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Background: Asthma-related burden remains poorly characterised in children in the United Kingdom (UK). We quantified recent trends in asthma prevalence and burden in a UK population-based cohort (1‒17-year-olds). Methods: The Clinical Practice Research Datalink Aurum database (2008‒2018) was utilised to assess annual asthma incidence and prevalence in 1‒17-year-olds and pre-school wheeze in 1‒5-year-olds, stratified by gender and age. During the same period, annual asthma exacerbation rates were assessed in those with either a diagnosis of pre-school wheeze or asthma. Results: Annual asthma incidence rates decreased by 51% from 1403.4 (95% confidence interval 1383.7‒1423.2) in 2008 to 688.0 (676.3‒699.9) per 105 person-years (PYs) in 2018, with the most pronounced decrease observed in 1‒5-year-olds (decreasing by 65%, from 2556.9 [2509.8‒2604.7] to 892.3 [866.9‒918.3] per 105 PYs). The corresponding decreases for the 6‒11- and 12‒17-year-olds were 36% (1139.9 [1110.6‒1169.7] to 739.9 [720.5‒759.8]) and 20% (572.3 [550.4‒594.9] to 459.5 [442.9‒476.4]) per 105 PYs, respectively. The incidence of pre-school wheeze decreased over time and was slightly more pronounced in the 1‒3-year-olds than in the 4-year-olds. Prevalence of asthma and pre-school wheeze also decreased over time, from 18.0% overall in 2008 to 10.2% in 2018 for asthma. Exacerbation rates increased over time from 1.33 (1.31‒1.35) per 10 PYs in 2008 to 1.81 (1.78‒1.83) per 10 PYs in 2018. Conclusion: Paediatric asthma incidence decreased in the UK since 2008, particularly in 1– 5-year-olds; this was accompanied by a decline in asthma prevalence. Pre-school wheeze incidence also decreased in this age group. However, exacerbation rates have been increasing.

Background Identifying correlates of cause-specific mortality in patients with COPD may aid the targeting of therapies to reduce mortality. We determined factors associated with causes of death in a primary care COPD population. Methods Clinical Practice Research Datalink Aurum was linked to Hospital Episode Statistics and death certificate data. People with COPD alive between 01/01/2010-01/01/2020 were included. Patient characteristics were defined before of follow-up: i) frequency and severity of exacerbations; ii) emphysema or chronic bronchitis; iii) GOLD group A-D; and iv) airflow limitation. We used Cox proportional hazards regression and competing risks to investigate the association between patient characteristics and risk of all-cause, COPD and cardiovascular (CV)-mortality. Results 339,647 people with COPD were included of which 97,882 died during follow-up (25.7% COPD-related and 23.3% CV-related). Airflow limitation, GOLD group, exacerbation frequency and severity, and COPD phenotype were associated with all-cause mortality. Exacerbations, both increased frequency and severity, were associated with COPD-related mortality (≥2 exacerbations vs none HR 1.64, 1.57-1.71; 1 severe vs none 2.17, 2.04-2.31, respectively). Patients in GOLD groups B-D had higher risk of COPD and CV-mortality compared with GOLD A (GOLD D vs A, HR for COPD-mortality 4.57, 4.23-4.93 and HR for CV-mortality 1.53, 1.41-1.65). Increasing airflow limitation was also associated with both COPD and CV-mortality (GOLD 4 vs 1, HR 12.63, 11.82-13.51 and HR 1.75, 1.60-1.91, respectively). Conclusion Poorer airflow limitation, worse functional status, and exacerbations had substantial associations with risk of all-cause mortality. Differing results for CV and COPD-related mortality suggests interventions to prevent mortality may need to target particular characteristics or time points in the disease course.

Objective To describe GP consultation rates for post-COVID-19 sequelae in non-hospitalised and hospitalised COVID-19 patients, and among non-hospitalised individuals describe how GP consultation rates for post-COVID-19 sequelae change over time, as well as following COVID-19 vaccination. Design Population-based cohort study. Setting 1,392 general practices in England contributing to the Clinical Practice Research Datalink Aurum database. Participants 456,002 COVID-19 cases diagnosed between 1st August 2020 to 14th February2021 (44.7% male; median age 61 years), either hospitalised within two weeks of diagnosis or not hospitalised and followed-up for a maximum of 9.2 months. A negative control group of individuals without COVID-19 (N=38,511) and patients with influenza before the pandemic (N=21,803) were used to contextualise findings. Main outcome measures Comparison of GP consultation rates for new symptoms, diseases, prescriptions and healthcare utilisation (HCU) in hospitalised and non-hospitalised individuals separately pre and post-COVID-19 infection using Cox regression and negative binomial regression for HCU. This was repeated for the negative control and influenza cohorts. In non-hospitalised individuals, outcomes were additionally described over time following COVID-19 diagnosis and compared pre and post-COVID-19 vaccine in individuals who were symptomatic post-COVID-19, using negative binomial regression. Results Relative to the negative control and influenza cohorts non-hospitalised patients (N=437,943) had significantly higher GP consultation rates for multiple sequelae, the most common being loss of smell/taste (HRadj 5.28 [95%CI 3.89 to 7.17]; p

Objectives: To characterize peak cardiac troponin levels, in patients presenting with acute myocardial infarction (AMI), according to their comorbid condition and determine the influence of peak troponin (cTn) levels on mortality. Methods: We included patients with the first admission for AMI in the United Kingdom. We used linear regression to estimate the association between eight common co-morbidities {diabetes mellitus(DM), previous angina, peripheral arterial disease(PAD), previous myocardial infarction(MI), chronic kidney disease(CKD), cerebrovascular disease(CVD), chronic heart failure(CHF), and chronic obstructive pulmonary disease(COPD)} and peak cTn. Peak cTn levels were adjusted for age, sex, smoking status and co-morbidities. Logistic regression and restricted cubic spline models were employed to investigate the association between peak cTn and 180-day mortality for each co-morbidity. Results: 330,367 patients with AMI were identified. Adjusted peak cTn levels were significantly higher in patients with CKD[adjusted % difference in peak cTnT for CKD=42%, 95%CI 13.1 to 78.4] and significantly lower for patients with COPD, previous angina, previous MI and CHF when compared to patients without the respective co-morbidities (reference group) [cTnI;COPD=-21.7%,95%CI -29.1 to -13.4;previous angina=-24.2%, 95%CI -29.6 to -8.3;previous MI=-13.5%, 95%CI -20.6 to -5.9;CHF=-28% 95%CI -37.2 to -17.6]. Risk of 180-day mortality in most of the co-morbidities did not change substantially after adjusting for peak cTn. In general, cTnI had a stronger association with mortality than cTnT. Conclusions: In this nationwide analyses of patients presenting with acute myocardial infarction, co-morbidities substantially influenced systemic concentrations of peak cTn. Comorbid illness is a significant predictor of mortality regardless of peak cTn levels and should be taken into consideration while interpreting cTn both as a diagnostic and prognostic biomarker.