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Calvert C, Brockway MM, Zoega H, Miller JE, Been JV, Amegah AK, Racine-Poon A, Oskoui SE, Abok II, Aghaeepour N, Akwaowo CD, Alshaikh BN, Ayede AI, Bacchini F, Barekatain B, Barnes R, Bebak K, Berard A, Bhutta ZA, Brook JR, Bryan LR, Cajachagua-Torres KN, Campbell-Yeo M, Chu DT, Connor KL, Cornette L, Cortés S, Daly M, Debauche C, Dedeke IOF, Einarsdóttir K, Engjom H, Estrada-Gutierrez G, Fantasia I, Fiorentino NM, Franklin M, Fraser A, Gachuno OW, Gallo LA, Gissler M, Håberg SE, Habibelahi A, Häggström J, Hookham L, Hui L, Huicho L, Hunter KJ, Huq S, Kc A, Kadambari S, Kelishadi R, Khalili N, Kippen J, Le Doare K, Llorca J, Magee LA, Magnus MC, Man KKC, Mburugu PM, Mediratta RP, Morris AD, Muhajarine N, Mulholland RH, Bonnard LN, Nakibuuka V, Nassar N, Nyadanu SD, Oakley L, Oladokun A, Olayemi OO, Olutekunbi OA, Oluwafemi RO, Ogunkunle TO, Orton C, Örtqvist AK, Ouma J, Oyapero O, Palmer KR, Pedersen LH, Pereira G, Pereyra I, Philip RK, Pruski D, Przybylski M, Quezada-Pinedo HG, Regan AK, Rhoda NR, Rihs TA, Riley T, Rocha TAH, Rolnik DL, Saner C, Schneuer FJ, Souter VL, Stephansson O, Sun S, Swift EM, Szabó M, Temmerman M, Tooke L, Urquia ML, von Dadelszen P, Wellenius GA, Whitehead C, Wong ICK, Wood R, Wróblewska-Seniuk K, Yeboah-Antwi K, Yilgwan CS, Zawiejska A, Sheikh A, Rodriguez N, Burgner D, Stock SJ, Azad MB. Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries. Nat Hum Behav 2023; 7:529-544. [PMID: 36849590 PMCID: PMC10129868 DOI: 10.1038/s41562-023-01522-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 01/06/2023] [Indexed: 03/01/2023]
Abstract
Preterm birth (PTB) is the leading cause of infant mortality worldwide. Changes in PTB rates, ranging from -90% to +30%, were reported in many countries following early COVID-19 pandemic response measures ('lockdowns'). It is unclear whether this variation reflects real differences in lockdown impacts, or perhaps differences in stillbirth rates and/or study designs. Here we present interrupted time series and meta-analyses using harmonized data from 52 million births in 26 countries, 18 of which had representative population-based data, with overall PTB rates ranging from 6% to 12% and stillbirth ranging from 2.5 to 10.5 per 1,000 births. We show small reductions in PTB in the first (odds ratio 0.96, 95% confidence interval 0.95-0.98, P value <0.0001), second (0.96, 0.92-0.99, 0.03) and third (0.97, 0.94-1.00, 0.09) months of lockdown, but not in the fourth month of lockdown (0.99, 0.96-1.01, 0.34), although there were some between-country differences after the first month. For high-income countries in this study, we did not observe an association between lockdown and stillbirths in the second (1.00, 0.88-1.14, 0.98), third (0.99, 0.88-1.12, 0.89) and fourth (1.01, 0.87-1.18, 0.86) months of lockdown, although we have imprecise estimates due to stillbirths being a relatively rare event. We did, however, find evidence of increased risk of stillbirth in the first month of lockdown in high-income countries (1.14, 1.02-1.29, 0.02) and, in Brazil, we found evidence for an association between lockdown and stillbirth in the second (1.09, 1.03-1.15, 0.002), third (1.10, 1.03-1.17, 0.003) and fourth (1.12, 1.05-1.19, <0.001) months of lockdown. With an estimated 14.8 million PTB annually worldwide, the modest reductions observed during early pandemic lockdowns translate into large numbers of PTB averted globally and warrant further research into causal pathways.
