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Objectives: Using electronic health records, we derived and internally validated a prediction model to estimate risk factors for long COVID and predict individual risk of developing long COVID., Design: Population-based, retrospective cohort study., Setting: Scotland., Participants: Adults (≥18 years) with a positive COVID-19 test, registered with a general medical practice between 1 March 2020 and 20 October 2022., Main Outcome Measures: Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for predictors of long COVID, and patients' predicted probabilities of developing long COVID., Results: A total of 68,486 (5.6%) patients were identified as having long COVID. Predictors of long COVID were increasing age (aOR: 3.84; 95% CI: 3.66-4.03 and aOR: 3.66; 95% CI: 3.27-4.09 in first and second splines), increasing body mass index (BMI) (aOR: 3.17; 95% CI: 2.78-3.61 and aOR: 3.09; 95% CI: 2.13-4.49 in first and second splines), severe COVID-19 (aOR: 1.78; 95% CI: 1.72-1.84); female sex (aOR: 1.56; 95% CI: 1.53-1.60), deprivation (most versus least deprived quintile, aOR: 1.40; 95% CI: 1.36-1.44), several existing health conditions. Predictors associated with reduced long COVID risk were testing positive while Delta or Omicron variants were dominant, relative to when the Wild-type variant was dominant (aOR: 0.85; 95% CI: 0.81-0.88 and aOR: 0.64; 95% CI: 0.61-0.67, respectively) having received one or two doses of COVID-19 vaccination, relative to unvaccinated (aOR: 0.90; 95% CI: 0.86-0.95 and aOR: 0.96; 95% CI: 0.93-1.00)., Conclusions: Older age, higher BMI, severe COVID-19 infection, female sex, deprivation and comorbidities were predictors of long COVID. Vaccination against COVID-19 and testing positive while Delta or Omicron variants were dominant predicted reduced risk.

There is uncertainty about how best to diagnose asthma, especially in primary care where mis-diagnosis is common. To address this, we developed a clinical decision support system (CDSS) for asthma diagnosis in children and young people (aged 5-25 years). This study explored the feasibility and acceptability of the CDSS in UK primary care. We recruited general practices from England and Scotland. The CDSS was available for use during routine consultations for six months. We analysed CDSS usage and, toward the end of the study, undertook qualitative interviews with clinicians who had used the CDSS. Within the 10 practices who completed the study, the CDSS was used by 75 out of 94 clinicians. 11 clinicians from 8 practices were interviewed. The CDSS was acceptable to participants who particularly commented on the ease of use and auto-population of information from the patient record. Barriers to use included the inability to record findings directly into the patient notes and a sense that, whilst possibly useful for trainees and junior colleagues, the CDSS would not necessarily lead to a change in their own practice. The CDSS was generally well received by primary care clinicians, though participants felt it would be most useful for trainees and less experienced colleagues., Competing Interests: Competing interests: C.S. reports unconditional honoraria via a Limited company for consultancy and delivery of education from AstraZeneca, Bedfont, Boehringer Inglehieim, Cheisi, GSK, Teva, and Trudell; policy lead PCRS and Co-chair of Early and Accurate Diagnosis working group of Taskforce for Lung Health. D.P. has advisory board membership with AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Viatris, Teva Pharmaceuticals; consultancy agreements with AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Viatris, Teva Pharmaceuticals; grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd.) from AstraZeneca, Chiesi, Viatris, Novartis, Regeneron Pharmaceuticals, Sanofi Genzyme, and UK National Health Service; payment for lectures/speaking engagements from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, Inside Practice, GlaxoSmithKline, Medscape, Viatris, Novartis, Regeneron Pharmaceuticals and Sanofi Genzyme, Teva Pharmaceuticals; payment for travel/accommodation/meeting expenses from AstraZeneca, Boehringer Ingelheim, Novartis, Medscape, Teva Pharmaceuticals.; owns 74% of the social enterprise Optimum Patient Care Ltd. (Australia and UK) and 92.61% of Observational and Pragmatic Research Institute Pte Ltd. (Singapore); 5% shareholding in Timestamp which develops adherence monitoring technology; is peer reviewer for grant committees of the UK Efficacy and Mechanism Evaluation programme, and Health Technology Assessment; and was an expert witness for GlaxoSmithKline. H.P. has received fees for non-promotional talks in sponsored symposia from Teva and Sandoz Pharmaceuticals. The remaining authors declare no competing interests., (© 2024. The Author(s).)

