The impact of primary care supported shielding on the risk of mortality in people vulnerable to COVID-19: English sentinel network matched cohort study - 24/07/21
, Mark Joy a , Julian Sherlock a , James P Sheppard a , Rachel Byford a , Oluwafunmi Akinyemi a , Clare R Bankhead a , Alexandra Deeks a , Filipa Ferreira a , Nicholas Jones a , Harshana Liyanage a , Dylan McGagh a , Brian Nicholson a , Jason Oke a , Cecilia Okusi a , Manasa Tripathy a , John Williams a , Richard Hobbs a , Simon de Lusignan a, b, ⁎
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Highlights |
• | Shielding was associated with half the risk of mortality in the first 21 days. |
• | Risk of mortality was 54% higher in shielded over the remaining nine weeks. |
• | Risk of mortality in shielded group increased after the end of shielding. |
• | Our findings stimulate debate on potential implementation of shielding in future waves. |
Summary |
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 1:1, matching to people with the same diagnoses not advised to shield (n = 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 (n = 24,752 shielded, n = 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 (HR = 0.50, 95%CI:0.41–0.59. p < 0.0001). Over the remaining nine weeks, mortality risk was 54% higher in the shielded group (HR=1.54, 95%CI:1.41–1.70, 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%CI:2.38–2.87, 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.
Le texte complet de cet article est disponible en PDF.Keywords : COVID-19, Shielding, Mortality, Medical records system, computerized
Plan
Vol 83 - N° 2
P. 228-236 - août 2021 Retour au numéro
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