Impact of tiered restrictions in December 2020 on COVID-19 hospitalisations in England: a synthetic control study
Objectives To evaluate the effectiveness of localised Tier 3 restrictions, implemented in England in December 2020, on reducing COVID-19 hospitalisations compared with less stringent Tier 2 measures and the variations by neighbourhood deprivation and the prevalence of Alpha (B.1.1.7) variant, the pr...
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BMJ Publishing Group
2025-01-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/15/1/e086802.full |
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| author | Daniel Hungerford Benjamin Barr Mark Green Marta García-Fiñana Iain Buchan Xingna Zhang |
| author_facet | Daniel Hungerford Benjamin Barr Mark Green Marta García-Fiñana Iain Buchan Xingna Zhang |
| author_sort | Daniel Hungerford |
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| description | Objectives To evaluate the effectiveness of localised Tier 3 restrictions, implemented in England in December 2020, on reducing COVID-19 hospitalisations compared with less stringent Tier 2 measures and the variations by neighbourhood deprivation and the prevalence of Alpha (B.1.1.7) variant, the primary variant of concern then, to measure hospital services’ burden and inequalities across different communities.Design Observational study using a synthetic control method, comparing weekly hospitalisation rates in Tier 3 areas to a synthetic control from Tier 2 areas.Setting England between 4 October 2020 and 21 February 2021.Participants 23 million people under Tier 3 restrictions, compared with a synthetic control group derived from 29 million people under Tier 2 restrictions.Interventions Tier 3 restrictions in designated areas were implemented from 7 December 2020, imposing stricter limits on gatherings and hospitality than Tier 2, followed by a national lockdown on 6 January 2021.Primary and secondary outcome measures Weekly COVID-19-related hospitalisations for neighbourhoods in England over 11 weeks following the interventions.Results Implementing Tier 3 restrictions were associated with a 17% average reduction in hospitalisations compared with Tier 2 areas (95% CI 13% to 21%; 8158 (6286 to 9981) in total). The effects were similar across different levels of neighbourhood deprivation and prevalence of the Alpha variant.Conclusions Regionally targeted Tier 3 restrictions in England had a moderate but significant effect on reducing hospitalisations. The impact did not exacerbate socioeconomic inequalities during the pandemic. Our findings suggest that regionally targeted restrictions can be effective in managing infectious diseases. |
| format | Article |
| id | doaj-art-d61db404809d469c813f2b7da8028c5b |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
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| spelling | doaj-art-d61db404809d469c813f2b7da8028c5b2025-01-07T19:50:14ZengBMJ Publishing GroupBMJ Open2044-60552025-01-0115110.1136/bmjopen-2024-086802Impact of tiered restrictions in December 2020 on COVID-19 hospitalisations in England: a synthetic control studyDaniel Hungerford0Benjamin Barr1Mark Green2Marta García-Fiñana3Iain Buchan4Xingna Zhang5National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UKDepartment of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK3 Department of Geography & Planning, University of Liverpool, Liverpool, UKDepartment of Health Data Science, University of Liverpool, Liverpool, UKNational Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UKDepartment of Public Health and Policy, University of Liverpool, Liverpool, UKObjectives To evaluate the effectiveness of localised Tier 3 restrictions, implemented in England in December 2020, on reducing COVID-19 hospitalisations compared with less stringent Tier 2 measures and the variations by neighbourhood deprivation and the prevalence of Alpha (B.1.1.7) variant, the primary variant of concern then, to measure hospital services’ burden and inequalities across different communities.Design Observational study using a synthetic control method, comparing weekly hospitalisation rates in Tier 3 areas to a synthetic control from Tier 2 areas.Setting England between 4 October 2020 and 21 February 2021.Participants 23 million people under Tier 3 restrictions, compared with a synthetic control group derived from 29 million people under Tier 2 restrictions.Interventions Tier 3 restrictions in designated areas were implemented from 7 December 2020, imposing stricter limits on gatherings and hospitality than Tier 2, followed by a national lockdown on 6 January 2021.Primary and secondary outcome measures Weekly COVID-19-related hospitalisations for neighbourhoods in England over 11 weeks following the interventions.Results Implementing Tier 3 restrictions were associated with a 17% average reduction in hospitalisations compared with Tier 2 areas (95% CI 13% to 21%; 8158 (6286 to 9981) in total). The effects were similar across different levels of neighbourhood deprivation and prevalence of the Alpha variant.Conclusions Regionally targeted Tier 3 restrictions in England had a moderate but significant effect on reducing hospitalisations. The impact did not exacerbate socioeconomic inequalities during the pandemic. Our findings suggest that regionally targeted restrictions can be effective in managing infectious diseases.https://bmjopen.bmj.com/content/15/1/e086802.full |
| spellingShingle | Daniel Hungerford Benjamin Barr Mark Green Marta García-Fiñana Iain Buchan Xingna Zhang Impact of tiered restrictions in December 2020 on COVID-19 hospitalisations in England: a synthetic control study BMJ Open |
| title | Impact of tiered restrictions in December 2020 on COVID-19 hospitalisations in England: a synthetic control study |
| title_full | Impact of tiered restrictions in December 2020 on COVID-19 hospitalisations in England: a synthetic control study |
| title_fullStr | Impact of tiered restrictions in December 2020 on COVID-19 hospitalisations in England: a synthetic control study |
| title_full_unstemmed | Impact of tiered restrictions in December 2020 on COVID-19 hospitalisations in England: a synthetic control study |
| title_short | Impact of tiered restrictions in December 2020 on COVID-19 hospitalisations in England: a synthetic control study |
| title_sort | impact of tiered restrictions in december 2020 on covid 19 hospitalisations in england a synthetic control study |
| url | https://bmjopen.bmj.com/content/15/1/e086802.full |
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