The Impact of Shielding Policy in Wales.

Objectives Shielding was introduced as part of the UK government’s response to the SARS-CoV-2 pandemic to protect Clinically Extremely Vulnerable (CEV) people from infection and serious illness. Various research questions emerged in relation to non-clinical vulnerabilities of those shielding which could be addressed by utilising available health and administrative data. Approach The Shielded Patient List (SPL) was linked with various datasets on the UK Secure Electronic Research Platform (UKSERP) including the Pupil Level Annual School Census (PLASC), National Survey and Ordnance Survey data for Wales. Some of these were anonymised datasets contained in the Secure Anonymised Information Linkage (SAIL) databank. Algorithms were applied to determine household composition and whether private outdoor space was available for the shielding group. Results were then extracted for Wales broken down by local authority. Results Results from the various strands of research related to shielding will be presented covering provision of outdoor space, household characteristics and composition. Conclusion These analyses demonstrate how population-level data resources can be leveraged quickly to answer newly-emerging policy questions as part of the response to the SARS-CoV-2 pandemic

Supporting People Data Linking Programme: Linked data research into the impact of housing-related support on use of healthcare services

Objectives With an annual budget of over £120 million, the Welsh Government Supporting People Programme provided housing-related support to help vulnerable people to avoid homelessness and live as independently as possible. The SPDLP aims to determine the impact of the programme on other public services I.e. healthcare. Methods Establish data sharing agreements and acquire data for 21 out of 22 Local Authorities. Link the acquired Wales-wide sample of Supporting People data with other routine health and administrative datasets in the SAIL Databank. Examine the impact on subsequent interactions with other services (i.e. health, social care, housing options and pre-16 education). Create control groups and identify subgroups of clients to better quantify the effects of the Supporting People intervention. Compare service utilisation groups of clients and non-clients to inform future provision of public services. Results Work to validate the SPDLP approach by applying the method from the earlier Supporting People Data Linking Feasibility Study (SPDLFS) to the most recent data has been completed. Results from this will be presented along with emerging findings related to repeat homelessness. The development of health economics approaches to evaluating the impact of the programme will also be presented. Conclusion For most local authorities in Wales, we have developed a longitudinal linked dataset comprising details of people at risk of homelessness. This has successfully enabled statistical research and analysis to explore the wider impact of government programmes to address inequalities and answer research questions around homelessness

Are population health surveys reliable for self-reporting conditions and relative well-being for those with asthma?

Background Person reported population sample surveys have been used to record information on self-reported health for a number of years and provide a useful information source for studies of disease burdens. Developments since 2013 have led to integration of health-related quality of life and subjective well-being as topic areas in some UK-based health surveys. The relative impact of different morbidities on subjective well-being in the UK though is unclear and has not been extensively researched. Objectives This descriptive study of a combined sample of two years of population-based data from the Welsh Health Survey (n=11,323) aims to address research questions relating to chronic conditions, self-reported health and well-being. The main questions are whether population surveys under- or overreport chronic conditions, and whether the relative level of mental wellbeing is different for those with chronic conditions to those without. Following this initial analysis it seeks to identify potential risk factors to mental wellbeing for those not affected by selected chronic conditions. Methods Survey data were linked with clinical data contained within the Secure Anonymised Information Linkage (SAIL) Databank using SQL (Structured Query Language). The association between selected chronic conditions and relative subjective well-being was then assessed using SF-36 Mental Component Scores as a measure of mental wellbeing. Analysis was based on contingency tables, graphs and logistic regression in SAS 9.4. Findings Results show that some self-reported chronic conditions can more easily be verified than others from clinical data. Aside from the selected chronic conditions, potential risk factors to mental well-being include type 2 diabetes, a history of circulatory diseases, psychoactive substance abuse and hypertension. Conclusions Linkage of survey data can provide useful insights into relative levels of self-reported illnesses and subjective well-being but can also be used effectively to explore the risks that other morbidities present to mental wellbeing

Evaluation of the shielding initiative in Wales (EVITE Immunity): protocol for a quasiexperimental study

