Lancet Public Health"},{"key":"pone.0294639.ref018","doi-asserted-by":"crossref","first-page":"e817","DOI":"10.3399\/bjgp20X713021","article-title":"Impact of COVID-19 on loneliness, mental health, and health service utilisation: a prospective cohort study of older adults with multimorbidity in primary care.","volume":"70","author":"SYS Wong","year":"2020","journal-title":"Br J Gen Pract."},{"key":"pone.0294639.ref019","first-page":"3","article-title":"Mental Health Symptomatology and Posttraumatic Growth among Those with Multimorbidity in COVID Pandemic: Cross-Sectional Findings from the STRONG Study in Greece.","author":"K Kavalidou","year":"2022","journal-title":"Psychiatry Int."},{"key":"pone.0294639.ref020","doi-asserted-by":"crossref","first-page":"e052495","DOI":"10.1136\/bmjopen-2021-052495","article-title":"Prevalence of anxiety and depressive symptoms and impact on self-management among adults with chronic conditions in Chicago, Illinois, USA, during the COVID-19 pandemic: a cross-sectional survey","volume":"12","author":"RM Lovett","year":"2022","journal-title":"BMJ Open"},{"key":"pone.0294639.ref021","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1186\/s12911-020-1082-7","article-title":"How an electronic health record became a real-world research resource: comparison between London\u2019s Whole Systems Integrated Care database and the Clinical Practice Research Datalink.","volume":"20","author":"A Bottle","year":"2020","journal-title":"BMC Med Inform Decis Mak"},{"key":"pone.0294639.ref022","author":"NHS Digital","year":"2022","journal-title":"Quality and Outcomes Framework (QOF)."},{"key":"pone.0294639.ref023","author":"NHS Digital","year":"2022","journal-title":"Primary Care Domain Reference Set Portal"},{"key":"pone.0294639.ref024","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1136\/bmj.329.7476.1207","article-title":"Counting hospital activity: spells or episodes?","volume":"329","year":"2004","journal-title":"BMJ"},{"key":"pone.0294639.ref025","first-page":"1","article-title":"The experience of older people with multimorbidity during the COVID-19 pandemic.","author":"Paola Zaninotto","year":"2020","journal-title":"UK: The English Longitudinal Study of Ageing (ELSA)"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0294639","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,23]],"date-time":"2024-02-23T18:59:45Z","timestamp":1708714785000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0294639"}},"subtitle":[],"editor":[{"given":"Sreeram V.","family":"Ramagopalan","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2024,2,23]]},"references-count":25,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,2,23]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0294639","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,23]]}}}