Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK.
Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK.
Public Health. 2023 May;218:12-20. doi: 10.1016/j.puhe.2023.02.008. Epub 2023 Feb 15.
The UK shielding policy intended to protect people at the highest risk of harm from COVID-19 infection. We aimed to describe intervention effects in Wales at 1 year.
Retrospective comparison of linked demographic and clinical data for cohorts comprising people identified for shielding from 23 March to 21 May 2020; and the rest of the population. Health records were extracted with event dates between 23 March 2020 and 22 March 2021 for the comparator cohort and from the date of inclusion until 1 year later for the shielded cohort.
The shielded cohort included 117,415 people, with 3,086,385 in the comparator cohort. The largest clinical categories in the shielded cohort were severe respiratory condition (35.5%), immunosuppressive therapy (25.9%) and cancer (18.6%). People in the shielded cohort were more likely to be female, aged ≥50 years, living in relatively deprived areas, care home residents and frail. The proportion of people tested for COVID-19 was higher in the shielded cohort (odds ratio [OR] 1.616; 95% confidence interval [CI] 1.597-1.637), with lower positivity rate incident rate ratios 0.716 (95% CI 0.697-0.736). The known infection rate was higher in the shielded cohort (5.9% vs 5.7%). People in the shielded cohort were more likely to die (OR 3.683; 95% CI: 3.583-3.786), have a critical care admission (OR 3.339; 95% CI: 3.111-3.583), hospital emergency admission (OR 2.883; 95% CI: 2.837-2.930), emergency department attendance (OR 1.893; 95% CI: 1.867-1.919) and common mental disorder (OR 1.762; 95% CI: 1.735-1.789).
Deaths and healthcare utilisation were higher amongst shielded people than the general population, as would be expected in the sicker population. Differences in testing rates, deprivation and pre-existing health are potential confounders; however, lack of clear impact on infection rates raises questions about the success of shielding and indicates that further research is required to fully evaluate this national policy intervention.
英国的隔离政策旨在保护感染 COVID-19 风险最高的人群。我们旨在描述威尔士在 1 年时的干预效果。
对 2020 年 3 月 23 日至 5 月 21 日期间确定进行隔离的人群以及其余人群的相关联的人口统计学和临床数据进行回顾性比较。将比较队列的事件日期在 2020 年 3 月 23 日至 2021 年 3 月 22 日之间，将受保护队列的事件日期从纳入日期到 1 年后之间提取健康记录。
受保护的队列包括 117415 人，对照组为 3086385 人。受保护队列中最大的临床类别为严重呼吸道疾病（35.5%）、免疫抑制治疗（25.9%）和癌症（18.6%）。受保护队列中的人更可能为女性、年龄≥50 岁、居住在相对贫困地区、住在养老院和体弱。受保护队列中接受 COVID-19 检测的比例较高（优势比[OR] 1.616；95%置信区间[CI] 1.597-1.637），阳性率的发生率比为 0.716（95%CI 0.697-0.736）。受保护队列中的已知感染率较高（5.9%比 5.7%）。受保护队列中的人更有可能死亡（OR 3.683；95%CI：3.583-3.786），需要重症监护（OR 3.339；95%CI：3.111-3.583），住院急诊（OR 2.883；95%CI：2.837-2.930），急诊就诊（OR 1.893；95%CI：1.867-1.919）和常见精神障碍（OR 1.762；95%CI：1.735-1.789）。
与一般人群相比，受保护人群的死亡人数和医疗利用率更高，这在病情较重的人群中是意料之中的。检测率、贫困和预先存在的健康状况的差异可能是混杂因素；然而，感染率没有明显下降，这对隔离政策的成功提出了质疑，并表明需要进一步研究来全面评估这一国家政策干预。
