Which combinations of Multiple Long-Term Conditions (MLTC) are associated with the greatest risk of hospital admission over the winter season, and to what extent does COVID-19 or influenza vaccination modify this risk?
An estimated 14 million people in England are living with two or more chronic conditions, referred to Multiple Long-Term Conditions (MLTC). We know that people living with MLTC have a higher risk of being admitted to hospital and of dying during the winter season. However, it is not known which combinations of MLTC are associated with the highest risk of these poor health outcomes, and if vaccinations (against COVID-19 or seasonal influenza) can lower this risk. Therefore, our aim is to examine which combinations of MLTC are associated with the highest risk of hospitalisation and death over the winter season, and to study the extent to which vaccinations might help alter this risk.
We will use an anonymised electronic database of patient records called the General Practice Extraction Service Data for pandemic planning and research (GDPPR), to carry out statistical tests with traditional mathematical methods and automated computer (machine learning) approaches to tell us which combinations of disease are most likely to have a high risk of these outcomes and if this risk can be altered by vaccination. We have a well-established interdisciplinary collaborative team who have expertise in this area, existing access to the data and the necessary infrastructure already in place to deliver the project with the highest standard and on time to improve care for people this winter.
We will generate rapid evidence to identify people with specific combinations of MLTC who have high risk of hospitalisation and provide an estimate on the role of vaccination against COVID-19 and seasonal influenza in reducing this risk.
Our findings will potentially save lives through a combination of identification of high-risk groups for earlier or prioritised implementation of preventive measures, and proportionate allocation of resources. The current NHS policy on vaccination for at-risk groups ahead of winter is broad when it comes to long-term conditions, and may contribute to the annual rates of incomplete vaccination in a sufficiently timely manner for maximum benefit. We will provide more detailed insights on who to prioritise at the start of the season for vaccination, if indeed this is shown to moderate some of the risks.
The issues stated above will be addressed in outputs from a number of related sub-projects. Follow the links below to view repositories containing the protocol, data curation and analysis code, and phenotyping algorithms and codelists for each sub-project:
This project has been approved by the CVD-COVID-UK/COVID-IMPACT Approvals & Oversight Board (Project ID: CCU059).