ABSTRACT
Background: Adverse events of special interest (AESIs) were pre-specified to be monitored for the COVID-19 vaccines. Some AESIs are not only associated with the vaccines, but with COVID-19. Our aim was to characterise the incidence rates of AESIs following SARS-CoV-2 infection in patients and compare these to historical rates in the general population. Methods: A multi-national cohort study with data from primary care, electronic health records, and insurance claims mapped to a common data model. This study's evidence was collected between Jan 1, 2017 and the conclusion of each database (which ranged from Jul 2020 to May 2022). The 16 pre-specified prevalent AESIs were: acute myocardial infarction, anaphylaxis, appendicitis, Bell's palsy, deep vein thrombosis, disseminated intravascular coagulation, encephalomyelitis, Guillain- Barré syndrome, haemorrhagic stroke, non-haemorrhagic stroke, immune thrombocytopenia, myocarditis/pericarditis, narcolepsy, pulmonary embolism, transverse myelitis, and thrombosis with thrombocytopenia. Age-sex standardised incidence rate ratios (SIR) were estimated to compare post-COVID-19 to pre-pandemic rates in each of the databases. Findings: Substantial heterogeneity by age was seen for AESI rates, with some clearly increasing with age but others following the opposite trend. Similarly, differences were also observed across databases for same health outcome and age-sex strata. All studied AESIs appeared consistently more common in the post-COVID-19 compared to the historical cohorts, with related meta-analytic SIRs ranging from 1.32 (1.05 to 1.66) for narcolepsy to 11.70 (10.10 to 13.70) for pulmonary embolism. Interpretation: Our findings suggest all AESIs are more common after COVID-19 than in the general population. Thromboembolic events were particularly common, and over 10-fold more so. More research is needed to contextualise post-COVID-19 complications in the longer term. Funding: None.
ABSTRACT
BACKGROUND: People with learning disabilities have higher rates of admitted patient care than the general population. This study explored emergency hospital admissions during 2018/19 in association with learning disability health check recording in general practice within the Kent Integrated Dataset during 2016/17 to 2018/19. METHODS: Multiple logistic regression evaluated the odds of emergency hospital admission by sex, age, deprivation, residence, risk score, long-term conditions, severe health needs and health check. During 2018/19, one or more emergency hospital admissions were recorded for 10.9% of the 5,759 persons recorded with learning disability. RESULTS: There were lower odds of emergency hospital admission in persons having had learning disability health check in the past 3 years even after adjustment. CONCLUSIONS: Comparison to nationally representative research suggests a consistent finding of benefit from learning disability health check on indicators of unplanned care use, supporting the view that learning disability health checks facilitate the addressing of key health needs.
Subject(s)
Intellectual Disability , Learning Disabilities , Data Analysis , Emergency Service, Hospital , Hospitals , Humans , Learning Disabilities/epidemiologyABSTRACT
BACKGROUND: Obesity is a significant health issue and key public health priority. This study explored body mass index (BMI) recording in general practice within the Kent Integrated Dataset. METHODS: Using a sample aged 18-100 years, resident within Kent, who were alive and currently registered to a Kent general practice as of 6 August 2018 within the Kent Integrated Dataset. We identified the latest BMI from event records between 2015/2016 and 2017/2018. Recording was evaluated by sex, age, deprivation, hypertension, serious mental illness and multimorbidity. RESULTS: Between 2015/2016 and 2017/2018 using the sample of 1 154 652 persons, BMI was recorded for 43.7% of the sample. Multiple logistic regression showed that BMI recording was higher in females, the middle age bands, persons living in the most deprived areas and within persons who were hypertensive, had serious mental illness or were multimorbid. CONCLUSIONS: Findings were aligned to previous research using nationally representative samples. Completeness of recording varied by age, sex, deprivation and comorbidity. Recording within general practice was aligned to chronic disease management. From a prevention perspective, earlier assessment and intervention for the management of excess weight within primary care may be an opportunity for avoiding increases in BMI trajectory. There may also be merit in recognising that the external disease agents that influence obesity can be controlled or reduced (obesogenic environment) from a national policy perspective. Such a perspective may also help reduce stigmatisation and the pressure around arguments that centre on personal responsibility for obesity.