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Affiliation(s)
- Clara Calvert
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Meredith Merilee Brockway
- Children's Hospital Research Institute of Manitoba, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Helga Zoega
- School of Population Health, Faculty of Medicine & Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Jessica E Miller
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Jasper V Been
- Division of Neonatology, Department of Paediatrics; Department of Obstetrics and Gynaecology; Department of Public Health; Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Adeladza Kofi Amegah
- Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana
| | | | | | - Ishaya I Abok
- Department of Pediatrics, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Nima Aghaeepour
- Department of Anesthesiology, Pain, and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Christie D Akwaowo
- Institute of Health Research and Development, University of Uyo Teaching Hospital, Uyo, Nigeria
- College of Health Sciences, University of Uyo, Uyo, Nigeria
| | - Belal N Alshaikh
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Adejumoke I Ayede
- Department of Pediatrics, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | | | - Behzad Barekatain
- Department of Pediatrics, Division of Neonatology, Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Karolina Bebak
- Obstetrics and Gynaecology Ward, District Public Hospital in Poznań, Poznań, Poland
| | - Anick Berard
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
- CHU Ste-Justine, Montreal, Quebec, Canada
- Faculty of Medicine, Université Claude Bernard Lyon 1, Lyon, France
| | - Zulfiqar A Bhutta
- Center of Excellence in Women Child Health, The Aga Khan University, Karachi, Pakistan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jeffrey R Brook
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lenroy R Bryan
- Department of Obstetrics & Gynaecology and Child Health, University of The West MonaIndies, Mona, Jamaica
| | - Kim N Cajachagua-Torres
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- The Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Centro de Investigación en Salud Materna e Infantil and Centro de Investigación para el Desarrollo Integral y Sostenible, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Marsha Campbell-Yeo
- School of Nursing, Dalhousie University and IWK Health, Halifax, Nova Scotia, Canada
| | - Dinh-Toi Chu
- Center for Biomedicine and Community Health, International School, Vietnam National University, Hanoi, Vietnam
| | - Kristin L Connor
- Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada
| | - Luc Cornette
- AZ St-Jan Bruges-Ostend AV Hospital, Bruges, Belgium
| | - Sandra Cortés
- Department of Public Health, School of Medicine, Advanced Center for Chronic Diseases Diagonal (ACCDIS), Santiago, Chile
| | - Mandy Daly
- Irish Neonatal Health Alliance, Wicklow, Ireland
| | - Christian Debauche
- Department of Neonatology, Cliniques Universitaires Saint-Luc, IREC, UCLouvain, Brussels, Belgium
- CEpiP (Centre d'Epidémiologie Périnatale), Brussels, Belgium
| | | | - Kristjana Einarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Hilde Engjom
- Department of Health Registry Research and Development, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Ilaria Fantasia
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo Children's Hospital, Trieste, Italy
| | - Nicole M Fiorentino
- Children's Hospital Research Institute of Manitoba, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Meredith Franklin
- Department of Statistical Sciences and School of the Environment, University of Toronto, Toronto, Ontario, Canada
| | - Abigail Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Onesmus W Gachuno
- Obstetrics and Gynecology, Medicine, University of Nairobi, Nairobi, Kenya
| | - Linda A Gallo
- School of Biomedical Sciences, The University of Queensland, St. Lucia, Queensland, Australia
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Siri E Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Abbas Habibelahi
- Neonatology, Neonatal Health Office, Ministry of Health and Medical Education, Tehran, Iran
| | | | - Lauren Hookham
- St. George's University, Makerere University - Johns Hopkins University Research Collaboration, London, UK
| | - Lisa Hui
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Luis Huicho
- Centro de Investigación en Salud Materna e Infantil, Centro de Investigación para el Desarrollo Integral y Sostenible and School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Sayeeda Huq
- Nutrition and Clinical Services Division, ICDDR,B (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | | | - Seilesh Kadambari
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Narjes Khalili
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Joanna Kippen
- Obstetrics and Gynaecology Ward, District Public Hospital in Poznań, Poznań, Poland
| | - Kirsty Le Doare
- International Centre for Neonatal and Paediatric Infection, St. George's, University of London, London, UK
- Medical Research Council/Uganda Virus Research Institute and London School of Medical Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Javier Llorca
- Universidad de Cantabria, Santander, Spain
- CIBERESP (Consortium for Biomedical Research in Epidemiology & Public Health, en Epidemiología y Salud Pública), Madrid, Spain
| | - Laura A Magee
- Institute of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Maria C Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Kenneth K C Man
- Research Department of Practice and Policy, University College London School of Pharmacy, London, UK
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
- Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong, Hong Kong
| | - Patrick M Mburugu
- Department of Child Health and Paediatrics, School of Medicine, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Rishi P Mediratta
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Nazeem Muhajarine
- Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Livia Nagy Bonnard
- Melletted a helyem Egyesület, Right(s) Beside You Association, Budapest, Hungary
| | - Victoria Nakibuuka
- Department of Paediatrics, St. Francis Nsambya Hospital, Kampala, Uganda
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sylvester D Nyadanu
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Education, Culture, and Health Opportunities (ECHO) Research Group International, Aflao, Ghana
| | - Laura Oakley
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Adesina Oladokun
- Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Oladapo O Olayemi
- Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | | | - Rosena O Oluwafemi
- Department of Paediatrics and Child Health, Mother and Child Hospital, Akure, Nigeria
| | - Taofik O Ogunkunle
- Department of Paediatrics, Dalhatu Araf Specialist Hospital, Lafia, Nigeria
| | | | - Anne K Örtqvist
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Visby County Hospital, Visby, Sweden
| | - Joseph Ouma
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Oyejoke Oyapero
- Paediatrics Department, Ikorodu General Hospital, Ikorodu, Nigeria
| | - Kirsten R Palmer
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Lars H Pedersen
- Department of Obstetrics and Gynecology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Gavin Pereira
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Curtin School of Population Health and enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Isabel Pereyra
- School of Nutrition, Catholic University del Maule, Region del Maule, Chile
| | - Roy K Philip
- Division of Neonatology, Department of Paediatrics, University Maternity Hospital Limerick and University of Limerick School of Medicine, Limerick, Ireland
| | - Dominik Pruski
- Obstetrics and Gynaecology Ward, District Public Hospital in Poznań, Poznań, Poland
| | - Marcin Przybylski
- Obstetrics and Gynaecology Ward, District Public Hospital in Poznań, Poznań, Poland
| | - Hugo G Quezada-Pinedo
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- The Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Centro de Investigación en Salud Materna e Infantil and Centro de Investigación para el Desarrollo Integral y Sostenible, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Annette K Regan
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | - Natasha R Rhoda
- Paediatric Department, School of Adolescent and Child Health, University of Cape Town, Cape Town, South Africa
- Mowbray Maternity Hospital, Western Cape Department of Health, Cape Town, South Africa
| | - Tonia A Rihs
- Federal Statistical Office (FSO), Neuchâtel, Switzerland
| | - Taylor Riley
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Thiago Augusto Hernandes Rocha
- Evidence and Intelligence for Action in Health Department, Pan-American Health Organization - World Health Organization, Washington, DC, USA
| | - Daniel L Rolnik
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Christoph Saner
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
- Division of Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Francisco J Schneuer
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Olof Stephansson
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Shengzhi Sun
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Emma M Swift
- Faculty of Nursing, Department of Midwifery, University of Iceland, Reykjavík, Iceland
| | - Miklós Szabó
- Division of Neonatology, 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Marleen Temmerman
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Lloyd Tooke
- Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Marcelo L Urquia
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Peter von Dadelszen
- Institute of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Clare Whitehead
- The Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Ian C K Wong
- Research Department of Practice and Policy, University College London School of Pharmacy, London, UK
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
- Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong, Hong Kong
| | - Rachael Wood
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Public Health Scotland, Edinburgh, UK
| | | | - Kojo Yeboah-Antwi
- Public Health Unit, Father Thomas Alan Rooney Memorial Hospital, Asankrangwa, Western Region, Ghana
| | | | - Agnieszka Zawiejska
- Department of Medical Simulation, Chair of Medical Education, Poznań University of Medical Sciences, Poznań, Poland
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Natalie Rodriguez
- Children's Hospital Research Institute of Manitoba, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David Burgner
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
| | - Sarah J Stock
- Usher Institute, University of Edinburgh, Edinburgh, UK.
