Research
OpenSAFELY has been built as a broad collaboration between a wide range of organisations and users with diverse skills and knowledge. This has enabled high quality research across the two largest electronic health record providers in the NHS, representing over 95% of the NHS patient population in England, to support urgent research into the COVID-19 emergency. To date, this has generated 63 published research outputs from more than 10 different organisations and includes work on understanding disease risk; monitoring the uptake of vaccines and novel treatments; evaluating vaccine effectiveness; assessing patient safety; understanding changes in patient care during and after the pandemic and informing restoration of service following disruption; assessing the impact of lockdowns; and informing public health guidance and policy.
Below, you will find details on each of these outputs, including links to published research, and the source code. Our blog contains more details on some of our research highlights and our NHS service analytics work.
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Identification of patients undergoing chronic kidney replacement therapy in primary and secondary care data
Identification of people receiving chronic kidney replacement therapy using primary and secondary care records compared with gold standard registry data.
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The impact of COVID-19 on azathioprine, leflunomide and methotrexate monitoring, and factors associated with change in monitoring rate
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.
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The impact of COVID-19 on medication reviews in English primary care
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.
- Preprint
Comparative safety and effectiveness of Pfizer BA.4-5 versus Sanofi during the spring 2023 COVID-19 booster vaccination programme in England
A comparison of the Pfizer BA.4-5 and Sanofi vaccines for protecting against Covid-19 during Spring 2023 booster programme in England
- Preprint
Changes in opioid prescribing during the COVID-19 pandemic in England
This study described changes in prevalent and new opioid prescribing during the COVID-19 pandemic, overall, among people in care homes, and stratified by demographics.
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Measuring BMI in 22 million patients in England
This study describes the use of four derivations of BMI in OpenSAFELY.
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Safety of direct-acting oral anticoagulant (DOAC) prescribing
This study aimed to identify the proportion of those prescribed a DOAC with recorded: weight, estimated Glomerular Filtration Rate (eGFR), creatinine, creatinine clearance (CrCl) and atrial fibrillation (AF). In those with recorded AF and CrCl prescribed the study aimed to identify the proportion with a recommended DOAC dose.
- Preprint
OpenSAFELY: a platform for analysing electronic health records designed for reproducible research
This paper describes OpenSAFELY's reproducibility-by-design approach in detail.
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Trends in inequalities in avoidable hospitalisations across the COVID-19 pandemic
We determine whether periods of disruption were associated with increased ‘avoidable’ hospital admissions and wider social inequalities in England.
- Preprint
Ursodeoxycholic acid and severe COVID-19 outcomes in people with liver disease
Cohort study investigating whether ursodeoxycholic acid was associated with COVID-19 related hospitalisation and death in people with primary biliary cirrhosis and primary sclerosing cholangitis.
- Preprint
Impact of COVID-19 on mental illness in vaccinated and unvaccinated people
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.
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Clinical and health inequality risk factors for non-COVID-related sepsis during the global COVID-19 pandemic
We used OpenSAFELY-TPP data to elucidate the association between non-Covid-19 related sepsis and a range of risk factors during the Covid-19 pandemic
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Consistency, completeness and external validity of ethnicity recording in NHS primary care records
We describe the completeness and consistency of primary care ethnicity recording in the OpenSAFELY-TPP database, containing linked primary care and hospital records in >25 million patients in England. We also compared the ethnic breakdown in OpenSAFELY-TPP with that of the 2021 UK census.
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Interpreting pathology test result values with comparators (<, >) in Electronic Health Records research
A short data report about comparators in pathology test results
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Antibiotics for Common Infections in Primary Care Before, During and after the COVID-19 Pandemic and Extent of Risk-Based Prescribing: Need for Personalised Guidelines
We assessed the changes in risk-based prescribing behaviours of antibiotics for common infections in primary care during the Covid-19 pandemic
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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.
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The impact of COVID-19 on medication reviews in English primary care
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.
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The impact of the COVID-19 pandemic on the treatment of common infections in primary care and the change to antibiotic prescribing in England
We studied how antibiotic precribing for common infections in primary changed duding the Covid-19 pandemic and how this may have affected clincial outcomes
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Impact of the COVID-19 pandemic on antipsychotic prescribing in individuals with autism, dementia, learning disability, serious mental illness or living in a care home
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.
- Preprint
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.
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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.
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Challenges in Estimating the Effectiveness of 2 Doses of COVID-19 Vaccine Beyond 6 Months in England
This paper discusses the challenges in estimating long-term (>6 months) vaccine effectiveness in observational data, primarily due to high uptake of a subsequent third vaccine dose.
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Impact of COVID-19 on recorded blood pressure screening and hypertension management in England
We describe the impact of the COVID-19 pandemic on blood pressure screening and hypertension management.
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Eleven 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.
- Preprint
Evaluation of the impact of COVID-19 pandemic on hospital admission related to common infections
We studied the changes in hospital admission rates for common infections during the Covid-19 pandemic, for those having and having not received antibiotic prescriptions in primary care
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Repeated antibiotic exposure and risk of hospitalisation and death following COVID-19 infection
We examined whether prior frequent antibiotic exposure is associated with severe COVID-19 outcomes.
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Ethnic differences in the indirect effects of the COVID-19 pandemic on clinical monitoring and hospitalisations for non-COVID conditions in England
We aimed to describe the impact of pandemic-related disruption on ethnic differences in clinical monitoring and hospital admissions for non-COVID conditions in England.
