Impact of the COVID-19 pandemic on incidence of tics in children and young people: a population-based cohort study

Background: Since the onset of the coronavirus (COVID-19) pandemic, clinicians have reported an increase in presentations of sudden and new onset tics particularly affecting teenage girls. This population-based study aimed to describe and compare the incidence of tics in children and young people in primary care before and during the COVID-19 pandemic in England. Methods: We used information from the UK Clinical Practice Research Datalink (CPRD) Aurum dataset and included males and females aged 4–11 years and 12–18 years between Jan 1, 2015, and Dec 31, 2021. We grouped the pre-pandemic period (2015–2019) and presented the pandemic years (2020, 2021) separately. We described the characteristics of children and young people with a first record of a motor or vocal tic in each time period. Incidence rates of tics by age-sex groups in 2015–2019, 2020, and 2021 were calculated. Negative binomial regression models were used to calculate incidence rate ratios. Findings: We included 3,867,709 males and females aged 4–18 years. Over 14,734,062 person-years of follow-up, 11,245 people had a first tic record during the whole study period. The characteristics of people with tics differed over time, with the proportion of females aged 12–18 years and the proportion with mental health conditions including anxiety increasing during the pandemic. Tic incidence rates per 10,000 person-years were highest for 4–11-year-old males in all three time periods (13.4 [95% confidence interval 13.0–13.8] in 2015–2019; 13.2 [12.3–14.1] in 2020; 15.1 [14.1–16.1] in 2021) but increased markedly during the pandemic in 12–18-year-old females, from 2.5 (2.3–2.7) in 2015–2019, to 10.3 (9.5–11.3) in 2020 and 13.1 (12.1–14.1) in 2021. There were smaller increases in incidence rates in 12–18-year-old males (4.6 [4.4–4.9] in 2015–2019; 4.7 [4.1–5.3] in 2020; 6.2 [5.5–6.9] in 2021) and 4–11-year-old females (4.9 [4.7–5.2] in 2015–2019; 5.7 [5.1–6.4] in 2020; 7.6 [6.9–8.3] in 2021). Incidence rate ratios comparing 2020 and 2021 with 2015–2019 were highest in the 12–18-year-old female subgroup (4.2 [3.6–4.8] in 2020; 5.3 [4.7–6.0] in 2021). Interpretation: The incidence of tics in children and young people increased across all age and sex groups during the COVID-19 pandemic, with a differentially large effect in teenage girls (a greater than four-fold increase). Furthermore, in those with tic symptoms, proportions with mental health disorders including anxiety increased during the pandemic. Further research is required on the social and contextual factors underpinning this rise in onset of tics in teenage girls. Funding: National Institute for Health Research Nottingham Biomedical Research Centre

The effect of influenza vaccination on risk of acute myocardial infarction: self-controlled case-series study

Acute myocardial infarction (AMI) peaks in winter months, partly linked to epidemic influenza. This implies that influenza vaccination may prevent some cases of AMI. This study investigated the association between influenza vaccination and AMI using the self-controlled case-series method. We identified 8180 cases of first AMI aged 40 years and over at time of diagnosis. The incidence of AMI was significantly reduced in the 60 days following vaccination (compared with the baseline period), ranging from a reduction of 32% (IRR 0.68; 95% CI 0.60–0.78) at 1–14 days after vaccination, to 18% (IRR 0.82; 95% CI 0.75–0.90) at 29–59 days after vaccination. Reductions in AMI incidence were more pronounced for early seasonal vaccinations before mid-November

Helicobacter pylori eradication for primary prevention of peptic ulcer bleeding in older patients prescribed aspirin (HEAT): a randomised placebo-controlled trial in primary care

Background: Peptic ulcers in patients on aspirin are associated with Helicobacter pylori infection. We investigated whether H. pylori eradication would protect against aspirin associated ulcer bleeding Methods: The Helicobacter Eradication Aspirin Trial (HEAT) was a randomised placebo-controlled trial (EudraCT 2011-003425-96), conducted in UK primary care using routinely collected clinical data. Consenting patients aged >60 years prescribed aspirin < 325 mg but not ulcerogenic or gastroprotective medication underwent C13 urea breath testing for H. pylori. Those with a positive test were randomised to receive either a combination of clarithromycin 500mg, metronidazole 400 mg and lansoprazole 30mg, or placebos twice daily for seven days . Follow up was by scrutiny of electronic data in primary and secondary care. The primary outcome, time to hospitalisation due to definite or probable peptic ulcer bleeding, was analysed by Cox proportional hazards method

Disparities in care and outcomes for primary liver cancer in England during 2008–2018: a cohort study of 8.52 million primary care population using the QResearch databaseResearch in context

Summary: Background: Liver cancer has one of the fastest rising incidence and mortality rates among all cancers in the UK, but it receives little attention. This study aims to understand the disparities in epidemiology and clinical pathways of primary liver cancer and identify the gaps for early detection and diagnosis of liver cancer in England. Methods: This study used a dynamic English primary care cohort of 8.52 million individuals aged ≥25 years in the QResearch database during 2008–2018, followed up to June 2021. The crude and age-standardised incidence rates, and the observed survival duration were calculated by sex and three liver cancer subtypes, including hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (CCA), and other specified/unspecified primary liver cancer. Regression models were used to investigate factors associated with an incident diagnosis of liver cancer, emergency presentation, late stage at diagnosis, receiving treatments, and survival duration after diagnosis by subtype. Findings: 7331 patients were diagnosed with primary liver cancer during follow-up. The age-standardised incidence rates increased over the study period, particularly for HCC in men (increased by 60%). Age, sex, socioeconomic deprivation, ethnicity, and geographical regions were all significantly associated with liver cancer incidence in the English primary care population. People aged ≥80 years were more likely to be diagnosed through emergency presentation and in late stages, less likely to receive treatments and had poorer survival than those aged <60 years. Men had a higher risk of being diagnosed with liver cancer than women, with a hazard ratio (HR) of 3.9 (95% confidence interval 3.6–4.2) for HCC, 1.2 (1.1–1.3) for CCA, and 1.7 (1.5–2.0) for other specified/unspecified liver cancer. Compared with white British, Asians and Black Africans were more likely to be diagnosed with HCC. Patients with higher socioeconomic deprivation were more likely to be diagnosed through the emergency route. Survival rates were poor overall. Patients diagnosed with HCC had better survival rates (14.5% at 10-year survival, 13.1%–16.0%) compared to CCA (4.4%, 3.4%–5.6%) and other specified/unspecified liver cancer (12.5%, 10.1%–15.2%). For 62.7% of patients with missing/unknown stage in liver cancer, their survival outcomes were between those diagnosed in Stages III and IV. Interpretation: This study provides an overview of the current epidemiology and the disparities in clinical pathways of primary liver cancer in England between 2008 and 2018. A complex public health approach is needed to tackle the rapid increase in incidence and the poor survival of liver cancer. Further studies are urgently needed to address the gaps in early detection and diagnosis of liver cancer in England. Funding: The Early Detection of Hepatocellular Liver Cancer (DeLIVER) project is funded by Cancer Research UK (Early Detection Programme Award, grant reference: C30358/A29725)