gms | German Medical Science

Background: There are many indirect effects of the COVID-19 pandemic that impact health through various pathways including secondary consequences on health and wellbeing due to delayed diagnosis, prevention, and medical treatment. In addition, the pandemic has clearly shown that a structured European mechanism to organize and share accurate health information between countries is urgently needed to exchange, organise and access reliable health information, especially in the area of population health.

Methods: As part of the Population Health Information Research Infrastructure (PHIRI) we have investigated four research use cases to measure the impact of COVID-19 on population health and show how a broad variety of routine data can be pooled and/or reused for secondary analysis in a distributed way across Europe. The first use case looks at direct and indirect determinants of COVID-19 infection and outcomes in vulnerable population groups, taking inequalities into account. This is followed by an analysis of delayed treatment of breast cancer patients in the context of COVID-19. The third research question deals with the impacts of COVID-19 on perinatal health inequalities while the fourth use case provides insights in changes in population mental health. These use cases represent pilot activities for the benefits and added value of an infrastructure that supports federated analysis by bringing together data from different European countries. The outcomes of the use cases aim to facilitate research by making scalable, reproducible methods available that are interoperable through the formalisation of data models, data management processes and analytical pipelines.

Results: In over 20 data contributing institutions, data was mobilised and analysed in a distributed manner. The results show that the age-standardised rates of health care utilisation for stroke, heart attack, arthroplasty and severe trauma decreased when the first wave of the COVID-19 pandemic hit in early 2020. The time to first treatment of breast cancer patients has increased in the majority of countries during the same time period. In the area of perinatal health, we observed that stillbirth rates showed a slight upward trend, while the singleton preterm rate decreased significantly. With regard to the influence of COVID-19 on mental health, some countries show either a constant, but majorly an increasing trend in diagnosis of depression or anxiety.

Discussion: The research use case results paint a heterogeneous picture of the indirect effects of COVID-19 on population health. Various explanatory approaches by experts from respective countries analysed can help understanding these trends. The enhanced PHIRI federated research infrastructure will provide a variety of services and tools for data discovery, data access, data analysis and research outputs publication following FAIR (Findable, Accessible, Interoperable, Reusable) principles and will serve as a sustainable cornerstone for the European Health Data Space (EHDS).

The authors declare that they have no competing interests.

The authors declare that a positive ethics committee vote has been obtained.