OpenSAFELY

Published Papers

OpenSAFELY: factors associated with COVID-19 death in 17 million patients

July 2020. Abstract: "COVID-19 has rapidly affected mortality worldwide. There is unprecedented urgency to understand who is most at risk of severe outcomes, requiring new approaches for timely analysis of large datasets. Working on behalf of NHS England, here we created OpenSAFELY: a secure health analytics platform covering 40% of all patients in England, holding patient data within the existing data centre of a major primary care electronic health records vendor. Primary care records of 17,278,392 adults were pseudonymously linked to 10,926 COVID-19-related deaths. COVID-19-related death was associated with: being male (hazard ratio (HR) 1.59, 95% confidence interval (CI) 1.53–1.65); older age and deprivation (both with a strong gradient); diabetes; severe asthma; and various other medical conditions. Compared with people with white ethnicity, Black and South Asian people were at higher risk even after adjustment for other factors (HR 1.48, 1.30–1.69 and 1.44, 1.32–1.58, respectively). We have quantified a range of clinical risk factors for COVID-19-related death in the largest cohort study conducted by any country to date. OpenSAFELY is rapidly adding further patients’ records; we will update and extend results regularly."

How to Cite: Williamson, E.J., Walker, A.J., Bhaskaran, K. et al. OpenSAFELY: factors associated with COVID-19 death in 17 million patients. Nature (2020). https://doi.org/10.1038/s41586-020-2521-4

Risk of COVID-19-related death among patients with chronic obstructive pulmonary disease or asthma prescribed inhaled corticosteroids: an observational cohort study using the OpenSAFELY platform

September 2020. Early descriptions of patients admitted to hospital during the COVID-19 pandemic showed a lower prevalence of asthma and chronic obstructive pulmonary disease (COPD) than would be expected for an acute respiratory disease like COVID-19, leading to speculation that inhaled corticosteroids (ICSs) might protect against infection with severe acute respiratory syndrome coronavirus 2 or the development of serious sequelae. Working on behalf of NHS England, we assessed the association between ICS and COVID-19-related death among people with COPD or asthma using linked electronic health records (EHRs) in England, UK.

How to Cite: Schultze, Anna, Alex J Walker, Brian MacKenna, Caroline E Morton, Krishnan Bhaskaran, Jeremy P Brown, Christopher T Rentsch, et al. ‘Risk of COVID-19-Related Death among Patients with Chronic Obstructive Pulmonary Disease or Asthma Prescribed Inhaled Corticosteroids: An Observational Cohort Study Using the OpenSAFELY Platform’. The Lancet Respiratory Medicine. Accessed 9 October 2020. https://doi.org/10.1016/S2213-2600(20)30415-X.

Papers Accepted for Publication

The versions of papers here are the pre-prints. Although accepted, there may be changes to the pre-print versions prior to final publication

Hydroxychloroquine for prevention of COVID-19 mortality: a population-based cohort study

September 2020 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 a difference in COVID-19 mortality among patients who received hydroxychloroquine for treatment of rheumatological disease prior to the COVID-19 outbreak in England.

Pre-Prints

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

August 2020 Working on behalf of NHS England, this paper used the OpenSAFELY platform to investigate the association between NSAID use and deaths from COVID-19. We found no evidence of a harmful effect of NSAIDs on COVID-19 related deaths. Risks from COVID-19 do not need to influence decisions about therapeutic use of NSAIDs.

HIV infection and COVID-19 death: population-based cohort analysis of UK primary care data and linked national death registrations within the OpenSAFELY platform

August 2020. Working on behalf of NHS England, this paper used the OpenSAFELY platform to estimate the association between HIV infection and COVID-19 death.

Factors associated with COVID-19-related hospital death in the linked electronic health records of 17 million adult NHS patients

May 2020. Working on behalf of NHS England, this paper used the OpenSAFELY platform to analyse the pseudonymised health data of over 17.4 million UK adults to discover the key factors associated with hospital death from COVID-19.

Ethnic differences in COVID-19 infection, hospitalisation, and mortality: an OpenSAFELY analysis of 17 million adults in England

September 2020. 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.

Study protocol: Comparison of different risk prediction modelling approaches for COVID-19 related death using the OpenSAFELY platform

October 2020. 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.

Supplemental Research

Post-publications supplement to Williamson, E.J., Walker, A.J., Bhaskaran, K. et al. OpenSAFELY: factors associated with COVID-19 death in 17 million patients. Nature (2020). https://doi.org/10.1038/s41586-020-2521-4

August 2020. In the above paper, working on behalf of NHS England, we estimated associations between a wide range of individual-level factors including demographics and comorbidities, and risk of COVID-19 death, but we did not explore interactions between variables. It is plausible that associations may depend on age, and evaluating this would inform more accurate risk prediction. The purpose of this supplement is therefore to present associations between individual-level factors and COVID-19 death,stratified by age group.

Download the supplement here.