| | - Meghan B Azad
- Children's Hospital Research Institute of Manitoba, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.
- Departments of Pediatrics and Child Health, Community Health Sciences, and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada, Winnipeg, Manitoba, Canada.
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2
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Shah SA, Mulholland RH, Wilkinson S, Katikireddi SV, Pan J, Shi T, Kerr S, Agrawal U, Rudan I, Simpson CR, Stock SJ, Macleod J, Murray JLK, McCowan C, Ritchie L, Woolhouse M, Sheikh A. Impact on emergency and elective hospital-based care in Scotland over the first 12 months of the pandemic: interrupted time-series analysis of national lockdowns. J R Soc Med 2022; 115:429-438. [PMID: 35502909 PMCID: PMC9723811 DOI: 10.1177/01410768221095239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 04/07/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES COVID-19 has resulted in the greatest disruption to National Health Service (NHS) care in its over 70-year history. Building on our previous work, we assessed the ongoing impact of pandemic-related disruption on provision of emergency and elective hospital-based care across Scotland over the first year of the pandemic. DESIGN We undertook interrupted time-series analyses to evaluate the impact of ongoing pandemic-related disruption on hospital NHS care provision at national level and across demographics and clinical specialties spanning the period 29 March 2020-28 March 2021. SETTING Scotland, UK. PARTICIPANTS Patients receiving hospital care from NHS Scotland. MAIN OUTCOME MEASURES We used the percentage change of accident and emergency attendances, and emergency and planned hospital admissions during the pandemic compared to the average admission rate for equivalent weeks in 2018-2019. RESULTS As restrictions were gradually lifted in Scotland after the first lockdown, hospital-based admissions increased approaching pre-pandemic levels. Subsequent tightening of restrictions in September 2020 were associated with a change in slope of relative weekly admissions rate: -1.98% (-2.38, -1.58) in accident and emergency attendance, -1.36% (-1.68, -1.04) in emergency admissions and -2.31% (-2.95, -1.66) in planned admissions. A similar pattern was seen across sex, socioeconomic status and most age groups, except children (0-14 years) where accident and emergency attendance, and emergency admissions were persistently low over the study period. CONCLUSIONS We found substantial disruption to urgent and planned inpatient healthcare provision in hospitals across NHS Scotland. There is the need for urgent policy responses to address continuing unmet health needs and to ensure resilience in the context of future pandemics.
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Affiliation(s)
- Syed Ahmar Shah
- Usher Institute, Edinburgh Medical School, University of
Edinburgh, Edinburgh, EH16 4UX UK
| | - Rachel H Mulholland
- Usher Institute, Edinburgh Medical School, University of
Edinburgh, Edinburgh, EH16 4UX UK
| | - Samantha Wilkinson
- Usher Institute, Edinburgh Medical School, University of
Edinburgh, Edinburgh, EH16 4UX UK
| | | | - Jiafeng Pan
- Department of Mathematics and Statistics, University of
Strathclyde, Glasgow, G1 1XH UK
| | - Ting Shi
- Usher Institute, Edinburgh Medical School, University of
Edinburgh, Edinburgh, EH16 4UX UK
| | - Steven Kerr
- Usher Institute, Edinburgh Medical School, University of
Edinburgh, Edinburgh, EH16 4UX UK
| | - Uktarsh Agrawal
- School of Medicine, University of St. Andrews, St Andrews, KY16
9TF UK
| | - Igor Rudan
- Usher Institute, Edinburgh Medical School, University of
Edinburgh, Edinburgh, EH16 4UX UK
| | - Colin R Simpson
- Usher Institute, Edinburgh Medical School, University of
Edinburgh, Edinburgh, EH16 4UX UK
- School of Health, Wellington Faculty of Health, Victoria
University of Wellington, PO Box 600,Wellington 6140 New Zealand
| | - Sarah J Stock
- Usher Institute, Edinburgh Medical School, University of
Edinburgh, Edinburgh, EH16 4UX UK
| | - John Macleod
- The National Institute for Health Research Applied Research
Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston
NHS Foundation Trust, Bristol, BS1 2NT, UK
| | | | - Colin McCowan
- School of Medicine, University of St. Andrews, St Andrews, KY16
9TF UK
| | - Lewis Ritchie
- Academic Primary Care, University of Aberdeen School of Medicine
and Dentistry, Aberdeen, AB24 3FX UK
| | - Mark Woolhouse
- Usher Institute, Edinburgh Medical School, University of
Edinburgh, Edinburgh, EH16 4UX UK
| | - Aziz Sheikh
- Usher Institute, Edinburgh Medical School, University of
Edinburgh, Edinburgh, EH16 4UX UK
