Evidence map›Paper›PMID 37468884›Full record

ArticleBMC medicine2023

Healthcare use attributable to COVID-19: a propensity-matched national electronic health records cohort study of 249,390 people in Wales, UK.

J Kennedy, M Parker, M Seaborne, M Mhereeg, A Walker, V Walker, S Denaxas, N Kennedy, S V Katikireddi, S Brophy

Open access · goldAbstract read
In one paragraph

Article in BMC medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
7.2field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 35 citations in OpenAlex.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 4 institutions in 2 countries.

J KennedyNational Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK.
M ParkerNational Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK. m.j.parker@swansea.ac.uk.
M SeaborneNational Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK.
M MhereegNational Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK.
A WalkerDatalab, Nuffield Dept of Primary Care Health Science, Radcliffe Primary Care Building, Oxford, OX2 6GG, UK.
V WalkerBristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK.
S DenaxasInstitute for Health Informatics, UCL, London, UK.
N KennedyNational Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK.
S V Katikireddi *MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
S Brophy *National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK.
Swansea University · GBMRC/CSO Social and Public Health Sciences Unit · GBMRC Epidemiology Unit · GBUniversity College London · GB

Funding

Chief Scientist Office SPHSU17Department of Health COV-LT-0009Medical Research Council HDR-9006Medical Research Council MC_PC_20030Medical Research Council MC_PC_20051Medical Research Council MC_PC_20059Medical Research Council MC_UU_00011/4Medical Research Council MC_UU_00022/2
6 · The paper itself

Abstract

backgroundTo determine the extent and nature of changes associated with COVID-19 infection in terms of healthcare utilisation, this study observed healthcare contact 1 to 4 and 5 to 24 weeks following a COVID-19 diagnosis compared to propensity-matched controls.

methodsTwo hundred forty nine thousand three hundred ninety Welsh individuals with a positive reverse transcription-polymerase chain reaction (RT-PCR) test were identified from data from national PCR test results. After elimination criteria, 98,600 positive individuals were matched to test negative and never tested controls using propensity matching. Cohorts were split on test location. Tests could be taken in either the hospital or community. Controls were those who had tested negative in their respective environments. Survival analysis was utilised for first clinical outcomes which are grouped into primary and secondary. Primary outcomes include post-viral-illness and fatigue as an indication of long-COVID. Secondary outcomes include clinical terminology concepts for embolism, respiratory conditions, mental health conditions, fit notes, or hospital attendance. Increased instantaneous risk for positive individuals was quantified using hazard ratios (HR) from Cox regression, while absolute risk (AR) and relative risk were quantified using life table analysis.

resultsAnalysis was conducted using all individuals and stratified by test location. Cases are compared to controls from the same test location. Fatigue (HR: 1.77, 95% CI: 1.34-2.25, p =  < 0.001) and embolism (HR: 1.50, 95% CI: 1.15-1.97, p = 0.003) were more likely to occur in all positive individuals in the first 4 weeks; however, anxiety and depression (HR: 0.83, 95% CI: 0.73-0.95, p = 0.007) were less likely. Positive individuals continued to be more at risk of fatigue (HR: 1.47, 95% CI: 1.24-1.75, p =  < 0.001) and embolism (HR: 1.51, 95% CI: 1.13-2.02, p = 0.005) after 4 weeks. All positive individuals are also at greater risk of post-viral illness (HR: 4.57, 95% CI: 1.77-11.80, p = 0.002). Despite statistical association between testing positive and several conditions, life table analysis shows that only a small minority of the study population were affected.

conclusionsCommunity COVID-19 disease is associated with increased risks of post-viral-illness, fatigue, embolism, and respiratory conditions. Despite elevated risks, the absolute healthcare burden is low. Subsequently, either very small proportions of people experience adverse outcomes following COVID-19 or they are not presenting to healthcare.

Indexed as

COVID-19Virus DiseasesCohort StudiesCOVID-19 TestingDelivery of Health CareElectronic Health RecordsFatigueHumansPost-Acute COVID-19 SyndromeSARS-CoV-2WalesBig dataCOVID-19Health dataLong–COVIDRoutine dataSARS-CoV-2

Identifiers

PMID37468884
PMCPMC10354936
OpenAlexW4384820508

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.