A novel ontological approach reveals underuse and variation in the use of physical activity interventions to address CVD risk factors in England primary care: Observational study (Preprint)

BACKGROUND In 2019, cardiovascular disease (CVD) accounted for 14% of total disability-adjusted life years and 30% of all deaths in England. Fast forwarding to 2020, many healthcare systems were on the verge of being overwhelmed by COVID-19, which disproportionately manifested as severe cases in populations affected by non-communicable diseases, most of which are CVD-risk factors. Physical activity interventions (PA-I) have been shown to play an important role in helping to address CVD risk factors and primary care has an essential role to play in supporting patients to improve their health through these types of interventions. OBJECTIVE In this manuscript, we explore the use of PA-I in primary care in England for different demographics of patients with a cardiovascular disease (CVD) risk factor. METHODS An existing ontology was used to capture PA-I and a new ontology was designed to cover several key concepts covering long-term conditions (LTC) indicating CVD risk factors. Readv2 and CTV3 codes were identified using the NHS Terms Browser. The Royal College of General Practitioners Research Surveillance Centre (RCGP RSC), a sentinel network of over 1800 primary care practices across England covering a population of over 15,000,000 registered patients, was used for data analyses covering a period from April 2017 to March 2021. To estimate the eligible population with a LTC that received a PA-I, the annual mean weekly rate/10,000 for a population with a given attribute (e.g. ethnicity) presenting to primary care with a LTC was used as a proxy for the eligible population for receiving a PA-I. The annual mean weekly rate/10,000 for a population with the same attribute (e.g. ethnicity) that received a PA-I was divided by proxy eligible population to determine the percentage of the population that received a PA-I that could have benefited from one. RESULTS Across all attributes and time periods (with the exception of the 18-39 group, 2017-2019) we see underuse of PA-I with a general trend of decreased use of PA-I after 2017. For the different attributes, the highest percentage of use is as follows: regions - London with ~40% use in 2019; ethnicities - ‘Other’ ethnicity with ~50% use in 2017; IMD - IMD1 (the most deprived quintile) with ~40% use in 2017; gender – females with ~35% use in 2017; age – 18-39 age group with ~100% use from 2017-2018. Additionally, there is marked variation that changes over time: ~2-fold greater use of PA-I in London compared to the Southeast in 2017, which increases to a nearly 4-fold increase by 2020; ~1.5-fold greater use of PA-I for the IMD-1 demographic compared to IMD5 in 2020; and ~3.5-fold greater use of PA-I for the 18-39 group compared to both the 40-64 and 65+ groups. CONCLUSIONS Our findings point to marked underuse and variation in PA-I use in primary care in England for individuals at risk of CVD. These results provide valuable insights that can inform policy and practice to improve population resilience while shifting away from a singular focus on supply-side constraints in healthcare systems.