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Association between living with children and outcomes from covid-19: OpenSAFELY cohort study of 12 million adults in England
BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n628 (Published 18 March 2021)
Cite this as: BMJ 2021;372:n628
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A bird’s eye view of the risk of covid-19 infection from children
This article has a correction. Please see:
Association between living with children and outcomes from covid-19: OpenSAFELY cohort study of 12 million adults in England - March 22, 2021
Harriet Forbes, assistant professor1, Caroline E Morton, epidemiologist2, Seb Bacon, chief technical officer2, Helen I McDonald, assistant professor1, Caroline Minassian, assistant professor1, Jeremy P Brown, research degree student1, Christopher T Rentsch, assistant professor1, Rohini Mathur, assistant professor1, Anna Schultze, research fellow1, Nicholas J DeVito, researcher2, Brian MacKenna, honorary research fellow pharmacist2, William J Hulme, statistician2, Richard Croker, pharmaceutical adviser2, Alex J Walker, epidemiologist2, Elizabeth J Williamson, professor1, Chris Bates, director of research and analytics3, Amir Mehrkar, senior clinical researcher2, Helen J Curtis, researcher2, David Evans, software developer2, Kevin Wing, assistant professor1, Peter Inglesby, consultant programmer2, Henry Drysdale, research fellow2, Angel Y S Wong, assistant professor1, Jonathan Cockburn, software developer3, Robert McManus, software developer3, John Parry, clinical director3, Frank Hester, founder and chief, executive officer3, Sam Harper, software developer3, Ian J Douglas, professor1, Liam Smeeth, professor1, Stephen J W Evans, professor1, Krishnan Bhaskaran, professor1, Rosalind M Eggo, associate professor1 4, Ben Goldacre, director2, Laurie A Tomlinson, associate professor1
Correspondence to: B Goldacre firstname.lastname@example.org (or @bengoldacre on Twitter)
Accepted 7 March 2021
Objective To investigate whether risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and outcomes of coronavirus disease 2019 (covid-19) differed between adults living with and without children during the first two waves of the UK pandemic.
Design Population based cohort study, on behalf of NHS England.
Setting Primary care data and pseudonymously linked hospital and intensive care admissions and death records from England, during wave 1 (1 February to 31 August 2020) and wave 2 (1 September to 18 December 2020).
Participants Two cohorts of adults (18 years and over) registered at a general practice on 1 February 2020 and 1 September 2020.
Main outcome measures Adjusted hazard ratios for SARS-CoV-2 infection, covid-19 related admission to hospital or intensive care, or death from covid-19, by presence of children in the household.
Results Among 9 334 392adults aged 65 years and under, during wave 1, living with children was not associated with materially increased risks of recorded SARS-CoV-2 infection, covid-19 related hospital or intensive care admission, or death from covid-19. In wave 2, among adults aged 65 years and under, living with children of any age was associated with an increased risk of recorded SARS-CoV-2 infection (hazard ratio 1.06 (95% confidence interval 1.05 to 1.08) for living with children aged 0-11 years; 1.22 (1.20 to 1.24) for living with children aged 12-18 years) and covid-19 related hospital admission (1.18 (1.06 to 1.31) for living with children aged 0-11; 1.26 (1.12 to 1.40) for living with children aged 12-18). Living with children aged 0-11 was associated with reduced risk of death from both covid-19 and non-covid-19 causes in both waves; living with children of any age was also associated with lower risk of dying from non-covid-19 causes. For adults 65 years and under during wave 2, living with children aged 0-11 years was associated with an increased absolute risk of having SARS-CoV-2 infection recorded of 40-60 per 10 000 people, from 810 to between 850 and 870, and an increase in the number of hospital admissions of 1-5 per 10 000 people, from 160 to between 161 and 165. Living with children aged 12-18 years was associated with an increase of 160-190 per 10 000 in the number of SARS-CoV-2 infections and an increase of 2-6 per 10 000 in the number of hospital admissions.
Conclusions In contrast to wave 1, evidence existed of increased risk of reported SARS-CoV-2 infection and covid-19 outcomes among adults living with children during wave 2. However, this did not translate into a materially increased risk of covid-19 mortality, and absolute increases in risk were small.
Christian Holm Hansen, Daniela Michlmayr, Sophie Madeleine Gubbels, Kåre Mølbak, Steen Ethelberg