Regional variation in epidemiology of COVID-19 in England
University Hospitals of Derby and Burton NHS Foundation Trust · NHS Trust
Expired The latest version ended on 28 July 2024. The September 2026 register still lists the agreement, but its term has passed.
- Reference
- DARS-NIC-391959-Q3C3G
- Latest version
- v2.2
- Term of latest version
- 29 July 2021 to 28 July 2024
- Start date
- 23 November 2020
- Data controller
- Sole Data Controller
- Commercial purposes
- No
- Sublicensing
- No
- Files released to date
- 22
Why the data was released
Objective for processing
The coronavirus disease 2019 (COVID-19) pandemic has caused significant morbidity and mortality and has affected some countries disproportionately. It has become evident that SARS-CoV-2 has shown variation in its virulence with some regions, within a country, more severely affected than others. In England, London and West Midlands the NHS were overwhelmed in the early period of the pandemic with increased in hospitalizations for pneumonia with multiorgan disease. As of 31st July 2020, the number of confirmed cases for COVID-19 have exceeded 17 million world-wide and 300,000 in United Kingdom with 46,000 deaths in UK alone.
In UK, the pandemic reached its peak in mid-April with confirmed cases decreasing by end of May 2020. One of the most serious complications of COVID-19 has been kidney involvement, in the form of acute kidney injury (AKI) but the incidence of this has ranged widely in reports from different centres, between 5% to 57%. In the only report from UK, the incidence of AKI in COVID-19 was 26.2% which was much higher than a comparable cohort of people admitted with non-COVID acute illnesses (12.4%). However, no data have been published regarding variation in the incidence of COVID associated AKI within the UK. The medical community rapidly learnt lessons in the first wave of the pandemic, for example regarding the use of continuous positive pressure ventilation (CPAP) in case of respiratory distress and the use of regional anticoagulation in AKI needing continuous renal replacement therapy (CRRT). There was no effective treatment available at the start of the pandemic and this resulted in death rate rising sharply in England as well as many other countries. It has now become evident that there has been considerable variation in mortality in individual hospitals and there is urgent need to understand the reasons for this unwanted variation. As the country tries to recover from the pandemic, it becomes more important to learn lessons with regards to its strategy of tackling the disease. This learning can then be applied to a possible second spike of COVID-19 to help mitigate the impact and improve outcomes.
The purpose of this study is to understand if variation exists in incidence and mortality in COVID patients and its complication namely, acute kidney injury, in England. The adjusted analysis will also focus on what are the causes of this variation from routinely collected data from rich source of hospital episode statistics (HES). This will help highlight areas of improvement and learning, for example, if the mortality in AKI in COVID patient is high in a particular District General Hospital (DGH), the analysis may help the DGH to look at the provisions to detect and manage AKI and nephrology services. Another example is that University Hospital of Derby and Burton Foundation Trust (UHDB)’s mortality in COVID patients was in top quartile in England it was highest in Midlands, though, Birmingham was worse hit. Without case-mix study, it is not possible to attain any learning of what were the factors which led to high mortality. Without this learning there is a risk of high mortality in COVID patients
To address this gap in knowledge, University Hospital of Derby and Burton Foundation Trust wishes to undertake a two arm, retrospective, cohort study of hospitalised patients 18 years and over on 01/03/2002 identified from national data collected during routine care in the hospital settings in England between 1st March 2020 and 31st March 2021 (to end of discharge period).
The University Hospital of Derby and Burton Foundation Trust (UHDB) wishes to combine national data base of Hospital Episode Statistics (HES) for Admitted Patient Care (APC) with Critical Care (CC) and Mortality data over a period of four months to determine the regional incidence and case fatality (epidemiology) of hospitalised patients with COVID-19 disease in England. The UHDB will also investigate the association between patient characteristics and patient outcomes in patients admitted with COVID-19 and Acute Kidney Failure (AKI) and explore the various determinants of mortality.
The primary outcome will be to determine in-hospital mortality in patients with COVID-19 disease and AKI in COVID-19.
The secondary outcomes will include all-cause mortality, need for ventilatory support, admission to Intensive Care Unit (ICU), length of stay.
PLEASE NOTE: Acute renal failure (ARF) has been replaced by new terminology, acute kidney injury (AKI), but due to lack of ICD-10 codes* for AKI, the ICD10 codes for acute renal failure will be requested and will be referred to as AKI in this agreement.
