Risk of COVID-19 in shielded and nursing care home patients: a cohort study in general practice

TY - JOUR

T1 - Risk of COVID-19 in shielded and nursing care home patients

T2 - a cohort study in general practice

AU - Wingfield, David

AU - Sharabiani, Mansour Taghavi Azar

AU - Majeed, Azeem

AU - Molokhia, Mariam

N1 - Funding Information: This research was in part supported by the National Institute for Health Research (NIHR) Applied Research Collaboration NW London. MM is supported by the Biomedical Research Centre at Guy’s and St Thomas' NHS Foundation Trust and King’s College London and the NIHR Applied Research Collaboration South London. The authors acknowledge the support of the Hammersmith and Fulham GP Partnership. The views expressed are those of the authors and not necessarily those of the Hammersmith and Fulham GP Partnership, the NHS, the NIHR, or the Department of Health and Social Care. Publisher Copyright: © 2021, The Authors

PY - 2021

Y1 - 2021

N2 - Background: COVID-19 cases were first detected in the UK in January 2020 and vulnerable patients were asked to shield from March to reduce their risk of COVID-19 infection. Aim: To determine the risk and determinants of COVID-19 diagnosis in shielded versus non-shielded groups, adjusted for key comorbidities not explained by shielding. Design & setting: Retrospective cohort study of adults with COVID-19 infection between 1 February 2020 and 15 May 2020 in west London. Method: Individuals diagnosed with COVID-19 were identified in SystmOne records using clinical codes. Infection risks were adjusted for sociodemographic factors, nursing home status, and comorbidities. Results: Of 57 713 adults, 573 (1%) individuals were identified as shielded and 1074 adults had documented COVID-19 infections (1.9%). COVID-19 infection rate in the shielded group individuals compared with non-shielded adult individuals was 6.5% (n = 37/573) versus 1.8% (n = 1037/57 140), P<0.001. A multivariable fully adjusted Cox proportional hazards (CPH) regression identified that COVID-19 infection was increased with shielding status (adjusted hazard ratio [aHR] 1.52; 95% confidence interval [CI ] = 1.00 to 2.30; P = 0.048). Other determinants of COVID-19 infection included nursing home residency (aHR 7.05; 95% CI = 4.22 to 11.77 P<0.001); Black African (aHR 2.52; 95% CI = 1.99 to 3.18 P<0.001), Other (aHR 1.74; 95% CI = 1.42 to 2.13; P<0.001), Non-stated (aHR 1.70; 95% CI = 1.02 to 2.84; P = 0.04), or South Asian ethnic group (aHR 1.46; 95% CI = 1.10 to 1.93; P = 0.01); history of respiratory disease (aHR 1.51; 95% CI = 1.06 to 2.16; P = 0.02); deprivation (third versus least deprived Index of Multiple Deprivation [IMD] quintile) (aHR 1.25; 95% CI = 1.01 to 1.56; P = 0.05); obesity (body mass index [BMI] >30 kg/m2 ) (aHR 1.39; 95% CI = 1.18 to 1.63 P<0.001); and age (aHR 1.02; 95% CI = 1.01 to 1.02 P<0.001. Male sex was associated with lower risk of COVID-19 infection (aHR 0.71; 95% CI = 0.62 to 0.82 P<0.001). Conclusion: Shielded individuals had a higher COVID-19 infection rate compared with non-shielded individuals, after adjusting for sociodemographic factors, nursing home status, and comorbidities

AB - Background: COVID-19 cases were first detected in the UK in January 2020 and vulnerable patients were asked to shield from March to reduce their risk of COVID-19 infection. Aim: To determine the risk and determinants of COVID-19 diagnosis in shielded versus non-shielded groups, adjusted for key comorbidities not explained by shielding. Design & setting: Retrospective cohort study of adults with COVID-19 infection between 1 February 2020 and 15 May 2020 in west London. Method: Individuals diagnosed with COVID-19 were identified in SystmOne records using clinical codes. Infection risks were adjusted for sociodemographic factors, nursing home status, and comorbidities. Results: Of 57 713 adults, 573 (1%) individuals were identified as shielded and 1074 adults had documented COVID-19 infections (1.9%). COVID-19 infection rate in the shielded group individuals compared with non-shielded adult individuals was 6.5% (n = 37/573) versus 1.8% (n = 1037/57 140), P<0.001. A multivariable fully adjusted Cox proportional hazards (CPH) regression identified that COVID-19 infection was increased with shielding status (adjusted hazard ratio [aHR] 1.52; 95% confidence interval [CI ] = 1.00 to 2.30; P = 0.048). Other determinants of COVID-19 infection included nursing home residency (aHR 7.05; 95% CI = 4.22 to 11.77 P<0.001); Black African (aHR 2.52; 95% CI = 1.99 to 3.18 P<0.001), Other (aHR 1.74; 95% CI = 1.42 to 2.13; P<0.001), Non-stated (aHR 1.70; 95% CI = 1.02 to 2.84; P = 0.04), or South Asian ethnic group (aHR 1.46; 95% CI = 1.10 to 1.93; P = 0.01); history of respiratory disease (aHR 1.51; 95% CI = 1.06 to 2.16; P = 0.02); deprivation (third versus least deprived Index of Multiple Deprivation [IMD] quintile) (aHR 1.25; 95% CI = 1.01 to 1.56; P = 0.05); obesity (body mass index [BMI] >30 kg/m2 ) (aHR 1.39; 95% CI = 1.18 to 1.63 P<0.001); and age (aHR 1.02; 95% CI = 1.01 to 1.02 P<0.001. Male sex was associated with lower risk of COVID-19 infection (aHR 0.71; 95% CI = 0.62 to 0.82 P<0.001). Conclusion: Shielded individuals had a higher COVID-19 infection rate compared with non-shielded individuals, after adjusting for sociodemographic factors, nursing home status, and comorbidities

KW - Covid-19

KW - Ethnic groups

KW - General practice

KW - Nursing homes

KW - Primary healthcare

KW - Shielding

UR - http://www.scopus.com/inward/record.url?scp=85123575863&partnerID=8YFLogxK

U2 - 10.3399/BJGPO.2021.0081

DO - 10.3399/BJGPO.2021.0081

M3 - Article

AN - SCOPUS:85123575863

SN - 2398-3795

VL - 5

JO - BJGP Open

JF - BJGP Open

IS - 6

ER -