The immediate impact of the COVID-19 pandemic on motor neuron disease services and mortality in Scotland
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LETTER TO THE EDITORS
The immediate impact of the COVID‑19 pandemic on motor neuron disease services and mortality in Scotland Stella A. Glasmacher1,2 · Juan Larraz1,2 · Arpan R. Mehta1,2,3,4 · Patrick K. A. Kearns1,2,3,5 · Michael Wong1,2 · Judith Newton1,2,3 · Richard Davenport1,6 · George Gorrie7 · Ian Morrison8 · Javier Carod Artal9 · Siddharthan Chandran1,2,3,4,6 · Suvankar Pal1,2,3,6,10 · CARE-MND Consortium Received: 31 July 2020 / Revised: 28 August 2020 / Accepted: 31 August 2020 © The Author(s) 2020
Dear Sirs, As of August 2020, more than 800,000 deaths worldwide have been attributed to COVID-19, of which > 41,000 have been in the United Kingdom and 2494 in Scotland [1]. People with MND (pwMND) may be particularly vulnerable. We completed a population-based analysis of the Scottish MND Register, CARE-MND [2] and a clinician survey, to measure the impact of the pandemic on (1) diagnostic rate, (2) mortality rate, and, (3) delivery of services. We compared all-cause mortality between 01/03–01/06 in 2015–2019 (comparator period) and 01/03–01/06 2020 (COVID-19 period) using multivariable Poisson regression including age ( 70 years) and year (2015–2020) as independent variables. The regression coefficients for 2015–2019 were pooled in a generic inverse variance random effects model to yield a summary coefficient. We performed Chi-squared test to compare socioeconomic status (SIMD) [3] between those who died and survivors during the COVID-19 period. To investigate the impact of the pandemic on care delivery, we undertook a structured online survey of MND * Suvankar Pal [email protected] 1
Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, UK
Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
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Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh, UK
healthcare professionals focussing on their access to diagnostics and interventions; the survey comprised multiple choice and free text questions. We identified 1062 pwMND, diagnosed between 01/01/2015–01/06/2020 (median age 68 [IQR 60–75], 632 (59.5%) male). Most (723, 77.7%) had amyotrophic lateral sclerosis. The number of new diagnoses remained constant after 2016 (range 42–45). Two pwMND, both with progressive muscular atrophy, died with confirmed or suspected COVID19. One person had an ALSFRS-R 36/48 in July 2020, did not use non-invasive ventilation and died unexpectedly. The other person had an ALSFRS-R of 20/48 in January 2020 and used non-invasive ventilation continuously. There was no difference in all-cause mortality between the COVID-19 and comparator periods (pooled regression coefficient 1.09 95% CIs 0.78, 1.53; P = 0.61). The mortality rate per 1000 cases was 114 (37/323) in the COVID-19 period and 124 in the comparator period (mean, SD 52.9). Mortality was higher above 70
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