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Daines L, Mulholland RH, Vasileiou E, Hammersley V, Weatherill D, Katikireddi SV, Kerr S, Moore E, Pesenti E, Quint JK, Shah SA, Shi T, Simpson CR, Robertson C, Sheikh A. Deriving and validating a risk prediction model for long COVID-19: protocol for an observational cohort study using linked Scottish data. BMJ Open 2022; 12:e059385. [PMID: 35793922 PMCID: PMC9260199 DOI: 10.1136/bmjopen-2021-059385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 06/17/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION COVID-19 is commonly experienced as an acute illness, yet some people continue to have symptoms that persist for weeks, or months (commonly referred to as 'long-COVID'). It remains unclear which patients are at highest risk of developing long-COVID. In this protocol, we describe plans to develop a prediction model to identify individuals at risk of developing long-COVID. METHODS AND ANALYSIS We will use the national Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) platform, a population-level linked dataset of routine electronic healthcare data from 5.4 million individuals in Scotland. We will identify potential indicators for long-COVID by identifying patterns in primary care data linked to information from out-of-hours general practitioner encounters, accident and emergency visits, hospital admissions, outpatient visits, medication prescribing/dispensing and mortality. We will investigate the potential indicators of long-COVID by performing a matched analysis between those with a positive reverse transcriptase PCR (RT-PCR) test for SARS-CoV-2 infection and two control groups: (1) individuals with at least one negative RT-PCR test and never tested positive; (2) the general population (everyone who did not test positive) of Scotland. Cluster analysis will then be used to determine the final definition of the outcome measure for long-COVID. We will then derive, internally and externally validate a prediction model to identify the epidemiological risk factors associated with long-COVID. ETHICS AND DISSEMINATION The EAVE II study has obtained approvals from the Research Ethics Committee (reference: 12/SS/0201), and the Public Benefit and Privacy Panel for Health and Social Care (reference: 1920-0279). Study findings will be published in peer-reviewed journals and presented at conferences. Understanding the predictors for long-COVID and identifying the patient groups at greatest risk of persisting symptoms will inform future treatments and preventative strategies for long-COVID.
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Affiliation(s)
- Luke Daines
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | | | | | | | | | - Steven Kerr
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Emily Moore
- Public Health Scotland, Glasgow and Edinburgh, UK
| | - Elisa Pesenti
- Institute of Cell Biology, University of Edinburgh, Edinburgh, UK
| | - Jennifer K Quint
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Ting Shi
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Colin R Simpson
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Chris Robertson
- Public Health Scotland, Glasgow and Edinburgh, UK
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
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4
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Närhi F, Moonesinghe SR, Shenkin SD, Drake TM, Mulholland RH, Donegan C, Dunning J, Fairfield CJ, Girvan M, Hardwick HE, Ho A, Leeming G, Nguyen-Van-Tam JS, Pius R, Russell CD, Shaw CA, Spencer RG, Turtle L, Openshaw PJM, Baillie JK, Harrison EM, Semple MG, Docherty AB. Implementation of corticosteroids in treatment of COVID-19 in the ISARIC WHO Clinical Characterisation Protocol UK: prospective, cohort study. Lancet Digit Health 2022; 4:e220-e234. [PMID: 35337642 PMCID: PMC8940185 DOI: 10.1016/s2589-7500(22)00018-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/16/2021] [Accepted: 01/13/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Dexamethasone was the first intervention proven to reduce mortality in patients with COVID-19 being treated in hospital. We aimed to evaluate the adoption of corticosteroids in the treatment of COVID-19 in the UK after the RECOVERY trial publication on June 16, 2020, and to identify discrepancies in care. METHODS We did an audit of clinical implementation of corticosteroids in a prospective, observational, cohort study in 237 UK acute care hospitals between March 16, 2020, and April 14, 2021, restricted to patients aged 18 years or older with proven or high likelihood of COVID-19, who received supplementary oxygen. The primary outcome was administration of dexamethasone, prednisolone, hydrocortisone, or methylprednisolone. This study is registered with ISRCTN, ISRCTN66726260. FINDINGS Between June 17, 2020, and April 14, 2021, 47 795 (75·2%) of 63 525 of patients on supplementary oxygen received corticosteroids, higher among patients requiring critical care than in those who received ward care (11 185 [86·6%] of 12 909 vs 36 415 [72·4%] of 50 278). Patients 50 years or older were significantly less likely to receive corticosteroids than those younger than 50 years (adjusted odds ratio 0·79 [95% CI 0·70-0·89], p=0·0001, for 70-79 years; 0·52 [0·46-0·58], p<0·0001, for >80 years), independent of patient demographics and illness severity. 84 (54·2%) of 155 pregnant women received corticosteroids. Rates of corticosteroid administration increased from 27·5% in the week before June 16, 2020, to 75-80% in January, 2021. INTERPRETATION Implementation of corticosteroids into clinical practice in the UK for patients with COVID-19 has been successful, but not universal. Patients older than 70 years, independent of illness severity, chronic neurological disease, and dementia, were less likely to receive corticosteroids than those who were younger, as were pregnant women. This could reflect appropriate clinical decision making, but the possibility of inequitable access to life-saving care should be considered. FUNDING UK National Institute for Health Research and UK Medical Research Council.
