The impact of primary care supported shielding on the risk of mortality in people vulnerable to COVID-19: English sentinel network matched cohort study.
J Infect
; 83(2): 228-236, 2021 08.
Article
in English
| MEDLINE | ID: covidwho-1230619
ABSTRACT
OBJECTIVES:
To mitigate risk of mortality from coronavirus 2019 infection (COVID-19), the UK government recommended 'shielding' of vulnerable people through self-isolation for 12 weeks.METHODS:
A retrospective cohort study using a nationally representative English primary care database comparing people aged >= 40 years who were recorded as being advised to shield using a fixed ratio of 11, matching to people with the same diagnoses not advised to shield (nâ¯=â¯77,360 per group). Time-to-death was compared using Cox regression, reporting the hazard ratio (HR) of mortality between groups. A sensitivity analysis compared exact matched cohorts (nâ¯=â¯24,752 shielded, nâ¯=â¯61,566 exact matches).RESULTS:
We found a time-varying HR of mortality between groups. In the first 21 days, the mortality risk in people shielding was half those not (HRâ¯=â¯0.50, 95%CI0.41-0.59. p < 0.0001). Over the remaining nine weeks, mortality risk was 54% higher in the shielded group (HR=1.54, 95%CI1.41-1.70, p < 0.0001). Beyond the shielding period, mortality risk was over two-and-a-half times higher in the shielded group (HR=2.61, 95%CI2.38-2.87, p < 0.0001).CONCLUSIONS:
Shielding halved the risk of mortality for 21 days. Mortality risk became higher across the remainder of the shielding period, rising to two-and-a-half times greater post-shielding. Shielding may be beneficial in the next wave of COVID-19.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
COVID-19
Type of study:
Cohort study
/
Experimental Studies
/
Observational study
/
Prognostic study
/
Randomized controlled trials
Limits:
Humans
Language:
English
Journal:
J Infect
Year:
2021
Document Type:
Article
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