Healthcare utilisation, symptoms, prescriptions and new disease in people with COVID-19 managed in the community or hospital.

Date of Approval: 
2021-03-16 00:00:00
Lay Summary: 
It is increasingly understood that there is a wide range of symptoms and consequences amongst people with COVID-19. Whilst those who have been hospitalised often have ongoing symptoms due to severity of illness, there is increasing concern that those who have “mild disease” (i.e. managed in the community) may also be at risk of ongoing symptoms and development of new diseases beyond initial illness. We aim to describe the symptom profiles, healthcare use and new diseases following COVID-19 infection in a group of people who test positive and are not hospitalised, those who are hospitalised, and if numbers allow, those who may have possible COVID-19 infection.
Technical Summary: 
Little is known about ongoing symptoms, healthcare utilisation and incidence of new disease among people with confirmed or possible COVID-19, and how this differs relative to severity of COVID-19 illness (i.e. those who are hospitalised). This will be a retrospective cohort study using routinely collected primary care records from CPRD Aurum in the first instance, followed by use of linked data from HES and ONS when more recent data are available. The study cohort will include adults who tested positive for COVID-19 or were diagnosed with possible COVID-19 between August - October 2020, with subsequent follow up until the end of data collection. We will describe outcomes between patients who were hospitalized with COVID-19 and patients who tested positive for COVID-19 but did not require hospitalization and if numbers allow, in those with possible COVID-19. We will estimate incidence of predefined symptoms, diseases, prescriptions and healthcare utilisation (including referral to hospital). We will use negative binomial regression to compare incidence rates based on aggregate level data taking into account the magnitude of both the numerator and denominator of interest. We plan to repeat analyses with a longer follow up period and with linked hospital and mortality data as they become available. The study cohort will include adults who tested positive for COVID-19 or were diagnosed with possible COVID-19 between August - February 2021.
Health Outcomes to be Measured: 
Our study period will only include people who test positive from August onwards, so essentially wave 2 and the time of wider testing to try to mitigate the fact people diagnosed in wave 1 are so different from those identified in wave 2. We will acknowledge the issue of occupational screening in the limitations. We will also look at people who test positive for covid post vaccine as we appreciate this may alter outcomes. Outcomes to be measured 1.Incidence of new symptoms following COVID-19: including respiratory (upper and lower), cardiovascular, gastrointestinal, musculoskeletal, dermatological, neurological, psychological and general 2.Incidence of new non-communicable diseases: including cardiovascular, respiratory, gastrointestinal, endocrine, renal, psychological/psychiatric conditions 3.Incidence of new medication prescriptions including inhalers, analgesics, diuretics 4.Healthcare utilisation, including referral to hospital 5. Difference in risk or rate of outcomes and healthcare use across patients post-COVID-19 diagnosis versus 12 months prior to COVID-19 6. Monthly rates of outcomes post-COVID-19 diagnosis 7. Difference in rates of outcomes and healthcare use across individuals who tested positive for COVID-19 and who subsequently received a vaccine for COVID-19, post versus pre vaccination timeframe.
Application Number: 
21_000370
Collaborators: 

Jennifer Quint - Chief Investigator - Imperial College London
Jennifer Quint - Corresponding Applicant - Imperial College London
Ann Morgan - Collaborator - Imperial College London
Ardita Koteci - Collaborator - Imperial College London
Chukwuma Iwundu - Collaborator - Imperial College London
Claudia Gulea - Collaborator - Imperial College London
Constantinos Kallis - Collaborator - Imperial College London
Hannah Whittaker - Collaborator - Imperial College London
Mark Weeks - Collaborator - Imperial College London
Rikisha Shah Gupta - Collaborator - Imperial College London

Linkages: 
HES Accident and Emergency;HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation