Role of primary T‐cell immunodeficiency and hepatitis B coinfection on spontaneous clearance of hepatitis C: The BC Hepatitis Testers Cohort

Islam, Nazrul; Krajden, Mel; Gilbert, Mark; Paul Gustafson; Yu, Amanda; Kuo, Margot; Chong, Mei; Alvarez, Maria; Wong, Jason; Tyndall, Mark W

Bosworth ML, Ahmed T, Larsen T, et al. Ethnic differences in COVID-19 mortality in the second and third waves of the pandemic in England during the vaccine rollout: a retrospective, population-based cohort study. BMC Medicine. 2023;21 (1) :13. Publisher's Version Abstract

Abstract Background Ethnic minority groups in England have been disproportionately affected by the COVID-19 pandemic and have lower vaccination rates than the White British population. We examined whether ethnic differences in COVID-19 mortality in England have continued since the vaccine rollout and to what extent differences in vaccination rates contributed to excess COVID-19 mortality after accounting for other risk factors. Methods We conducted a retrospective, population-based cohort study of 28.8 million adults aged 30–100 years in England. Self-reported ethnicity was obtained from the 2011 Census. The outcome was death involving COVID-19 during the second (8 December 2020 to 12 June 2021) and third wave (13 June 2021 to 1 December 2021). We calculated hazard ratios (HRs) for death involving COVID-19, sequentially adjusting for age, residence type, geographical factors, sociodemographic characteristics, pre-pandemic health, and vaccination status. Results Age-adjusted HRs of death involving COVID-19 were elevated for most ethnic minority groups during both waves, particularly for groups with lowest vaccination rates (Bangladeshi, Pakistani, Black African, and Black Caribbean). HRs were attenuated after adjusting for geographical factors, sociodemographic characteristics, and pre-pandemic health. Further adjusting for vaccination status substantially reduced residual HRs for Black African, Black Caribbean, and Pakistani groups in the third wave. Fully adjusted HRs only remained elevated for the Bangladeshi group (men: 2.19 [95% CI 1.72–2.78]; women: 2.12 [1.58–2.86]) and Pakistani men (1.24 [1.06–1.46]). Conclusions Lower COVID-19 vaccination uptake in several ethnic minority groups may drive some of the differences in COVID-19 mortality compared to White British. Public health strategies to increase vaccination uptake in ethnic minority groups would help reduce inequalities in COVID-19 mortality, which have remained substantial since the start of the vaccination campaign.

Wright LF, Cheema K, Goldacre R, et al. Effects of the COVID-19 pandemic on secondary care for cardiovascular disease in the UK: an electronic health record analysis across three countries. European Heart Journal - Quality of Care and Clinical Outcomes. 2022. Publisher's Version Abstract

Although morbidity and mortality from COVID-19 have been widely reported, the indirect effects of the pandemic beyond 2020 on other major diseases and health service activity have not been well described.Analyses used national administrative electronic hospital records in England, Scotland, and Wales for 2016–21. Admissions and procedures during the pandemic (2020–21) related to six major cardiovascular conditions [acute coronary syndrome (ACS), heart failure (HF), stroke/transient ischaemic attack (TIA), peripheral arterial disease (PAD), aortic aneurysm (AA), and venous thromboembolism(VTE)] were compared with the annual average in the pre-pandemic period (2016–19). Differences were assessed by time period and urgency of care.In 2020, there were 31 064 (−6%) fewer hospital admissions [14 506 (−4%) fewer emergencies, 16 560 (−23%) fewer elective admissions] compared with 2016–19 for the six major cardiovascular diseases (CVDs) combined. The proportional reduction in admissions was similar in all three countries. Overall, hospital admissions returned to pre-pandemic levels in 2021. Elective admissions remained substantially below expected levels for almost all conditions in all three countries [−10 996 (−15%) fewer admissions]. However, these reductions were offset by higher than expected total emergency admissions [+25 878 (+6%) higher admissions], notably for HF and stroke in England, and for VTE in all three countries. Analyses for procedures showed similar temporal variations to admissions.The present study highlights increasing emergency cardiovascular admissions during the pandemic, in the context of a substantial and sustained reduction in elective admissions and procedures. This is likely to increase further the demands on cardiovascular services over the coming years.

Ahern AL, Breeze P, Fusco F, et al. Effectiveness and cost-effectiveness of referral to a commercial open group behavioural weight management programme in adults with overweight and obesity: 5-year follow-up of the WRAP randomised controlled trial. The Lancet Public Health. 2022;7 (10) :e866-e875. Publisher's Version Abstract

Summary Background There is evidence that commercially available behavioural weight management programmes can lead to short-term weight loss and reductions in glycaemia. Here, we aimed to provide the 5-year impact and cost-effectiveness of these interventions compared with a brief intervention. Methods WRAP was a non-blinded, parallel-group randomised controlled trial (RCT). We recruited from primary care practices in England and randomly assigned participants to one of three interventions (brief intervention, 12-week open-group behavioural programme [WW, formerly Weight Watchers], or a 52-week open-group WW behavioural programme) in an uneven (2:5:5) allocation. Participants were followed up 5 years after randomisation using data from measurement visits at primary care practices or a research centre, review of primary care electronic medical notes, and self-report questionnaires. The primary outcome was change in weight at 5 years follow-up, assessed using analysis of covariance. We also estimated cost-effectiveness of the intervention. This study is registered at Current Controlled Trials, ISRCTN64986150. Findings Between Oct 18, 2012, and Feb 10, 2014, we recruited 1269 eligible participants (two participants were randomly assigned but not eligible and therefore excluded) and 1040 (82%) consented to be approached about additional follow-up and to have their medical notes reviewed at 5 years. The primary outcome (weight) was ascertained for 871 (69%) of 1267 eligible participants. Mean duration of follow-up was 5·1 (SD 0·3) years. Mean weight change from baseline to 5 years was −0·46 (SD 8·31) kg in the brief intervention group, −1·95 (9·55) kg in the 12-week programme group, and −2·67 (9·81) kg in the 52-week programme. The adjusted difference in weight change was –1·76 (95% CI –3·68 to 0·17) kg between the 52-week programme and the brief intervention; –0·80 (–2·13 to 0·54) kg between the 52-week and the 12-week programme; and –0·96 (–2·90 to 0·97) kg between the 12-week programme and the brief intervention. During the trial, the 12-week programme incurred the lowest cost and produced the highest quality-adjusted life-years (QALY). Simulations beyond 5 years suggested that the 52-week programme would deliver the highest QALYs at the lowest cost and would be the most cost-effective. No participants reported adverse events related to the intervention. Interpretation Although the difference in weight change between groups was not statistically significant, some weight loss was maintained at 5 years after an open-group behavioural weight management programme. Health economic modelling suggests that this could have important implications to reduce the incidence of weight-related disease and these interventions might be cost-saving. Funding The UK National Institute for Health and Care Research Programme Grants for Applied Research and the Medical Research Council.

Islam N, Cole TJ, Ross JS, Feeney T, Loder E. Post-submission changes to prespecified statistical analysis plans. BMJ. 2022;378 :o2244. Publisher's Version

Thygesen JH, Tomlinson C, Hollings S, et al. COVID-19 trajectories among 57 million adults in England: a cohort study using electronic health records. The Lancet Digital Health. 2022;4 (7) :e542–e557. Publisher's Version

Bates SE, Thomas C, Islam N, et al. Using health economic modelling to inform the design and development of an intervention: estimating the justifiable cost of weight loss maintenance in the UK. BMC Public Health. 2022;22 (1) :290. Publisher's Version Abstract

Abstract Background There is a need to develop cost-effective weight loss maintenance interventions to prolong the positive impact of weight loss on health outcomes. Conducting pre-trial health economic modelling is recommended to inform the design and development of behavioural interventions. We aimed to use health economic modelling to estimate the maximum cost per-person (justifiable cost) of a cost-effective behavioural weight loss maintenance intervention, given an estimated intervention effect for individuals with: i) a Body Mass Index (BMI) of 28 kg/m 2 or above without diabetes and ii) a diagnosis of type 2 diabetes prescribed a single non-insulin diabetes medication. Methods The School for Public Health Research Diabetes prevention model was used to estimate the lifetime Quality-adjusted life year (QALY) gains, healthcare costs, and maximum justifiable cost associated with a weight loss maintenance intervention. Based on a meta-analysis, the estimated effect of a weight loss maintenance intervention following a 9 kg weight loss, was a regain of 1.33 kg and 4.38 kg in years one and two respectively compared to greater regain of 2.84 kg and 5.6 kg in the control group. Sensitivity analysis was conducted around the rate of regain, duration of effect and initial weight loss. Results The justifiable cost for a weight loss maintenance intervention at an ICER of £20,000 per QALY was £104.64 for an individual with a BMI of 28 or over and £88.14 for an individual with type 2 diabetes. Within sensitivity analysis, this varied from £36.42 to £203.77 for the former, and between £29.98 and £173.05 for the latter. Conclusions Researchers developing a weight loss maintenance intervention should consider these maximum justifiable cost estimates and the potential impact of the duration of effect and initial weight loss when designing intervention content and deciding target populations. Future research should consider using the methods demonstrated in this study to use health economic modelling to inform the design and budgetary decisions in the development of a behavioural interventions.

Matthews AA, Danaei G, Islam N, Kurth T. Target trial emulation: applying principles of randomised trials to observational studies. BMJ. 2022;378 :e071108. Publisher's Version

Bermingham C, Morgan J, Ayoubkhani D, et al. Estimating the effectiveness of first dose of COVID-19 vaccine against mortality in England: a quasi-experimental study. American Journal of Epidemiology. 2022 :kwac157. Publisher's Version

Gillies CL, Rowlands AV, Razieh C, et al. Association between household size and COVID-19: A UK Biobank observational study. Journal of the Royal Society of Medicine. 2022;115 (4) :138-44. Publisher's Version

Yates T, Summerfield A, Razieh C, et al. A population-based cohort study of obesity, ethnicity and COVID-19 mortality in 12.6 million adults in England. Nature Communications. 2022;13 :624. Publisher's Version

Islam N. “Excess deaths” is the best metric for tracking the pandemic. BMJ. 2022;376 :o285. Publisher's Version

Norris T, Razieh C, Zaccardi F, et al. Impact of cardiometabolic multimorbidity and ethnicity on cardiovascular/renal complications in patients with COVID-19. Heart. 2022;108 (15) :1200-1208. Publisher's Version

Islam N, Lacey B, Shabnam S, et al. Social inequality and the syndemic of chronic disease and COVID-19: county-level analysis in the USA. J Epidemiol Community Health. 2021;75 (6) :496–500. Publisher's Version

Razieh C, Zaccardi F, Islam N, et al. Ethnic minorities and COVID-19: Examining whether excess risk is mediated through deprivation. European Journal of Public Health. 2021;31 (3) :630–4. Publisher's Version

Rowlands AV, Kloecker DE, Chudasama Y, et al. Association of timing and balance of physical activity and rest/sleep with risk of COVID-19: a UK Biobank Study. In: Mayo Clinic Proceedings. Vol 96. Elsevier ; 2021 :156–164. Publisher's Version

Khunti K, Zaccardi F, Islam N, Yates T. Uses and abuses of real-world data in generating evidence during a pandemic. Journal of the Royal Society of Medicine. 2021;114 (3) :109–10. Publisher's Version

Yates T, Zaccardi F, Islam N, et al. Obesity, chronic disease, age, and in-hospital mortality in patients with covid-19: analysis of ISARIC clinical characterisation protocol UK cohort. BMC infectious diseases. 2021;21 :717. Publisher's Version

Wilcox CR, Islam N, Dambha-Miller H. Association between influenza vaccination and hospitalisation or all-cause mortality in people with COVID-19: a retrospective cohort study. BMJ Open Respiratory Research. 2021;8 (1) :e000857. Publisher's Version

Rowlands AV, Gillies C, Chudasama Y, et al. Association of working shifts, inside and outside of healthcare, with severe COVID- 19: an observational study. BMC public health. 2021;21 :773. Publisher's Version

Islam N, Jdanov DA, Shkolnikov VM, et al. Effects of covid-19 pandemic on life expectancy and premature mortality in 2020: time series analysis in 37 countries. BMJ. 2021;375 :e066768. Publisher's Version

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Nazrul Islam

MBBS, MSc, MPH, PhD

Role of primary T‐cell immunodeficiency and hepatitis B coinfection on spontaneous clearance of hepatitis C: The BC Hepatitis Testers Cohort

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