Research

Impact of COVID-19 on mental illness

This study examined associations of COVID-19 with subsequent mental illness in the pre-vaccination period of the pandemic and for unvaccinated and vaccinated people after vaccination became available. We compared rates of common and severe mental illness after a diagnosis of COVID-19 with rates before or without COVID-19. We also investigated variation in these associations between subgroups defined by COVID-19 severity, age, sex, ethnicity, prior mental illness, and prior SARS-COV-2 infection.

Group A streptococcal cases and treatments during the COVID-19 pandemic and 2022 outbreak

This study described the impact of the COVID-19 pandemic on Group A streptococcal (GAS) cases and related antibiotic prescriptions.

Effect of the 2022 COVID-19 booster vaccination campaign in 50 year olds in England

This study evaluated the effectiveness of the 2022 autumn COVID-19 booster campaign in 50 year olds in England using a regression discontinuity design.

Fit notes associated with COVID-19 in 24 million patients’ primary care records

This study quantified the fit note rate in people with documented SARS-CoV-2 infection or COVID-19 diagnosis in 2020, 2021 and 2022 overall, by demographics, and by time since diagnosis. We also used adjusted Cox regression to compare the fit note rate to the general population.

The impact of COVID-19 on medication reviews

This study investigated whether the rate of medication reviews in primary care were affected during the COVID-19 pandemic, with breakdown by regional, clinical and demographic subgroups.

Key measures for monitoring general practice clinical activity during COVID-19

This paper presents an important effort to develop an open-source software framework for monitoring trends and variations in healthcare over time in England. They demonstrate a compelling example of how this system can track key healthcare indicators over the course of the COVID-19 pandemic.

DMARD safety monitoring during the COVID-19 pandemic

This study investigated whether disease-modifying anti-rheumatic drug (DMARD) safety monitoring was affected during the COVID-19 pandemic, with additional focus on effects within key health inequality groups.

Changes in medication safety indicators in England throughout the covid-19 pandemic

This study aimed to implement complex, PINCER (pharmacist led information technology intervention) prescribing indicators, on a national scale with general practice data to describe the impact of the covid-19 pandemic on safe prescribing.

Effectiveness of sotrovimab and molnupiravir in community settings in England across the Omicron BA.1 and BA.2 sublineages

We used the OpenSAFELY platform to emulate target trials to estimate the effectiveness of sotrovimab or molnupiravir, versus no treatment.

Impact of COVID-19 on broad-spectrum antibiotic prescribing for common infections in primary care in England

The COVID-19 pandemic impacted the healthcare systems, adding extra pressure to reduce antimicrobial resistance. Therefore, we aimed to evaluate changes in antibiotic prescription patterns after COVID-19 started.

The impact of COVID -19 on antibiotic prescribing in primary care in England

This study aimed to predict risks of potentially inappropriate antibiotic type and repeat prescribing and assess changes during COVID-19.

Changes in COVID-19-related mortality in England from 2020 to 2022

This study aimed to describe the burden of COVID-19-related mortality in population subgroups and how this has changed over successive waves of the pandemic, and report trends in absolute and relative COVID-19-related mortality risks across clinical and demographic population subgroups from 2020 to 2022.

NHS Service Restoration Observatory 2: changes in primary care clinical activity

This study aimed to describe changes in the volume and variation of coded clinical activity in general practice during COVID-19 across six clinical areas: cardiovascular disease, diabetes, mental health, female and reproductive health, screening and related procedures, and processes related to medication.

Deaths at home during the Covid-19 pandemic

A comparison of the services used by people who died at home in England in the first year of the pandemic to the year prior to the pandemic, exploring indicators of quality of care, and looking at differences between sociodemographic groups.

Postoperative mortality and complications in patients with and without pre-operative SARS-CoV-2

We adapted the COVIDSurg protocol for a service evaluation of surgical procedures that took place within the English NHS from 17 March 2018 to 17 March 2022.

Long term and repeat antibiotic prescribing during the COVID-19 pandemic

We analyses repeat and non-repeat antibiotic prescribing to identify any changes in behaviour throughout the COVID-19 pandemic and to inform ongoing development of stewardship interventions in England.