*What are ICD-10 codes? ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. A handy look-up tool for ICD-10 codes can be found here: https://icdcodelookup.com/icd-10/codes
DATA MINIMISATION USING ICD-10 CODES
N17.0 for acute renal failure with tubular necrosis, N17.1 for acute renal failure with acute cortical necrosis, N17.2 for acute renal failure with medullary necrosis, N17.8 for other acute renal failure and N17.9 for acute renal failure, unspecified. The severity of AKI requiring dialysis will be identified by additional procedure code of X40.2 for peritoneal dialysis, X40.3 for haemodialysis, or X40.4 for hemofiltration, X40.5 for automated peritoneal dialysis and X40.6 for continuous ambulatory peritoneal dialysis in any of the 25 procedure codes. These codes have established biological and clinical plausibility and are widely used in acute kidney injury research.
The study will consist of two arms of study:
First arm: Epidemiology of COVID-19 in England
All patients who are admitted to a hospital with COVID-19 infection between 1st March 2020 and 31st March 2021 (to end of discharge period) and who meet following criteria will be included:
1) Diagnostic code for COVID-19 (U07.1) in any of the 20 diagnoses codes
2) Adult patients 18 years of age and upwards [those with a birth date on or before 01/03/2002].
Exclusion criteria:
1) Paediatric patients under 18 years of age [those with a birth date after 01/03/2002].
2) Patients with chronic kidney disease starting dialysis, exclude the following ICD-10 codes: Z99.2 – dependence on renal dialysis, L74.2 - arteriovenous fistula or L74.3 - arteriovenous shunt during the inpatient admission.]
Second arm: Epidemiology of AKI in COVID-19 in England
All patients who are admitted to a hospital with acute kidney injury (AKI) between 1st March 2020 and 31st March 2021 (to end of discharge period) and who meet following criteria will be included:
1) Diagnostic code for AKI (N17) in any of the 20 diagnoses codes
2) Adult patients 18 years of age and upwards [those with a birth date on or before 01/03/2002].
Exclusion criteria:
1) Paediatric patients under 18 years of age [those with a birth date after 01/03/2002].
2) Patients on chronic maintenance haemodialysis or peritoneal dialysis
3) Patients with chronic kidney disease starting dialysis, exclude the following ICD-10 codes: Z99.2 – dependence on renal dialysis, L74.2 - arteriovenous fistula or L74.3 - arteriovenous shunt during the inpatient admission.]
All episodes for each cohort individual will be required to ensure there is no survival bias in the analysis.
- for the first part of the study, NHS Digital will identify all cases of hospitalised individuals with COVID-19 between 1st March 2020 and 31st March 2021 (to end of discharge period) by using validated International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code of U07.1 (COVID-19, virus identified) in any of the diagnoses codes, in keeping with the objective of the study. This will be the COVID-19 AKI cohort.
- For the second part of the study, NHS Digital will identify hospitalised individuals with following ICD-10 codes for acute kidney injury (AKI) [as identified by ICD-10 code of N17 in any of the 20 diagnostic codes] between 1st March 2020 and 31st March 2021 (to end of discharge period) will be included:
N17.0 for acute renal failure with tubular necrosis,
N17.1 for acute renal failure with acute cortical necrosis,
N17.2 for acute renal failure with medullary necrosis,
N17.8 for other acute renal failure and
N17.9 for acute renal failure, unspecified.
AKI patients requiring dialysis will be identified by additional procedure code of X40.2 for peritoneal dialysis, X40.3 for haemodialysis, or X40.4 for hemofiltration, X40.5 for automated peritoneal dialysis and X40.6 for continuous ambulatory peritoneal dialysis in any of the 25 procedures.
The AKI cohort without COVID-19 will serve as AKI control.
To exclude patients with chronic kidney disease starting dialysis, NHS Digital will exclude patients who had following codes:
Z99.2 – dependence on renal dialysis,
L74.2 - arteriovenous fistula or
L74.3 - arteriovenous shunt during the inpatient admission.
This algorithm has been shown to be sensitive and specific, with a high positive and negative predictive value (all >90%).
For both arms of the study, the UHDB will obtain data on patient demographics, admissions and discharge details, hospital characteristics, in-hospital mortality, disposition, length of stay (LOS), deprivation decile and up to 20 diagnosis and 25 procedure codes that are based on the ICD-10-CM and OPCS-4 from the HES database.