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Affiliation(s)
- Fiina Närhi
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - S Ramani Moonesinghe
- Department for Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK; Health Services Research Centre, National Institute for Academic Anaesthesia, Royal College of Anaesthetists, London, UK
| | | | - Thomas M Drake
- Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
| | | | - Cara Donegan
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Jake Dunning
- Faculty of Medicine, Imperial College London, London, UK
| | | | - Michelle Girvan
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Hayley E Hardwick
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Antonia Ho
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Gary Leeming
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Jonathan S Nguyen-Van-Tam
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK; UK Department of Health and Social Care, Field Epidemiology Service, London, UK
| | - Riinu Pius
- Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
| | - Clark D Russell
- Usher Institute, Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Catherine A Shaw
- Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
| | | | - Lance Turtle
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | | | | | - Ewen M Harrison
- Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
| | - Malcolm G Semple
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
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Agrawal U, Katikireddi SV, McCowan C, Mulholland RH, Azcoaga-Lorenzo A, Amele S, Fagbamigbe AF, Vasileiou E, Grange Z, Shi T, Kerr S, Moore E, Murray JLK, Shah SA, Ritchie L, O'Reilly D, Stock SJ, Beggs J, Chuter A, Torabi F, Akbari A, Bedston S, McMenamin J, Wood R, Tang RSM, de Lusignan S, Hobbs FDR, Woolhouse M, Simpson CR, Robertson C, Sheikh A. COVID-19 hospital admissions and deaths after BNT162b2 and ChAdOx1 nCoV-19 vaccinations in 2·57 million people in Scotland (EAVE II): a prospective cohort study. Lancet Respir Med 2021; 9:1439-1449. [PMID: 34599903 PMCID: PMC8480963 DOI: 10.1016/s2213-2600(21)00380-5] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The UK COVID-19 vaccination programme has prioritised vaccination of those at the highest risk of COVID-19 mortality and hospitalisation. The programme was rolled out in Scotland during winter 2020-21, when SARS-CoV-2 infection rates were at their highest since the pandemic started, despite social distancing measures being in place. We aimed to estimate the frequency of COVID-19 hospitalisation or death in people who received at least one vaccine dose and characterise these individuals. METHODS We conducted a prospective cohort study using the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) national surveillance platform, which contained linked vaccination, primary care, RT-PCR testing, hospitalisation, and mortality records for 5·4 million people (around 99% of the population) in Scotland. Individuals were followed up from receiving their first dose of the BNT162b2 (Pfizer-BioNTech) or ChAdOx1 nCoV-19 (Oxford-AstraZeneca) COVID-19 vaccines until admission to hospital for COVID-19, death, or the end of the study period on April 18, 2021. We used a time-dependent Poisson regression model to estimate rate ratios (RRs) for demographic and clinical factors associated with COVID-19 hospitalisation or death 14 days or more after the first vaccine dose, stratified by vaccine type. FINDINGS Between Dec 8, 2020, and April 18, 2021, 2 572 008 individuals received their first dose of vaccine-841 090 (32·7%) received BNT162b2 and 1 730 918 (67·3%) received ChAdOx1. 1196 (<0·1%) individuals were admitted to hospital or died due to COVID-19 illness (883 hospitalised, of whom 228 died, and 313 who died due to COVID-19 without hospitalisation) 14 days or more after their first vaccine dose. These severe COVID-19 outcomes were associated with older age (≥80 years vs 18-64 years adjusted RR 4·75, 95% CI 3·85-5·87), comorbidities (five or more risk groups vs less than five risk groups 4·24, 3·34-5·39), hospitalisation in the previous 4 weeks (3·00, 2·47-3·65), high-risk occupations (ten or more previous COVID-19 tests vs less than ten previous COVID-19 tests 2·14, 1·62-2·81), care home residence (1·63, 1·32-2·02), socioeconomic deprivation (most deprived quintile vs least deprived quintile 1·57, 1·30-1·90), being male (1·27, 1·13-1·43), and being an ex-smoker (ex-smoker vs non-smoker 1·18, 1·01-1·38). A history of COVID-19 before vaccination was protective (0·40, 0·29-0·54). INTERPRETATION COVID-19 hospitalisations and deaths were uncommon 14 days or more after the first vaccine dose in this national analysis in the context of a high background incidence of SARS-CoV-2 infection and with extensive social distancing measures in place. Sociodemographic and clinical features known to increase the risk of severe disease in unvaccinated populations were also associated with severe outcomes in people receiving their first dose of vaccine and could help inform case management and future vaccine policy formulation. FUNDING UK Research and Innovation (Medical Research Council), Research and Innovation Industrial Strategy Challenge Fund, Scottish Government, and Health Data Research UK.
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Affiliation(s)
- Utkarsh Agrawal
- School of Medicine, University of St Andrews, St Andrews, UK
| | | | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | | | | | - Sarah Amele
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | | | | | | | - Ting Shi
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Steven Kerr
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | | | | | - Lewis Ritchie
- Academic Primary Care, University of Aberdeen School of Medicine and Dentistry, Aberdeen, UK
| | - Dermot O'Reilly
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, UK
| | - Sarah J Stock
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Jillian Beggs
- BREATHE-The Health Data Research Hub for Respiratory Health, Edinburgh, UK
| | - Antony Chuter
- BREATHE-The Health Data Research Hub for Respiratory Health, Edinburgh, UK
| | - Fatemah Torabi
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Stuart Bedston
- Population Data Science, Swansea University Medical School, Swansea, UK
| | | | - Rachael Wood
- Usher Institute, The University of Edinburgh, Edinburgh, UK; Public Health Scotland, Glasgow, UK
| | - Ruby S M Tang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mark Woolhouse
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Colin R Simpson
- Usher Institute, The University of Edinburgh, Edinburgh, UK; School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Chris Robertson
- Public Health Scotland, Glasgow, UK; Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK.
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6
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Mulholland RH, Vasileiou E, Simpson CR, Robertson C, Ritchie LD, Agrawal U, Woolhouse M, Murray JL, Stagg HR, Docherty AB, McCowan C, Wood R, Stock SJ, Sheikh A. Cohort Profile: Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) Database. Int J Epidemiol 2021; 50:1064-1074. [PMID: 34089614 PMCID: PMC8195245 DOI: 10.1093/ije/dyab028] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2021] [Indexed: 12/30/2022] Open
Affiliation(s)
| | | | - Colin R Simpson
- Usher Institute, University of Edinburgh, Edinburgh, UK.,School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK.,Public Health Scotland, Glasgow and Edinburgh, UK
| | - Lewis D Ritchie
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - Utkarsh Agrawal
- School of Medicine, University of St Andrews, St Andrews, UK
| | | | | | - Helen R Stagg
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Rachael Wood
- Usher Institute, University of Edinburgh, Edinburgh, UK.,Public Health Scotland, Glasgow and Edinburgh, UK
| | - Sarah J Stock
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
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7
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Docherty AB, Mulholland RH, Lone NI, Cheyne CP, De Angelis D, Diaz-Ordaz K, Donegan C, Drake TM, Dunning J, Funk S, García-Fiñana M, Girvan M, Hardwick HE, Harrison J, Ho A, Hughes DM, Keogh RH, Kirwan PD, Leeming G, Nguyen Van-Tam JS, Pius R, Russell CD, Spencer RG, Tom BD, Turtle L, Openshaw PJ, Baillie JK, Harrison EM, Semple MG. Changes in in-hospital mortality in the first wave of COVID-19: a multicentre prospective observational cohort study using the WHO Clinical Characterisation Protocol UK. Lancet Respir Med 2021; 9:773-785. [PMID: 34000238 PMCID: PMC8121531 DOI: 10.1016/s2213-2600(21)00175-2] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/14/2021] [Accepted: 03/28/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Mortality rates in hospitalised patients with COVID-19 in the UK appeared to decline during the first wave of the pandemic. We aimed to quantify potential drivers of this change and identify groups of patients who remain at high risk of dying in hospital. METHODS In this multicentre prospective observational cohort study, the International Severe Acute Respiratory and Emerging Infections Consortium WHO Clinical Characterisation Protocol UK recruited a prospective cohort of patients with COVID-19 admitted to 247 acute hospitals in England, Scotland, and Wales during the first wave of the pandemic (between March 9 and Aug 2, 2020). We included all patients aged 18 years and older with clinical signs and symptoms of COVID-19 or confirmed COVID-19 (by RT-PCR test) from assumed community-acquired infection. We did a three-way decomposition mediation analysis using natural effects models to explore associations between week of admission and in-hospital mortality, adjusting for confounders (demographics, comorbidities, and severity of illness) and quantifying potential mediators (level of respiratory support and steroid treatment). The primary outcome was weekly in-hospital mortality at 28 days, defined as the proportion of patients who had died within 28 days of admission of all patients admitted in the observed week, and it was assessed in all patients with an outcome. This study is registered with the ISRCTN Registry, ISRCTN66726260. FINDINGS Between March 9, and Aug 2, 2020, we recruited 80 713 patients, of whom 63 972 were eligible and included in the study. Unadjusted weekly in-hospital mortality declined from 32·3% (95% CI 31·8-32·7) in March 9 to April 26, 2020, to 16·4% (15·0-17·8) in June 15 to Aug 2, 2020. Reductions in mortality were observed in all age groups, in all ethnic groups, for both sexes, and in patients with and without comorbidities. After adjustment, there was a 32% reduction in the risk of mortality per 7-week period (odds ratio [OR] 0·68 [95% CI 0·65-0·71]). The higher proportions of patients with severe disease and comorbidities earlier in the first wave (March and April) than in June and July accounted for 10·2% of this reduction. The use of respiratory support changed during the first wave, with gradually increased use of non-invasive ventilation over the first wave. Changes in respiratory support and use of steroids accounted for 22·2%, OR 0·95 (0·94-0·95) of the reduction in in-hospital mortality. INTERPRETATION The reduction in in-hospital mortality in patients with COVID-19 during the first wave in the UK was partly accounted for by changes in the case-mix and illness severity. A significant reduction in in-hospital mortality was associated with differences in respiratory support and critical care use, which could partly reflect accrual of clinical knowledge. The remaining improvement in in-hospital mortality is not explained by these factors, and could be associated with changes in community behaviour, inoculum dose, and hospital capacity strain. FUNDING National Institute for Health Research and the Medical Research Council.
