Comparison of COVID-19 outcomes among shielded and non-shielded populations
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Abstract
Many western countries used shielding (extended self-isolation) of people presumed to be at high-risk from COVID-19 to protect them and reduce healthcare demand. To investigate the effectiveness of this strategy, we linked family practitioner, prescribing, laboratory, hospital and death records and compared COVID-19 outcomes among shielded and non-shielded individuals in the West of Scotland. Of the 1.3 million population, 27,747 (2.03%) were advised to shield, and 353,085 (26.85%) were classified a priori as moderate risk. COVID-19 testing was more common in the shielded (7.01%) and moderate risk (2.03%) groups, than low risk (0.73%). Referent to low-risk, the shielded group had higher confirmed infections (RR 8.45, 95% 7.44–9.59), case-fatality (RR 5.62, 95% CI 4.47–7.07) and population mortality (RR 57.56, 95% 44.06–75.19). The moderate-risk had intermediate confirmed infections (RR 4.11, 95% CI 3.82–4.42) and population mortality (RR 25.41, 95% CI 20.36–31.71) but, due to their higher prevalence, made the largest contribution to deaths (PAF 75.30%). Age ≥ 70 years accounted for 49.55% of deaths. In conclusion, in spite of the shielding strategy, high risk individuals were at increased risk of death. Furthermore, to be effective as a population strategy, shielding criteria would have needed to be widely expanded to include other criteria, such as the elderly.
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SciScore for 10.1101/2020.09.17.20196436: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: Ethical approvals: The study was approved by the NHS GGC Primary Care Information Sharing Group and the NHS GGC Local Privacy Advisory Committee (Reference GSH/20RM005) and was covered by the generic Safe Haven Research Ethics Committee approval (GSH20RM005_COVID_Community). Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: An explicit section about the …SciScore for 10.1101/2020.09.17.20196436: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: Ethical approvals: The study was approved by the NHS GGC Primary Care Information Sharing Group and the NHS GGC Local Privacy Advisory Committee (Reference GSH/20RM005) and was covered by the generic Safe Haven Research Ethics Committee approval (GSH20RM005_COVID_Community). Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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SciScore for 10.1101/2020.09.17.20196436: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Ethical approvals The study was approved by the NHS Greater Glasgow and Clyde Primary Care Information Sharing Group and the NHS Greater Glasgow and Clyde Local Privacy Advisory Committee (LPAC) (Reference GSH/20RM005) and was covered by the generic Safe Haven Research Ethics Committee approval (GSH20RM005_COVID_Community). Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from Limitat…
SciScore for 10.1101/2020.09.17.20196436: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Ethical approvals The study was approved by the NHS Greater Glasgow and Clyde Primary Care Information Sharing Group and the NHS Greater Glasgow and Clyde Local Privacy Advisory Committee (LPAC) (Reference GSH/20RM005) and was covered by the generic Safe Haven Research Ethics Committee approval (GSH20RM005_COVID_Community). Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
Strengths and Limitations This study adds to the existing evidence of the possible effectiveness of a shielding strategy which is currently limited to mathematical modelling of population effects based on assumptions 11–19. Ours was a large-scale, unselected general population study. The data cover a period when shielding was in place. Linkage of primary care, laboratory, hospital and death data enabled us to examine a range of COVID-19 outcomes and study a range of exposure variables including the overall risk categories and their individual criteria. The datasets were linked using exact, rather than probabilistic, matching. We were able to adjust for potential sociodemographic confounders. The exposure data were collected prior to the outcomes occurring avoiding potential reverse causation and recall or recording bias. We did not have data on potential lifestyle confounding factors such as smoking and obesity, or ethnicity. We did not analyse multimorbidity or other potential risk factors not currently included in the high or moderate risk categories as the aim was to evaluate the current strategy. The shielding and moderate-risk criteria were correct at the time of extracting data but may be revised over time. Implications of findings Our findings suggest that our attempts to shield those at highest risk have not been as successful as hoped, with those advised to shield experiencing higher rates of infection and death. ICU provision has been successfully protected but via ...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
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