Data for critical care admission, discharge and organ support will be obtained from the linked HES Admitted Patient Care and Critical Care data set. Patients status at 30-day will be obtained from mortality data via the Civil Registrations (Deaths) - Secondary Care Cut data set.
Patients will not be contacted. Data requested will be pseudonymised and no attempt will be made to re-identify patients.
LEGAL BASIS
The General Data Protection Regulation Article 6 (1) (e) and Article 9 (2) (j) are the legal basis for the processing of the data. Article 6 (1) (e) states that processing is necessary for the public interest. The purpose of this application is to determine the regional incidence and case fatality (epidemiology) of hospitalised patients with COVID-19 disease in England. The understanding gained from this data analysis will help to prevent this unwanted variation in second spike of COVID-19. This data will not be used for commercial purposes, will not be provided in record level form to any third party and will not be used for direct marketing. Only patients residing in England and Wales have been included in this study.
Processing activities
DATA SUMMARY:
The agreement requests two extract of record-level pseudonymised data made up from HES APC and HES CC, linked to Civil Registration (Deaths) Secondary Care Cut in order to obtain Date of Death for a cohort of individuals who were admitted to hospital between 1st March 2020 and 31st January 2021 filtered by a 1) diagnosis of Covid-19 and 2)diagnosis of Acute Kidney Injury (AKI).
There is no flow of data into NHS Digital.
***METHODOLOGY:
METHODOLOGY - There will be two extracts of linked record level pseudonymised HES APC, HES CC and Mortality data –
1. All Adult patients 18 years of age and upwards [those with a birth date on or before 01/03/2002] who are admitted to the hospital with COVID-19 infection between 1st March 2020 and 31st March 2021 (to end of discharge period). Including Diagnostic code for COVID-19 (U07.1) in any of the 20 diagnoses codes. This will exclude all patients under 18 years of age [those with a birth date after 01/03/2002].
2. All Adult patients 18 years of age and upwards [those with a birth date on or before 01/03/2002] who are admitted to the hospital with acute kidney injury (AKI) between 1st March 2020 and 31st March 2021 (to end of discharge period). Including Diagnostic code for AKI (N17) in any of the 20 diagnoses codes. this will exclude all patients under 18 years of age [those with a birth date after 01/03/2002] and patients on chronic maintenance haemodialysis or peritoneal dialysis and chronic kidney disease starting dialysis.
AKI patients requiring dialysis – The applicant has developed a syntax to identify any acute dialysis.
To exclude patients with chronic kidney disease starting dialysis, NHS Digital will exclude patients who had following codes:
Z99.2 – dependence on renal dialysis,
L74.2 - arteriovenous fistula or
L74.3 - arteriovenous shunt during the inpatient admission.
3. There is no need for flags as it causes record duplication. The applicant will identify U071 & N17 from DIAG_3_CONCAT OR DIAG_4_CONCAT
All episodes for each cohort individual will be required to ensure there is no survival bias in the analysis.
5. The pseudonymised data extract will be disseminated in one drop via the Secure File Transfer Service (SEFT).
The data will be analysed to find any association with regional variation in COVID mortality and AKI.***
The pseudonymised data extract will be analysed as per the study objectives stated above by the study chief investigator who is a substantive employee of UHDB. The data will be stored and processed on a UHDB Trust server with two-factor authentication on the VPN to connect to the Trust Network secure access via a Trust remote device. All hard drives are encrypted using 128-bit encryption. A username and password are required to log into the Trust remote device with a username and password, and a further unique code number required as second factor authentication for the VPN end-to-end encrypted tunnel. The VPN tunnel uses AES-256 encryption. Data will not be downloaded to the remote device. The data quality will be checked to ensure validity and the chief investigator is responsible for upholding UHDB’s information governance and data security policies.
University Hospitals of Derby and Burton NHS Foundation Trust will take the responsibilities of Sponsor as defined in the UK Policy Framework for Health and Social Care Research. University Hospitals of Derby and Burton NHS Foundation Trust do not use any public cloud storage or processing services and all server backups are stored on site. IT support is in-house. Data will not be transferred outside of the UK.
The data will be analysed to find any association with regional variation in COVID mortality and AKI.