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Affiliation(s)
| | | | - Nazir I Lone
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Christopher P Cheyne
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | | | | | - Cara Donegan
- Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Thomas M Drake
- Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
| | - Jake Dunning
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Sebastian Funk
- London School of Hygiene & Tropical Medicine, London, UK
| | - Marta García-Fiñana
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Michelle Girvan
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Hayley E Hardwick
- Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Janet Harrison
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Antonia Ho
- MRC University of Glasgow Centre for Virus Research, Glasgow, UK
| | - David M Hughes
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Ruth H Keogh
- London School of Hygiene & Tropical Medicine, London, UK
| | - Peter D Kirwan
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Gary Leeming
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Jonathan S Nguyen Van-Tam
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Riinu Pius
- Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
| | - Clark D Russell
- The Usher Institute, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Rebecca G Spencer
- Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Brian Dm Tom
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Lance Turtle
- Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Peter Jm Openshaw
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | | | - Ewen M Harrison
- Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
| | - Malcolm G Semple
- Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK; Department of Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK
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8
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Stock SJ, Zoega H, Brockway M, Mulholland RH, Miller JE, Been JV, Wood R, Abok II, Alshaikh B, Ayede AI, Bacchini F, Bhutta ZA, Brew BK, Brook J, Calvert C, Campbell-Yeo M, Chan D, Chirombo J, Connor KL, Daly M, Einarsdóttir K, Fantasia I, Franklin M, Fraser A, Håberg SE, Hui L, Huicho L, Magnus MC, Morris AD, Nagy-Bonnard L, Nassar N, Nyadanu SD, Iyabode Olabisi D, Palmer KR, Pedersen LH, Pereira G, Racine-Poon A, Ranger M, Rihs T, Saner C, Sheikh A, Swift EM, Tooke L, Urquia ML, Whitehead C, Yilgwan C, Rodriguez N, Burgner D, Azad MB. The international Perinatal Outcomes in the Pandemic (iPOP) study: protocol. Wellcome Open Res 2021; 6:21. [PMID: 34722933 PMCID: PMC8524299 DOI: 10.12688/wellcomeopenres.16507.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 11/20/2022] Open
Abstract
Preterm birth is the leading cause of infant death worldwide, but the causes of preterm birth are largely unknown. During the early COVID-19 lockdowns, dramatic reductions in preterm birth were reported; however, these trends may be offset by increases in stillbirth rates. It is important to study these trends globally as the pandemic continues, and to understand the underlying cause(s). Lockdowns have dramatically impacted maternal workload, access to healthcare, hygiene practices, and air pollution - all of which could impact perinatal outcomes and might affect pregnant women differently in different regions of the world. In the international Perinatal Outcomes in the Pandemic (iPOP) Study, we will seize the unique opportunity offered by the COVID-19 pandemic to answer urgent questions about perinatal health. In the first two study phases, we will use population-based aggregate data and standardized outcome definitions to: 1) Determine rates of preterm birth, low birth weight, and stillbirth and describe changes during lockdowns; and assess if these changes are consistent globally, or differ by region and income setting, 2) Determine if the magnitude of changes in adverse perinatal outcomes during lockdown are modified by regional differences in COVID-19 infection rates, lockdown stringency, adherence to lockdown measures, air quality, or other social and economic markers, obtained from publicly available datasets. We will undertake an interrupted time series analysis covering births from January 2015 through July 2020. The iPOP Study will involve at least 121 researchers in 37 countries, including obstetricians, neonatologists, epidemiologists, public health researchers, environmental scientists, and policymakers. We will leverage the most disruptive and widespread “natural experiment” of our lifetime to make rapid discoveries about preterm birth. Whether the COVID-19 pandemic is worsening or unexpectedly improving perinatal outcomes, our research will provide critical new information to shape prenatal care strategies throughout (and well beyond) the pandemic.
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Affiliation(s)
| | - Helga Zoega
- Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Meredith Brockway
- Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | | | - Jessica E. Miller
- Infection and Immunity, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia
| | - Jasper V. Been
- Division of Neonatology, Department of Paediatrics, Erasmus MC - Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Public Health, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Rachael Wood
- Public Health Scotland, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Ishaya I. Abok
- Department of Paediatrics, University of Jos, Jos, Nigeria
| | - Belal Alshaikh
- Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Adejumoke I. Ayede
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria
- University College Hospital, Ibadan, Nigeria
| | | | - Zulfiqar A. Bhutta
- Center of Excellence in Women Child Health, The Aga Khan University South-Central Asia & East Africa, Karachi, Pakistan
| | - Bronwyn K. Brew
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health, UNSW Sydney, Sydney, Australia
| | - Jeffrey Brook
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Canada
| | - Clara Calvert
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Deborah Chan
- Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - James Chirombo
- Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi
| | | | - Mandy Daly
- IWK Health Centre, Halifax, Canada
- Advocacy & Policymaking, Irish Neonatal Health Alliance, Dublin, Ireland
| | - Kristjana Einarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Ilaria Fantasia
- Unit of Fetal Medicine and Prenatal Diagnosis Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Meredith Franklin
- Division of Biostatistics, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Abigail Fraser
- MRC Integrative Epidemiology Unit,, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Siri Eldevik Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Lisa Hui