Objectives: We undertook a national analysis to characterise and identify risk factors for acute respiratory infections (ARIs) resulting in hospitalisation during the winter period in Scotland., Design: A population-based retrospective cohort analysis., Setting: Scotland., Participants: The study involved 5.4 million residents in Scotland., Main Outcome Measures: Cox proportional hazard models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for the association between risk factors and ARI hospitalisation., Results: Between 1 September 2022 and 31 January 2023, there were 22,284 (10.9% of 203,549 with any emergency hospitalisation) ARI hospitalisations (1759 in children and 20,525 in adults) in Scotland. Compared with the reference group of children aged 6-17 years, the risk of ARI hospitalisation was higher in children aged 3-5 years (aHR = 4.55; 95% CI: 4.11-5.04). Compared with those aged 25-29 years, the risk of ARI hospitalisation was highest among the oldest adults aged ≥80 years (aHR = 7.86; 95% CI: 7.06-8.76). Adults from more deprived areas (most deprived vs. least deprived, aHR = 1.64; 95% CI: 1.57-1.72), with existing health conditions (≥5 vs. 0 health conditions, aHR = 4.84; 95% CI: 4.53-5.18) or with history of all-cause emergency admissions (≥6 vs. 0 previous emergency admissions, aHR = 7.53; 95% CI: 5.48-10.35) were at a higher risk of ARI hospitalisations. The risk increased by the number of existing health conditions and previous emergency admission. Similar associations were seen in children., Conclusions: Younger children, older adults, those from more deprived backgrounds and individuals with greater numbers of pre-existing conditions and previous emergency admission were at increased risk for winter hospitalisations for ARI.

Background: We compared the quality of ethnicity coding within the Public Health Scotland Ethnicity Look-up (PHS-EL) dataset, and other National Health Service datasets, with the 2011 Scottish Census., Methods: Measures of quality included the level of missingness and misclassification. We examined the impact of misclassification using Cox proportional hazards to compare the risk of severe coronavirus disease (COVID-19) (hospitalization & death) by ethnic group., Results: Misclassification within PHS-EL was higher for all minority ethnic groups [12.5 to 69.1%] compared with the White Scottish majority [5.1%] and highest in the White Gypsy/Traveller group [69.1%]. Missingness in PHS-EL was highest among the White Other British group [39%] and lowest among the Pakistani group [17%]. PHS-EL data often underestimated severe COVID-19 risk compared with Census data. e.g. in the White Gypsy/Traveller group the Hazard Ratio (HR) was 1.68 [95% Confidence Intervals (CI): 1.03, 2.74] compared with the White Scottish majority using Census ethnicity data and 0.73 [95% CI: 0.10, 5.15] using PHS-EL data; and HR was 2.03 [95% CI: 1.20, 3.44] in the Census for the Bangladeshi group versus 1.45 [95% CI: 0.75, 2.78] in PHS-EL., Conclusions: Poor quality ethnicity coding in health records can bias estimates, thereby threatening monitoring and understanding ethnic inequalities in health., (© The Author(s) 2023. Published by Oxford University Press on behalf of Faculty of Public Health.)

Background: This study aims to estimate ethnic inequalities in risk for positive SARS-CoV-2 tests, COVID-19 hospitalisations and deaths over time in Scotland., Methods: We conducted a population-based cohort study where the 2011 Scottish Census was linked to health records. We included all individuals ≥ 16 years living in Scotland on 1 March 2020. The study period was from 1 March 2020 to 17 April 2022. Self-reported ethnic group was taken from the census and Cox proportional hazard models estimated HRs for positive SARS-CoV-2 tests, hospitalisations and deaths, adjusted for age, sex and health board. We also conducted separate analyses for each of the four waves of COVID-19 to assess changes in risk over time., Findings: Of the 4 358 339 individuals analysed, 1 093 234 positive SARS-CoV-2 tests, 37 437 hospitalisations and 14 158 deaths occurred. The risk of COVID-19 hospitalisation or death among ethnic minority groups was often higher for White Gypsy/Traveller (HR 2.21, 95% CI (1.61 to 3.06)) and Pakistani 2.09 (1.90 to 2.29) groups compared with the white Scottish group. The risk of COVID-19 hospitalisation or death following confirmed positive SARS-CoV-2 test was particularly higher for White Gypsy/Traveller 2.55 (1.81-3.58), Pakistani 1.75 (1.59-1.73) and African 1.61 (1.28-2.03) individuals relative to white Scottish individuals. However, the risk of COVID-19-related death following hospitalisation did not differ. The risk of COVID-19 outcomes for ethnic minority groups was higher in the first three waves compared with the fourth wave., Interpretation: Most ethnic minority groups were at increased risk of adverse COVID-19 outcomes in Scotland, especially White Gypsy/Traveller and Pakistani groups. Ethnic inequalities persisted following community infection but not following hospitalisation, suggesting differences in hospital treatment did not substantially contribute to ethnic inequalities., Competing Interests: Competing interests: SVK was cochair of the Scottish Government’s Expert Reference Group on Ethnicity and COVID-19 and a member of the Scientific Advisory Group on Emergencies subgroup on ethnicity., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)