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
Affiliations
- Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, London, UK
- John Macleod
- University of Bristol, Bristol, UK
- Daniel McCartney
- 1 Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh, UK
- Aziz Sheikh
- Usher Institute, University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK
- Annie Herbert
- Ben Goldacre
- 11 Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- David Evans
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Louise Jones
- Sam Harper
- TPP, Leeds, UK
- Michael Green
- Nicholas Timpson
- John Wright
- Liam Smeeth
- director
- Laurie A Tomlinson
- 1 London School of Hygiene & Tropical Medicine, London, UK
- Sinead Brophy
- 1 National Centre for Population Health and Wellbeing Research, Swansea University, Swansea, UK
- Kate Tilling
- 1 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Andy Gibson
- Paola Zaninotto
- Stefan Neubauer
- Oxford NIHR Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Yinghui Wei
- School of Engineering, Computing and Mathematics, Plymouth University, Plymouth, UK
- Betty Raman
- Chloe Park
- Alun Hughes
- Jonathan Sterne
- Elena Lukaschuk
- University of Oxford, Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK
- Stefan Piechnik
- Angela Wood
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Mark Green
- Department of Geography & Planning, University of Liverpool, Liverpool, UK
- Agnieszka Lemanska
- 5 University of Surrey, Guildford, UK
- Krishnan Bhaskaran
- 2 London School of Hygiene and Tropical Medicine, London, UK
- Kathryn Willan
- Elsie Horne
- Hannah Woodward
- Ian Douglas
- Andrew Wong
- Andy Boyd
- Harriet Forbes
- 1 Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Sinéad Langan
- Nishi Chaturvedi
- Tom Palmer
- Kathryn Mansfield
- Rachel Denholm
- Emily Herrett
- Kevin Wang
- 1Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, Tübingen, Baden-Württemberg, Germany
- Bo Hou
- Felix Greaves
- 7 National Institute for Health and Care Excellence, London, UK
- Laura Sheard
- 1 Health Sciences, University of York, York, UK
- Praveetha Patalay
- Kishan Patel
- Jessica Morley
- postdoctoral research associate
- Bang Zheng
- 1 London School of Hygiene & Tropical Medicine, London, UK
- Charlotte Booth
- Spiros Denaxas
- 1 Institute of Health Informatics, University College London, London, UK
- Brian MacKenna
- 4 NHS England, Redditch, UK
- Ruth E Costello
- 1 London School of Hygiene & Tropical Medicine, London, UK
- Jonathan Kennedy
- William Hulme
- Michael Parker
- Ethox Centre, University of Oxford, Oxford, UK
- Geneviève Cezard
- Syed A Shah
- Amir Mehrkar
- 11 Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Peter Inglesby
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Jonathan Cockburn
- TPP, Leeds, UK
- Laurie Tomlinson
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
- John Parry
- TPP, Leeds, UK
- Frank Hester
- TPP, Leeds, UK
- Eoin McElroy
- Amelia Green
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Gillian Santorelli
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Trust, Bradford, UK
- Alisia Carnemolla
- Richard Shaw
- Samantha Ip
- Venexia Walker
- senior research fellow
- Emma L Turner
- Richard Thomas
- Rebecca Rhead
- 5 Social Research Institute, University College London, Centre for Longitudinal Studies, London, UK
- Archie Campbell
- 1 Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh, UK
- Ellen Thompson
- Ruth Bowyer
- Jane Maddock
- Division of Surgery and Interventional Science, Institute of Sport, Exercise and Health, UCL, London, UK
- Helen Curtis
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Alex Walker
- 2 University of Oxford, Oxford, UK
- Olivia Hamilton
- Rosie McEachan
- Ellena Badrick
- 7 Faculty of Health Studies, University of Bradford, Bradford, West Yorkshire, UK
- Stephen Smith
- Richard Dobson
- Department of Biostatistics and Health Informatics, King`s College London, London, UK
- Stela McLachlan
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
- Vanessa Ferreira
- Vittal Katikireddi
- Scott Walker
- Lucy Teece
- Department of Population Health Sciences, University of Leicester, Leicester, UK
- Simon Davy
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- John Tazare
- 1 London School of Hygiene & Tropical Medicine, London, UK
- Bettina Moltrecht
- Theocharis Kromydas
- Giorgio Di Gessa
- Gareth Griffith
- Viyaasan Mahalingasivam
- 1 London School of Hygiene & Tropical Medicine, London, UK
- Elizabeth Tunnicliffe
- George Hickman
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Tom Ward
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Rebecca M Smith
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Sam Parsons
- Callum Stewart
- Amos Folarin
- Daniel Kopasker
- Claire Steves
- Louis Fisher
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Sebastian C J Bacon
- 1 Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, Unviersity of Oxford, Oxford, UK
- Lisa Hopcroft
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Robin Y Park
- 1 Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, Unviersity of Oxford, Oxford, UK
- Jon Massey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Iain Dillingham
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Steven Maude
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Wels Jacques
- Linda Nab
- Christopher Bates
- The Phoenix Partnership Leeds Ltd, Horsforth, West Yorkshire, UK
- Milan Wiedemann
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Ruth Mitchell
- Chao Fang
- Fatima Almaghrabi
- Jingmin Zhu
- 4 University College London Institute of Epidemiology and Health Care, London, UK
- Lucy Bridges
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Kurt Taylor
- Colm Andrews
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Jean Stafford
- Nathan Cheetham
- Department of Twin Research and Genetic Epidemiology, King`s College London, London, UK
- Sebastian CJ Bacon
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Alicja Rapala
- Robin Flaig
- 3 Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
- Andrea L Schaffer
- 1 Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, Unviersity of Oxford, Oxford, UK
- 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
- 5 Social Research Institute, University College London, Centre for Longitudinal Studies, London, UK
- Charis Bridger-Staatz
- Paz Garcia
- Maxim Freydin
- Amy Roberts
- Alex Walker Ben Goldacre
- Jess Morley
- postdoctoral research associate
- 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
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.
