BMJ Open (Jul 2024)

Changes in sick notes associated with COVID-19 from 2020 to 2022: a cohort study in 24 million primary care patients in OpenSAFELY-TPP

  • Andrew Steptoe,
  • ,
  • John Macleod,
  • Daniel McCartney,
  • Aziz Sheikh,
  • Annie Herbert,
  • Ben Goldacre,
  • David Evans,
  • Louise Jones,
  • Sam Harper,
  • Michael Green,
  • Nicholas Timpson,
  • John Wright,
  • Liam Smeeth,
  • Laurie A Tomlinson,
  • Sinead Brophy,
  • Kate Tilling,
  • Andy Gibson,
  • Paola Zaninotto,
  • Stefan Neubauer,
  • Yinghui Wei,
  • Betty Raman,
  • Chloe Park,
  • Alun Hughes,
  • Jonathan Sterne,
  • Elena Lukaschuk,
  • Stefan Piechnik,
  • Angela Wood,
  • Mark Green,
  • Agnieszka Lemanska,
  • Krishnan Bhaskaran,
  • Kathryn Willan,
  • Elsie Horne,
  • Hannah Woodward,
  • Ian Douglas,
  • Andrew Wong,
  • Andy Boyd,
  • Harriet Forbes,
  • Sinéad Langan,
  • Nishi Chaturvedi,
  • Tom Palmer,
  • Kathryn Mansfield,
  • Rachel Denholm,
  • Emily Herrett,
  • Kevin Wang,
  • Bo Hou,
  • Felix Greaves,
  • Laura Sheard,
  • Praveetha Patalay,
  • Kishan Patel,
  • Jessica Morley,
  • Bang Zheng,
  • Charlotte Booth,
  • Spiros Denaxas,
  • Brian MacKenna,
  • Ruth E Costello,
  • Jonathan Kennedy,
  • William Hulme,
  • Michael Parker,
  • Geneviève Cezard,
  • Syed A Shah,
  • Amir Mehrkar,
  • Peter Inglesby,
  • Jonathan Cockburn,
  • Laurie Tomlinson,
  • John Parry,
  • Frank Hester,
  • Eoin McElroy,
  • Amelia Green,
  • Gillian Santorelli,
  • Alisia Carnemolla,
  • Richard Shaw,
  • Samantha Ip,
  • Venexia Walker,
  • Emma L Turner,
  • Richard Thomas,
  • Rebecca Rhead,
  • Archie Campbell,
  • Ellen Thompson,
  • Ruth Bowyer,
  • Jane Maddock,
  • Helen Curtis,
  • Alex Walker,
  • Olivia Hamilton,
  • Rosie McEachan,
  • Ellena Badrick,
  • Stephen Smith,
  • Richard Dobson,
  • Stela McLachlan,
  • Vanessa Ferreira,
  • Vittal Katikireddi,
  • Scott Walker,
  • Lucy Teece,
  • Simon Davy,
  • John Tazare,
  • Bettina Moltrecht,
  • Theocharis Kromydas,
  • Giorgio Di Gessa,
  • Gareth Griffith,
  • Viyaasan Mahalingasivam,
  • Elizabeth Tunnicliffe,
  • George Hickman,
  • Tom Ward,
  • Rebecca M Smith,
  • Sam Parsons,
  • Callum Stewart,
  • Amos Folarin,
  • Daniel Kopasker,
  • Claire Steves,
  • Louis Fisher,
  • Sebastian C J Bacon,
  • Lisa Hopcroft,
  • Robin Y Park,
  • Jon Massey,
  • Iain Dillingham,
  • Steven Maude,
  • Wels Jacques,
  • Linda Nab,
  • Christopher Bates,
  • Milan Wiedemann,
  • Ruth Mitchell,
  • Chao Fang,
  • Fatima Almaghrabi,
  • Jingmin Zhu,
  • Lucy Bridges,
  • Kurt Taylor,
  • Colm Andrews,
  • Jean Stafford,
  • Nathan Cheetham,
  • Sebastian CJ Bacon,
  • Alicja Rapala,
  • Robin Flaig,
  • Andrea L Schaffer,
  • Benjamin FC Butler-Cole,
  • Liam Hart Ben Goldacre,
  • Thomas O’Dwyer,
  • Dylan Williams,
  • Anika Knueppel,
  • Katharine M Evans,
  • Samantha Berman,
  • Matthew Crane,
  • Rebecca Whitehorn,
  • Jacqui Oakley,
  • Diane Foster,
  • Kirsteen C Campbell,
  • Alex Kwong,
  • Ana Goncalves Soares,
  • Renin Toms,
  • Lizzie Huntley,
  • Laura Fox,
  • Rochelle Knight,
  • Northstone Kate,
  • Kanagaratnam Arun,
  • Teri North,
  • Marwa AL Arab,
  • Jose IC Coronado,
  • Arun S Karthikeyan,
  • Ploubidis George,
  • Bozena Wielgoszewska,
  • Charis Bridger-Staatz,
  • Paz Garcia,
  • Maxim Freydin,
  • Amy Roberts,
  • Alex Walker Ben Goldacre,
  • Jess Morley,
  • Anoop Shah Richard Silverwood,
  • Thomas Cowling,
  • Kate Mansfield,
  • Tiffany Yang,
  • Tom Bolton,
  • Alexia Sampri,
  • Elena Rafeti,
  • Robert Willans,
  • Fiona Glen,
  • Steve Sharp,
  • Lee Hamill Howes,
  • Lidia Nigrelli,
  • Fintan McArdle,
  • Chelsea Beckford,
  • Yatharth Ranjan,
  • Jd Carpentieri,
  • Sarah Baz,
  • John Kellas,
  • Laura C Saunders,
  • James M Wild,
  • Peter Jezzard,
  • Zeena-Britt Sanders,
  • Lucy Finnigan,
  • Milla Kibble,
  • Francisco Perez-Reche,
  • Dominik Piehlmaier,
  • Edward Parker