Trends and variation in first dose COVID vaccine coverage amongst 5-15 year olds in England

Describing trends and variation in first dose COVID vaccine coverage in different clinical and demographic groups amongst adolescents and children in England

OpenSAFELY NHS Service Restoration Observatory 2

We describe changes in the volume and variation of coded clinical activity in general practice in: (i) cardiovascular disease, (ii) diabetes, (iii) mental health, (iv) female and reproductive health, (v) screening, and (vi) processes related to medication.

Vaccine uptake in people with kidney disease

We describe COVID-19 vaccine coverage among people with moderate-to-severe kidney disease in England up to 31 August 2022, and characterise individual-level factors associated with delayed vaccine uptake.

Primary care coding activity related to the use of online consultation systems or remote consulting

We explore general practice coding activity associated with the use of online consultation systems in terms of trends, COVID-19 effect, variation and quality.

Trends, regional variation and clinical characteristics of recipients of antivirals and neutralising monoclonal antibodies

This paper aims to develop a framework for detailed near real-time monitoring of treatment deployment, to ascertain eligibility status for patients and to describe trends and variation in coverage of treatment between geographic, clinical and demographic groups.

The impact of the COVID-19 pandemic on Antipsychotic Prescribing

We describe the impact of the the COVID-19 pandemic on antipsychotic prescribing in those with autism, dementia, learning disability, serious mental illness or living in a care home.

Ethnic differences in the indirect impacts of the COVID-19 pandemic

We describe how the COVID-19 pandemic has impacted ethnic differences in clinical monitoring and hospitalisations for non-COVID conditions

Challenges in estimating waning effectiveness of two doses of COVID-19 vaccines beyond six months

Quantifying the waning effectiveness of second COVID-19 vaccination beyond six months and against the omicron variant

Comparative effectiveness of two- and three-dose schedules involving AZD1222 and BNT162b2 in people with kidney disease

We compared the risk of COVID-19 among people with moderate-severe kidney disease who received different combinations of Astrazeneca and Pfizer–BioNTech COVID-19 vaccine over the course of the pandemic

Service Restoration Observatory - Key Measures or primary care activity

We develop key measures of primary care activity and describe the trends in these measures throughout the COVID-19 pandemic.

Incidence and management of inflammatory arthritis in England before and during the COVID-19 pandemic

We used OpenSAFELY to replicate key metrics from the National Early Inflammatory Arthritis Audit (NEIAA), and to assess the impact of COVID-19 on the delivery of care for people with autoimmune inflammatory arthritis in England.

Changes in COVID-19-related mortality across key demographic and clinical subgroups

This paper describes how COVID-19 related mortality has changed over time during the pandemic. Rates of COVID-19 related death are calculated for many demographic and clinical patient groups.

Waning effectiveness of BNT162b2 and ChAdOx1 covid-19 vaccines over six months since second dose

A cohort study to assess the extent of waning of effectiveness following a second dose of BNT162b2 and ChAdOx1 covid-19 vaccines

Comparative effectiveness of ChAdOx1 versus BNT162b2 COVID-19 vaccines in Health and Social Care workers in England

A compararison of the effectiveness of the BNT162b2 mRNA (Pfizer-BioNTech) and the ChAdOx1 (Oxford-AstraZeneca) COVID-19 vaccines against infection and COVID-19 disease in health and social care workers.

Representativeness of OpenSAFELY-TPP data compared to the population of England

This paper investigates the representativeness of OpenSAFELY-TPP data by comparing it to national population estimates.

The impact of COVID-19 on prescribing of pancreatic enzyme replacement therapy for people with unresectable pancreatic cancer in England

This paper describes the trends in primary care prescribing of enzyme replacement therapy, and how this changed during the COVID-19 pandemic.

Long COVID burden and risk factors in 10 UK longitudinal studies and electronic health records

This paper combines results from longitudinal cohort studies with electronic health data from OpenSAFELY, to describe how risk of long COVID varies amongst demographic and clinical factors.

Risk of severe COVID-19 outcomes associated with immune-mediated inflammatory diseases and immune modifying therapies

Effectiveness of BNT162b2 booster doses in England

We estimate the effectiveness of boosting with BNT162b2 compared with no boosting in eligible adults who had received two primary course vaccine doses in England.

