Clinical coding of long COVID in English primary care: a federated analysis of 58 million patient records in situ using OpenSAFELY
The OpenSAFELY Collaborative None., Walker A., MacKenna B., Inglesby P., Rentsch C., Curtis H., Morton C., Morley J., Mehrkar A., Bacon S., Hickman G., Bates C., Croker R., Evans D., Ward T., Cockburn J., Davy S., Bhaskaran K., Schultze A., Williamson E., Hulme W., McDonald H., Tomlinson L., Mathur R., Eggo R., Wing K., Wong AYS., Forbes H., Tazare J., Parry J., Hester F., Harper S., O’Hanlon S., Eavis A., Jarvis R., Avramov D., Griffiths P., Fowles A., Parkes N., Douglas I., Evans SJW., Smeeth L., Goldacre B.
Background Long COVID is a term to describe new or persistent symptoms at least four weeks after onset of acute COVID-19. Clinical codes to describe this phenomenon were released in November 2020 in the UK, but it is not known how these codes have been used in practice. Methods Working on behalf of NHS England, we used OpenSAFELY data encompassing 96% of the English population. We measured the proportion of people with a recorded code for long COVID, overall and by demographic factors, electronic health record software system, and week. We also measured variation in recording amongst practices. Results Long COVID was recorded for 23,273 people. Coding was unevenly distributed amongst practices, with 26.7% of practices having not used the codes at all. Regional variation was high, ranging between 20.3 per 100,000 people for East of England (95% confidence interval 19.3-21.4) and 55.6 in London (95% CI 54.1-57.1). The rate was higher amongst women (52.1, 95% CI 51.3-52.9) compared to men (28.1, 95% CI 27.5-28.7), and higher amongst practices using EMIS software (53.7, 95% CI 52.9-54.4) compared to TPP software (20.9, 95% CI 20.3-21.4). Conclusions Long COVID coding in primary care is low compared with early reports of long COVID prevalence. This may reflect under-coding, sub-optimal communication of clinical terms, under-diagnosis, a true low prevalence of long COVID diagnosed by clinicians, or a combination of factors. We recommend increased awareness of diagnostic codes, to facilitate research and planning of services; and surveys of clinicians’ experiences, to complement ongoing patient surveys.