DOI
https://doi.org/10.1136/bmjopen-2023-080600
Journal volume & issue
Vol. 14, no. 7

Abstract

Read online

Objectives Long-term sickness absence from employment has negative consequences for the economy and can lead to widened health inequalities. Sick notes (also called ‘fit notes’) are issued by general practitioners when a person cannot work for health reasons for more than 7 days. We quantified the sick note rate in people with evidence of COVID-19 in 2020, 2021 and 2022, as an indication of the burden for people recovering from COVID-19.Design Cohort study.Setting With National Health Service (NHS) England approval, we used routine clinical data (primary care, hospital and COVID-19 testing records) within the OpenSAFELY-TPP database.Participants People 18–64 years with a recorded positive test or diagnosis of COVID-19 in 2020 (n=365 421), 2021 (n=1 206 555) or 2022 (n=1 321 313); general population matched in age, sex and region in 2019 (n=3 140 326), 2020 (n=3 439 534), 2021 (n=4 571 469) and 2022 (n=4 818 870); people hospitalised with pneumonia in 2019 (n=29 673).Primary outcome measure Receipt of a sick note in primary care.Results Among people with a positive SARS-CoV-2 test or COVID-19 diagnosis, the sick note rate was 4.88 per 100 person-months (95% CI 4.83 to 4.93) in 2020, 2.66 (95% CI 2.64 to 2.67) in 2021 and 1.73 (95% CI 1.72 to 1.73) in 2022. Compared with the age, sex and region-matched general population, the adjusted HR for receipt of a sick note over the entire follow-up period (up to 10 months) was 4.07 (95% CI 4.02 to 4.12) in 2020 decreasing to 1.57 (95% CI 1.56 to 1.58) in 2022. The HR was highest in the first 30 days postdiagnosis in all years. Among people hospitalised with COVID-19, after adjustment, the sick note rate was lower than in people hospitalised with pneumonia.Conclusions Given the under-recording of postacute COVID-19-related symptoms, these findings contribute a valuable perspective on the long-term effects of COVID-19. Despite likely underestimation of the sick note rate, sick notes were issued more frequently to people with COVID-19 compared with those without, even in an era when most people are vaccinated. Most sick notes occurred in the first 30 days postdiagnosis, but the increased risk several months postdiagnosis may provide further evidence of the long-term impact.