Safety of COVID-19 vaccination and acute neurological events

This paper investigates the potential association of COVID-19 vaccination with three acute neurological events: Guillain-Barré syndrome (GBS), transverse myelitis and Bell’s palsy.

Comparative effectiveness of sotrovimab and molnupiravir for prevention of severe COVID-19

This paper aims to compare the effectiveness of sotrovimab (a neutralising monoclonal antibody) vs. molnupiravir (an antiviral) in preventing severe COVID-19 outcomes in non-hospitalised high-risk COVID-19 adult patients

Impact of First UK COVID-19 Lockdown on Hospital Admissions

This study used OpenSAFELY (on behalf of NHS England), EAVEII (Scotland) and SAIL Databank (Wales) to investigate the weekly hospital admission rates for cancer, cardiovascular and respiratory conditions (excluding COVID-19) broken down by disease, sex, socioeconomic group and ethnicity group in a federated analysis across England, Scotland and Wales.

Changes in English medication safety indicators throughout the COVID-19 pandemic

To describe the impact of the COVID-19 pandemic on safe prescribing, using the PINCER prescribing indicators; to implement complex prescribing indicators at national scale using GP data. This study uses a population based cohort study, with the approval of NHS England using the OpenSAFELY platform, covering Electronic health record data from 56.8 million NHS patients’ general practice records

A&E attendance following infection with COVID-19

We estimate the risk of accident and emergency (AE) attendance following confirmation of SARS-CoV-2 infection in England, comparing infection with Omicron to Delta

Association between household composition and severe COVID-19 outcomes in older people

This paper aims to quantify the association between household composition and risk of severe COVID-19 by ethnicity for older individuals

Association between oral anticoagulants and COVID-19-related outcomes

This paper investigates the association between OACs and COVID-19 outcomes in those with atrial fibrillation and a CHA2DS2-VASc score of 2.

Waning effectiveness of BNT162b2 and ChAdOx1 COVID-19 vaccines over six months since second dose

This paper investigates the rate at which COVID-19 vaccine effectiveness wanes over time

Potentially inappropriate prescribing of DOACs to people with mechanical heart valves

National guidance was issued during the COVID-19 pandemic to switch patients on warfarin to direct oral anticoagulants (DOACs) where appropriate as these require less frequent blood testing. DOACs are not recommended for patients with mechanical heart valves. We conducted a retrospective cohort study of DOAC prescribing in people with a record of a mechanical heart valve between September 2019 and May 2021, and describe the characteristics of this population.

Comparison of methods for predicting COVID-19-related death in the general population using the OpenSAFELY platform

This paper evaluate different methods for predicting COVID-19-related death using the OpenSAFELY platform

Overall and cause-specific hospitalisation and death after COVID-19 hospitalisation

This paper investigates whether risks of hospital admission and death, overall and by specific cause, are raised following discharge from a COVID-19 hospitalisation.

Mortality among Care Home Residents in England during the first and second waves of the COVID-19 pandemic

This paper describe trends in the mortality risk among residents of care homes compared to private homes during the first and second waves of the COVID-19 pandemic in England.

Describing the population experiencing COVID-19 vaccine breakthrough following second vaccination

This paper describes the characters of individuals who have experienced COVID-19 vaccine breakthrough after their second vaccination.

Impact of First UK COVID-19 Lockdown on Hospital Admissions

This study used OpenSAFELY (on behalf of NHS England), EAVEII (Scotland) and SAIL Databank (Wales) to investigate the weekly hospital admission rates for cancer, cardiovascular and respiratory conditions (excluding COVID-19) broken down by disease, sex, socioeconomic group and ethnicity group in a federated analysis across England, Scotland and Wales.

Impact of national guidance on switching anticoagulant therapy during COVID-19

This paper describes which people were switched from warfarin to DOACs during the COVID-19 pandemic following an update in national guidance

OpenSAFELY NHS Service Restoration Observatory 1

Working on behalf of NHS England, this study used the OpenSAFELY platform to describe the volume and variation of coded clinical activity in general practice between January 2019 and September 2020, taking respiratory disease and laboratory procedures as examples.

