The Effects of India’s COVID-19 Lockdown on Critical Non-COVID Health Care and Outcomes: Evidence from a Retrospective Cohort Analysis of Dialysis Patients

India’s COVID-19 lockdown, one of the most severe in the world, is widely believed to have disrupted critical non-COVID health services. However, linking these disruptions to effects on health outcomes has been difficult due to the lack of reliable, up-to-date health outcomes data. We identified all dialysis patients under a statewide health insurance program in Rajasthan, India, and conducted surveys to examine the effects of the lockdown on care access, morbidity, and mortality. 63% of patients experienced a disruption to their care. Transport barriers, hospital service disruptions, and difficulty obtaining medicines were the most common causes. We compared monthly mortality in the four months after the lockdown with pre-lockdown mortality trends, as well as with mortality trends for a similar cohort in the previous year. Mortality in May 2020, after a month of exposure to the lockdown, was 1.70 percentage points or 64% (p=0.01) higher than in March 2020 and total excess mortality between April and July was estimated to be 22%. Morbidity, hospitalization, and mortality between May and July were strongly positively associated with lockdown-related disruptions to care, providing further evidence that the uptick in mortality was driven by the lockdown. Females, socioeconomically disadvantaged groups, and patients living far from the health system faced worse outcomes. The results highlight the unintended consequences of the lockdown on critical, life-saving non-COVID health services that must be taken into account in the implementation of future policy efforts to control the spread of pandemics.