Introduction: Shielding aimed to protect those predicted to be at highest risk from COVID-19 and was uniquely implemented in the UK during the COVID-19 pandemic. Clinically extremely vulnerable people identified through algorithms and screening of routine National Health Service (NHS) data were individually and strongly advised to stay at home and strictly self-isolate even from others in their household. This study will generate a logic model of the intervention and evaluate the effects and costs of shielding to inform policy development and delivery during future pandemics. Methods and analysis: This is a quasiexperimental study undertaken in Wales where records for people who were identified for shielding were already anonymously linked into integrated data systems for public health decision-making. We will: interview policy-makers to understand rationale for shielding advice to inform analysis and interpretation of results; use anonymised individual-level data to select people identified for shielding advice in March 2020 and a matched cohort, from routine electronic health data sources, to compare outcomes; survey a stratified random sample of each group about activities and quality of life at 12 months; use routine and newly collected blood data to assess immunity; interview people who were identified for shielding and their carers and NHS staff who delivered healthcare during shielding, to explore compliance and experiences; collect healthcare resource use data to calculate implementation costs and cost–consequences. Our team includes people who were shielding, who used their experience to help design and deliver this study. Ethics and dissemination: The study has received approval from the Newcastle North Tyneside 2 Research Ethics Committee (IRAS 295050). We will disseminate results directly to UK government policy-makers, publish in peer-reviewed journals, present at scientific and policy conferences and share accessible summaries of results online and through public and patient networks

Impact of social deprivation on outcome following transcatheter aortic valve implantation (TAVI)

Objectives We sought to evaluate whether socioeconomic status influences outcome after first-time transcatheter aortic valve implantation (TAVI). Method This is a single-centre study carried out in Swansea, South West Wales, UK between 5 November 2009 and 10 June 2018. Data included age, gender, domiciliary postal code, comorbidities, complications post-TAVI, length of stay, follow-up time and survival status. The Welsh Index of Multiple Deprivation, 2014 was used to stratify cases by level of social deprivation according to domiciliary postal codes. Results Study population was 387 patients of whom 213 (54.8%) were men with mean age ±SD of 82.8±8.3 years. Patients, who were less deprived (296 (76.4%)), were more likely to be older (83.5±7.9 vs 80.4±9.3, p<0.05) and to be married (83.2% vs 69.7%, p<0.05). Conversely, ‘more deprived’ patients (91 (23.6%)) were more likely to have a longer stay in hospital as compared with patients in the ‘less deprived group’ (29.6±32.7 days vs 21.3±21.1 days, p<0.05). However, 30-day, 1-year and 3-year survival/mortality rates were similar across all socioeconomic levels. Conclusions This is the first study in which social deprivation has been investigated as a risk factor for mortality in a high-risk group of patients with severe aortic stenosis undergoing TAVI. Residing in a ‘more deprived’ area in South West Wales is not associated with adverse outcome following TAVI but patients who are ‘more deprived’ tend to stay longer in hospital compared with patients who are ‘less deprived’

Effects of the COVID-19 pandemic on the mental health of clinically extremely vulnerable children and children living with clinically extremely vulnerable people in Wales: a data linkage study

Objectives To determine whether clinically extremely vulnerable (CEV) children or children living with a CEV person in Wales were at greater risk of presenting with anxiety or depression in primary or secondary care during the COVID-19 pandemic compared with children in the general population and to compare patterns of anxiety and depression during the pandemic (23 March 2020–31 January 2021, referred to as 2020/2021) and before the pandemic (23 March 2019–31 January 2020, referred to as 2019/2020), between CEV children and the general population.Design Population-based cross-sectional cohort study using anonymised, linked, routinely collected health and administrative data held in the Secure Anonymised Information Linkage Databank. CEV individuals were identified using the COVID-19 shielded patient list.Setting Primary and secondary healthcare settings covering 80% of the population of Wales.Participants Children aged 2–17 in Wales: CEV (3769); living with a CEV person (20 033); or neither (415 009).Primary outcome measure First record of anxiety or depression in primary or secondary healthcare in 2019/2020 and 2020/2021, identified using Read and International Classification of Diseases V.10 codes.Results A Cox regression model adjusted for demographics and history of anxiety or depression revealed that only CEV children were at greater risk of presenting with anxiety or depression during the pandemic compared with the general population (HR=2.27, 95% CI=1.94 to 2.66, p&lt;0.001). Compared with the general population, the risk among CEV children was higher in 2020/2021 (risk ratio 3.04) compared with 2019/2020 (risk ratio 1.90). In 2020/2021, the period prevalence of anxiety or depression increased slightly among CEV children, but declined among the general population.Conclusions Differences in the period prevalence of recorded anxiety or depression in healthcare between CEV children and the general population were largely driven by a reduction in presentations to healthcare services by children in the general population during the pandemic