Clinical coding of long COVID in English primary care

Working on behalf of NHS England, this paper used the OpenSAFELY platform to measure the proportion of people with a recorded code for long COVID, overall and by demographic factors, electronic health record software system, and week.

Association between warfarin and COVID-19-related outcomes

This paper investigates the association between warfarin and COVID-19 outcomes compared with direct oral anticoagulants (DOACs)

Trends and clinical characteristics of COVID-19 vaccine recipients

Working on behalf of NHS England this study analysed 57.9 million patient records in situ and in near-real-time within the infrastructure of the Electronic Health Record (EHR) software vendors EMIS and TPP using OpenSAFELY. The paper describes vaccine coverage and time trends across a range of demographic and fine-grained clinical subgroups in eight Joint Committee on Vaccination and Immunisation (JCVI) priority cohorts.

Risk of severe COVID-19 outcomes associated with immune-mediated inflammatory diseases and immune modifying therapies

Severity of Severe Acute Respiratory System Coronavirus 2 (SARS-CoV-2) Alpha Variant (B.1.1.7) in England

This paper aims to describe the severity of the alpha variant in terms of the pathway of disease from testing positive to hospital admission and death.

Potentially inappropriate prescribing of DOACs to people with mechanical heart valves

National guidance was issued during the COVID-19 pandemic to switch patients on warfarin to direct oral anticoagulants (DOACs) where appropriate as these require less frequent blood testing. DOACs are not recommended for patients with mechanical heart valves. We conducted a retrospective cohort study of DOAC prescribing in people with a record of a mechanical heart valve between September 2019 and May 2021, and describe the characteristics of this population.

HIV infection and COVID-19 death

This paper uses the OpenSAFELY platform to investigate whether HIV infection is associated with risk of COVID-19 death

Recording of “COVID-19 vaccine declined” among vaccination priority groups

A description of the patterns of usage of codes for COVID-19 vaccines being declined.

Overall and cause-specific hospitalisation and death after COVID-19 hospitalisation

This paper aims to investigate whether risks of hospital admission and death, overall and by specific cause, are raised following discharge from a COVID-19 hospitalisation.

Risk factors for long COVID

Factors associated with deaths due to COVID-19 versus other causes

Working on behalf of NHS England, this study investigates how specific factors are differentially associated with COVID-19 mortality as compared to mortality from other causes.

Ethnic differences in SARS-CoV-2 infection and COVID-19-related hospitalisation

Working on behalf of NHS England, this paper used the OpenSAFELY platform to quantify ethnic differences in SARS-CoV-2 infection and COVID-19 outcomes during the first and second waves of the COVID-19 pandemic in England.

Association between oral anticoagulants and COVID-19 related outcomes

Working on behalf of NHS England, this study used the OpenSAFELY platform to investigate the role of routinely prescribed oral anticoagulants (OACs) in COVID-19 outcomes, comparing current OAC use versus non-use in Study 1; and warfarin versus direct oral anticoagulants (DOACs) in Study 2.

Identifying Care Home Residents in Electronic Health Records

This short data report describes the partial overlap between three methods for identifying care home residents in EHR, and provides detailed instructions for how to implement these in OpenSAFELY-TPP to support research into the impact of the COVID-19 pandemic on care home residents.

Rates of serious clinical outcomes in survivors of hospitalisation with COVID-19

Patients with COVID-19 are thought to be at higher risk of cardiometabolic and pulmonary complications, but quantification of that risk is limited. Working on behalf of NHS England, this study aimed to describe the overall burden of these complications in survivors of severe COVID-19 using OpenSAFELY.

Case fatality risk of the SARS-CoV-2 variant of concern B.1.1.7

Working on behalf of NHS England, this paper uses the OpenSAFELY platform to estimate the risk of death following confirmation of SARS-CoV-2 infection in England, comparing infection with VOC to non-VOC, after accounting for demographic factors and comorbidities

Risks of COVID-19 hospital admission and death for people with learning disabilities

Working on behalf of NHS England, this paper used the OpenSAFELY platform to assess the association between learning disability and risk of hospitalisation and mortality from COVID-19 in England among adults and children.

Association between living with children and outcomes from covid-19

Working on behalf of NHS England, this paper used the OpenSAFELY platform to investigate whether risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and outcomes of coronavirus disease 2019 (covid-19) differed between adults living with and without children during the first two waves of the UK pandemic.