By signing the Data Sharing Agreement, all organisations party to this agreement must comply with the Data Sharing Framework Contract, including requirements on the use (and purposes of that use) by "Personnel" (as defined within the Data Sharing Framework Contract i.e.: employees, agents and contractors of the Data Recipient who may have access to that data).
HES DISCLOSURE CONTROL / SMALL NUMBER SUPPRESSION
In order to protect patient confidentiality, when presenting results calculated from HES record level data, outputs will contain only aggregate level data with small numbers suppressed in line with HES Analysis Guide. When publishing HES data, you must make sure that:
· cell values from 1 to 7 are suppressed at a local level to prevent possible identification of individuals from small counts within the table.
· Zeros (0) do not need to be suppressed.
· All other counts will be rounded to the nearest 5.
Data will not be made available to any third parties other than those specified except in the form of aggregated outputs with small numbers suppressed in line with the HES Analysis Guide.
Expected output
The University Hospital of Derby and Burton Foundation Trust (UHDB) hope to identify crude mortality rate and mortality rate adjusted for age, gender, ethnicity and comorbidities for each region in England for AKI and COVID-19. Determinants of mortality will be examined for trusts of the same size and population served as University Hospital of Derby and Burton Foundation Trust. The analysis will be completed within 60 days of receiving the data from NHS Digital, with the study manuscript prepared 6 months from receiving the data.
The data will be processed and the results will be presented as a report to the University Hospital of Derby and Burton Foundation Trust Board. The data analysis will also be submitted to peer-reviewed journals and presented in Nephrology conferences, nationally and internationally. The results will be presented to the Renal Association, the European Renal Association and American Society of Nephrology in November 2021
The data analysis will generate aggregate data with statistical inferences. All outputs will be aggregated with small numbers suppressed in line with the HES Analysis Guide.
The results of the research analysis will be disseminated to stakeholders during the project and after its completion. The target of this dissemination will be NHS stake holders, like UHDB, policy makers, medical fraternity, patients and researchers. The portal of dissemination of the results will be:
- Conferences (as above),
- briefing document to the UHDB Trust board,
- peer-reviewed journals (Open access / free journals are preferred as they are well read and are not restricted to subscription), which advertise the findings via social media such as Twitter.
- oral presentations in grand rounds and teaching sessions.
Expected measurable benefits
The COVID-19 pandemic has exposed the unwanted variation in COVID-19 outcome as evidence by Public Health England’s - and later NHS England's - report on COVID-19 Daily Deaths (https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-daily-deaths/) .
For example, UHDB has reported high crude mortality as compared to other trusts in the region. Unwanted variation is care or outcome that is not consistent with a patient’s preference or related to their underlying illness. The King’s Fund has done some work in variation in care but not specifically to any disease process. The variation in outcome may be because of various reasons - differing underlying health conditions in the population, deprivation, physician preference and knowledge and ethnic diversity. Many clinical decisions seem to be subtly influenced by the availability of particular services: increasing bed availability, example is intensive care beds, is known to lead to an increase in admissions. This study will help to find if there is any association between COVID-19 mortality and the various factors which are being studied – age, gender, ethnicity, deprivation. In adjusted analysis if a region seems to have greater mortality, that will need further investigation. The data needs to be analysed to find which factors are associated with mortality and that may increase the understanding.
The benefits of this study is that it provides new information to people, health care workers and policymakers on the difference in incidence, mortality and complication like AKI in COVID-19 infection in different parts of England. The study will also look at various factors associated with increase mortality in COVID-19 and incidence of AKI and its associated mortality. This new found knowledge will be useful at tackling health inequalities and minimising adverse events like AKI in patients with COVID-19 and mortality in AKI patients. The benefit extends to the NHS trust or regions who can then look at process of care for patients who have died to understand what changes they should make to reduce this unwanted variation.
SPECIFIC STUDY BENENFITS
1) The study will establish if there is regional variation in mortality in COVID-19.
2) The study will assess if there is any associations between patient demographics, clinical characteristics, and associated chronic illness with mortality.
3) The study will assess if there is association between AKI and mortality in COVID-19 patients.
4) The study will highlight regions with higher adjusted mortality and will help Trusts to delve deeper into reasons of mortality by looking at process of care through case-note reviews.
5) The study will also evaluate the predictors of AKI in patients with COVID-19.