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Luis Huicho
- Centro de Investigación en Salud Materna e Infantil, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Centro de Investigación para el Desarrollo Integral y Sostenible, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Maria C. Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | | | | | - Natasha Nassar
- Children’s Hospital at Westmead Clinical School, University of Sydney, Sydney, Australia
| | - Sylvester Dodzi Nyadanu
- School of Public Health, Curtin University, Perth, Australia
- Education, Culture, and Health Opportunities (ECHO) Research Group International, Aflao, Ghana
| | | | - Kirsten R. Palmer
- Monash Health Department of Obstetrics & Gynaecology, Monash University, Clayton, Australia
| | - Lars Henning Pedersen
- Department of Obstetrics & Gynaecology, Aarhus University Hospital, Aarhus, Denmark
- Clinical Medicine & Biomedicine, Aarhus University, Aarhus, Denmark
| | - Gavin Pereira
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- School of Public Health, Curtin University, Perth, Australia
- Telethon Kids Institute, Nedlands, Australia
| | | | - Manon Ranger
- BC Children’s & Women’s Hospital Research Institute, School of Nursing, University of British Columbia, Vanvouver, Canada
| | - Tonia Rihs
- Federal Statistical Office, Neuchatel, Switzerland
| | - Christoph Saner
- Department of Pediatric Endocrinology, Diabetology, and Metabolism, University Children`s Hospital Bern, Inselspital, Bern, Switzerland
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Emma M. Swift
- Department of Midwifery, Faculty of Nursing, University of Iceland, Reykjavík, Iceland
| | - Lloyd Tooke
- Department of Neonatology, University of Cape Town, Cape Town, South Africa
- Department of Neonatology, Groote Schuur Hospital, Cape Town, South Africa
| | - Marcelo L. Urquia
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Clare Whitehead
- Pregnancy Research Centre, The Royal Women's Hospital, Melbourne, Australia
| | | | - Natalie Rodriguez
- Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - David Burgner
- Infection and Immunity, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Meghan B. Azad
- Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
- Children’s Hospital Research Institute of Manitoba, The Children’s Hospital Foundation of Manitoba, Winnipeg, Canada
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9
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Mulholland RH, Wood R, Stagg HR, Fischbacher C, Villacampa J, Simpson CR, Vasileiou E, McCowan C, Stock SJ, Docherty AB, Ritchie LD, Agrawal U, Robertson C, Murray JL, MacKenzie F, Sheikh A. Impact of COVID-19 on accident and emergency attendances and emergency and planned hospital admissions in Scotland: an interrupted time-series analysis. J R Soc Med 2020; 113:444-453. [PMID: 33012218 PMCID: PMC7686524 DOI: 10.1177/0141076820962447] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Following the outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus and the subsequent global spread of the 2019 novel coronavirus disease (COVID-19), health systems and the populations who use them have faced unprecedented challenges. We aimed to measure the impact of COVID-19 on the uptake of hospital-based care at a national level. DESIGN The study period (weeks ending 5 January to 28 June 2020) encompassed the pandemic announcement by the World Health Organization and the initiation of the UK lockdown. We undertook an interrupted time-series analysis to evaluate the impact of these events on hospital services at a national level and across demographics, clinical specialties and National Health Service Health Boards. SETTING Scotland, UK. PARTICIPANTS Patients receiving hospital care from National Health Service Scotland. MAIN OUTCOME MEASURES Accident and emergency (A&E) attendances, and emergency and planned hospital admissions measured using the relative change of weekly counts in 2020 to the averaged counts for equivalent weeks in 2018 and 2019. RESULTS Before the pandemic announcement, the uptake of hospital care was largely consistent with historical levels. This was followed by sharp drops in all outcomes until UK lockdown, where activity began to steadily increase. This time-period saw an average reduction of -40.7% (95% confidence interval [CI]: -47.7 to -33.7) in A&E attendances, -25.8% (95% CI: -31.1 to -20.4) in emergency hospital admissions and -60.9% (95% CI: -66.1 to -55.7) in planned hospital admissions, in comparison to the 2018-2019 averages. All subgroup trends were broadly consistent within outcomes, but with notable variations across age groups, specialties and geography. CONCLUSIONS COVID-19 has had a profoundly disruptive impact on hospital-based care across National Health Service Scotland. This has likely led to an adverse effect on non-COVID-19-related illnesses, increasing the possibility of potentially avoidable morbidity and mortality. Further research is required to elucidate these impacts.
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Affiliation(s)
| | - Rachael Wood
- National Health Service Scotland, Public Health Scotland, Glasgow G2 6QE and Edinburgh EH12 9EB, UK.,Centre for Brain Sciences, Centre for Population Health, University of Edinburgh, Edinburgh EH8 9YL, UK
| | - Helen R Stagg
- Usher Institute, University of Edinburgh, Edinburgh EH8 9YL, UK
| | - Colin Fischbacher
- National Health Service Scotland, Public Health Scotland, Glasgow G2 6QE and Edinburgh EH12 9EB, UK
| | - Jaime Villacampa
- National Health Service Scotland, Public Health Scotland, Glasgow G2 6QE and Edinburgh EH12 9EB, UK
| | - Colin R Simpson
- Usher Institute, University of Edinburgh, Edinburgh EH8 9YL, UK.,School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington PO Box 600, Wellington 6140, New Zealand
| | | | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews KY16 9AJ, UK
| | - Sarah J Stock
- Usher Institute, University of Edinburgh, Edinburgh EH8 9YL, UK
| | | | - Lewis D Ritchie
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen AB24 3FX, UK
| | - Utkarsh Agrawal
- School of Medicine, University of St Andrews, St Andrews KY16 9AJ, UK
| | - Chris Robertson
- National Health Service Scotland, Public Health Scotland, Glasgow G2 6QE and Edinburgh EH12 9EB, UK.,Department of Mathematics and Statistics, University of Strathclyde, Glasgow G1 1XQ, UK
| | - Josephine Lk Murray
- National Health Service Scotland, Public Health Scotland, Glasgow G2 6QE and Edinburgh EH12 9EB, UK
| | - Fiona MacKenzie
- National Health Service Scotland, Public Health Scotland, Glasgow G2 6QE and Edinburgh EH12 9EB, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh EH8 9YL, UK
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Affiliation(s)
| | - Ian P Sinha
- Alder Hey Children's Hospital, Liverpool, UK. .,University of Liverpool, Liverpool, UK.
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