Predicting COVID-19 related death using the OpenSAFELY platform

Working on behalf of NHS England, this study used the OpenSAFELY platform to compare approaches for obtaining relative and absolute estimates of risk of 28-day COVID-19 mortality for adults in the general population of England in the context of changing levels of circulating infection.

Changes in the rate of cardiometabolic and pulmonary events during the COVID-19 pandemic

Working on behalf of NHS England, this study used the OpenSAFELY platform to describe the overall rate of various key clinical events over time, and their relationship with COVID-19.

Ethnicity and COVID-19 death in the early part of the COVID-19 second wave in England

This short data report investigates whether there were ethic inequalities in COVID-19 death in the second wave in England

NHS COVID-19 Vaccine Coverage

Working on behalf of NHS England, this study used the OpenSAFELY platform to develop a framework for detailed near-real-time monitoring of COVID-19 vaccine roll-out; to describe trends and variation in coverage by geographic area, and between key clinical and demographic patient groups.

Factors associated with deaths due to COVID-19 versus other causes

This paper investigates the factors associated with deaths due to COVID-19 versus other causes

OpenSAFELY NHS Service Restoration Observatory 1

This paper describes the volume and variation of coded clinical activity in English primary care across 23.8 million patients’ records, taking respiratory disease and laboratory procedures as key examples.

HIV and COVID-19

Working on behalf of NHS England, this paper used the OpenSAFELY platform to investigate the association between HIV infection and COVID-19 mortality.

Warfarin, DOACS, and COVID-19

Working on behalf of NHS England, this study investigates which people were switched from warfarin to DOACs following national guidance during the first wave of the COVID-19 pandemic; seeks to identify potentially unsafe co-prescribing of anticoagulants; and assesses whether abnormal clotting results have become more frequent during the pandemic.

Use of NSAIDs and risk of death from Covid-19

Working on behalf of NHS England, this paper used the OpenSAFELY platform to assess the association between routinely prescribed non-steroidal anti-inflammatory drugs (NSAIDs) and deaths from COVID-19.

Hydroxychloroquine and COVID-19 mortality

Working on behalf of NHS England, this paper used the OpenSAFELY platform to investigate the effectiveness of hydroxychloroquine for prevention, as opposed to treatment, of COVID-19 mortality. We found no evidence of benefit or harm after adjusting for important differences between people with the same health conditions prescribed hydroxychloroquine or not.

Living with children

Working on behalf of NHS England, this study investigates whether risk of infection with SARs-CoV-2 and severe outcomes differed between adults living with and without children.

Comparison of different risk prediction modelling approaches for COVID-19

This protocol reports details of a planned study to explore the extent to which incorporating time-varying measures of infection burden over time improves the quality of risk prediction models for COVID-19 death in a large population of adult patients in England.

COPD, Asthma, Corticosteroids and Covid-19-related death

Working on behalf of NHS England, this paper used the OpenSAFELY platform to investigate the association between ICS and COVID-19-related death among people with COPD or asthma using linked electronic health records (EHRs) in England, UK.

Ethnic differences in COVID-19 infection, hospitalisation, and mortality

Working on behalf of NHS England, the aim of this study was to identify ethnic differences in the risk of COVID-19 infection, hospitalisation and mortality using a large general population cohort in England.

Do adults prescribed non-steroidal anti-inflammatory drugs have an increased risk of death from COVID-19?

This paper aims to assess the association between NSAID use and deaths from COVID-19 using OpenSAFELY

Factors associated with Covid-19 death

Working on behalf of NHS England, this paper used the OpenSAFELY platform to quantify a range of clinical risk factors for COVID-19-related death in the largest cohort study conducted by any country to date.

COPD, Asthma, Corticosteroids and Covid-19-related death

Working on behalf of NHS England, this paper used the OpenSAFELY platform to investigate the association between ICS and COVID-19-related death among people with COPD or asthma using linked electronic health records (EHRs) in England, UK.

Factors associated with Covid-19 death

Working on behalf of NHS England, this paper used the OpenSAFELY platform to quantify a range of clinical risk factors for COVID-19-related death in the largest cohort study conducted by any country to date.