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Patient Characteristics Associated with Repeat Antibiotic Prescribing Pre- and during the COVID-19 Pandemic
With the approval of NHS England, we conducted a retrospective cohort study of >19 million English primary care patient records using the OpenSAFELY-TPP analytics platform. We analysed repeat/non-repeat prescribing frequency in monthly patient cohorts between January 2020 and 2022.
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A National Audit of Pancreatic Enzyme Prescribing in Pancreatic Cancer from 2015 to 2023 in England
Investigating the impact of the COVID-19 pandemic on PERT prescribing to people with unresectable pancreatic cancer and to investigate the national and regional rates from January 2015 to January 2023.
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Changes in medication safety indicators in England throughout the covid-19 pandemic using OpenSAFELY
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.
- Preprint
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.
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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.
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The impact of COVID-19 on antibiotic prescribing in primary care in England
This study predicted risk factors for potentially inappropriate prescribing in primary care and how this changed during the Covid-19 pandemic
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Challenges in Estimating the Effectiveness of COVID-19 Vaccination Using Observational Data
This paper discusses the challenges in estimating vaccine effectiveness using observational data, and describes two approaches that help to overcome these challenges.
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Changes in COVID-19-related mortality across key demographic and clinical subgroups 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.
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Deaths at home during the Covid-19 pandemic and implications for patients and services
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.
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Postoperative mortality and complications in patients with and without pre-operative SARS-CoV-2 infection
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.
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Comparative effectiveness of BNT162b2 versus mRNA-1273 covid-19 vaccine boosting in England
A comparison of the Pfizer and Moderna vaccines for protecting against Covid-19 during the first booster programme in England
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First dose COVID-19 vaccine coverage amongst adolescents and children in England
Describing trends and variation in first dose COVID vaccine coverage in different clinical and demographic groups amongst adolescents and children in England
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Trends, variation, and clinical characteristics of recipients of antiviral drugs and neutralising monoclonal antibodies for covid-19 in community settings
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.
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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.
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Factors associated with COVID-19 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.
- Preprint
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.
- Preprint
Challenges in estimating waning effectiveness of two doses of BNT162b2 and ChAdOx1 COVID-19 vaccines beyond six months
Quantifying the waning effectiveness of second COVID-19 vaccination beyond six months and against the omicron variant
- Preprint
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
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Comparative effectiveness of sotrovimab and molnupiravir for prevention of severe covid-19 outcomes in patients in the community
Comparing the effectiveness of sotrovimab (a neutralising monoclonal antibody) with molnupiravir (an antiviral) in preventing severe outcomes of covid-19 in adult patients infected with SARS-CoV-2 in the community and at high risk of severe outcomes from covid-19.
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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.
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Recording of ‘COVID-19 vaccine declined’
A description of the patterns of usage of codes for COVID-19 vaccines being declined.
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Association between household composition and severe COVID-19 outcomes in older people by ethnicity
This paper aims to quantify the association between household composition and risk of severe COVID-19 by ethnicity for older individuals
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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
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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.
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Representativeness of electronic health record platform 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.
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Describing the population experiencing COVID-19 vaccine breakthrough following second vaccination in England
This paper describes the characters of individuals who have experienced COVID-19 vaccine breakthrough after their second vaccination.
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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.
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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.
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Risk of severe COVID-19 outcomes associated with immune-mediated inflammatory diseases and immune modifying therapies
This paper aimed to assess the risk of severe COVID-19 in adults with immune-mediated inflammatory diseases and in those on immune-modifying therapies.
- Preprint
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.
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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.
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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.
- Preprint
Accident and emergency (AE) attendance in England following infection with SARS-CoV-2 Omicron or Delta
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
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Rates of serious clinical outcomes in survivors of hospitalisation with COVID-19 in England
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.
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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
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Potentially inappropriate prescribing of DOACs to people 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.
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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.
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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.
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OpenSAFELY NHS Service Restoration Observatory 1: primary care clinical activity in England during the first wave of COVID-19
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.
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Trends and clinical characteristics of COVID-19 vaccine recipients
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.
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Impact of national guidance on switching anticoagulant therapy during COVID-19 pandemic
This paper describes which people were switched from warfarin to DOACs during the COVID-19 pandemic following an update in national guidance
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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.
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Association between warfarin and COVID-19-related outcomes compared with direct oral anticoagulants
This paper conducted a population-based cohort study investigating the association between warfarin and COVID-19 outcomes compared with direct oral anticoagulants (DOACs).
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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.
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Risks of covid-19 hospital admission and death for people with learning disability
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.
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Factors associated with deaths due to COVID-19 versus other causes
We aimed to investigate how specific factors are differentially associated with COVID-19 mortality as compared to mortality from causes other than COVID-19.
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Ethnic differences in SARS-CoV-2 infection and COVID-19-related hospitalisation, intensive care unit admission, and death in 17 million adults in England
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.
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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.
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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.
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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
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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.
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Short report: 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.
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Use of non-steroidal anti-inflammatory drugs 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.
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HIV infection and COVID-19 death
Working on behalf of NHS England, this paper used the OpenSAFELY platform to investigate the association between HIV infection and COVID-19 mortality.
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Effect of pre-exposure use of hydroxychloroquine on 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.
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Comparison of different risk prediction modelling approaches for COVID-19 related death using the OpenSAFELY platform
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.
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Risk of COVID-19-related death among patients with chronic obstructive pulmonary disease or asthma prescribed inhaled corticosteroids
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.
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Factors associated with COVID-19-related death using OpenSAFELY
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.