This will help all the regions and the NHS trust to understand the unwanted clinical variation in outcome and make efforts to learn and reduce these unwanted variations in care and minimise the variation in outcome. It is important for policy makers, stake holders, medical professionals and patient and public themselves to understand the reason for these unwanted variations to minimise patient harm and reduce morbidity and mortality. The understanding gained from this data analysis may help to prevent this unwanted variation in second spike of COVID-19.
Depending on the availability of data estimated target dates for analysis are:
- Data will be reviewed and prepared for statistical analysis (3 months);
- Analysis of data (1 month);
- The results will be reviewed by research team and patient representative and any additional analysis may be performed (1 month);
- Writing of manuscript and review by all researchers and patient representative (2 months);
- Peer-review publications (6 months)
Patient Involvement is in the form of a patient representative who has been involved in design and methodology of the study protocol. The patient representative has reviewed the protocol and will be involved in the analysis of the results. The results will be disseminated through patient organizations like the National Kidney Foundation.
Benefits reported so far
Not stated in the register.
Datasets on the latest version
Legal basis for provision: Health and Social Care Act 2012 - s261 - 'Other dissemination of information'; Health and Social Care Act 2012 - s261 - 'Other dissemination of information'; Health and Social Care Act 2012 - s261 - 'Other dissemination of information'
| Dataset | Type of data | Sensitivity | Frequency | Confidential data |
|---|---|---|---|---|
| Civil Registrations of Death - Secondary Care Cut | Anonymised - ICO Code Compliant | Sensitive | One-Off | Does not include the flow of confidential data |
| Civil Registrations of Death - Secondary Care Cut | Anonymised - ICO Code Compliant | Sensitive | One-Off | Does not include the flow of confidential data |
| HES-ID to MPS-ID HES Admitted Patient Care | Anonymised - ICO Code Compliant | Non-Sensitive | One-Off | Does not include the flow of confidential data |
| HES:Civil Registration (Deaths) bridge | Anonymised - ICO Code Compliant | Non-Sensitive | One-Off | Does not include the flow of confidential data |
| HES:Civil Registration (Deaths) bridge | Anonymised - ICO Code Compliant | Non-Sensitive | One-Off | Does not include the flow of confidential data |
| Hospital Episode Statistics Admitted Patient Care (HES APC) | Anonymised - ICO Code Compliant | Non-Sensitive | One-Off | Does not include the flow of confidential data |
| Hospital Episode Statistics Admitted Patient Care (HES APC) | Anonymised - ICO Code Compliant | Non-Sensitive | One-Off | Does not include the flow of confidential data |
| Hospital Episode Statistics Critical Care (HES Critical Care) | Anonymised - ICO Code Compliant | Non-Sensitive | One-Off | Does not include the flow of confidential data |
| Hospital Episode Statistics Critical Care (HES Critical Care) | Anonymised - ICO Code Compliant | Non-Sensitive | One-Off | Does not include the flow of confidential data |
Files released
Files released counts only files released externally by DARS. Access granted in NHS England's own systems, such as its Secure Data Environment, is not included.
Patient opt-outs were not applied to any of the 22 files released under this agreement, across every version. About opt-outs
Files released against version 2.2 of this agreement, summarised by dataset.
| Dataset | Files | First released | Last released | Opt-outs applied |
|---|---|---|---|---|
| Hospital Episode Statistics Admitted Patient Care (HES APC) | 6 | December 2021 | December 2021 | No |
| Hospital Episode Statistics Critical Care (HES Critical Care) | 6 | December 2021 | December 2021 | No |
| Civil Registrations of Death - Secondary Care Cut | 2 | December 2021 | December 2021 | No |
| HES:Civil Registration (Deaths) bridge | 2 | December 2021 | December 2021 | No |
Version history
The register lists each renewal of this agreement as a separate row. This site has 3 versions.
DARS-NIC-391959-Q3C3G-v2.2 29 July 2021 to 28 July 2024
- Title
- Regional variation in epidemiology of COVID-19 in England
- Commercial
- No
- Sublicensing
- No
- Datasets
- 9
- Files released
- 16
Datasets: Civil Registrations of Death - Secondary Care Cut; Civil Registrations of Death - Secondary Care Cut; HES-ID to MPS-ID HES Admitted Patient Care; HES:Civil Registration (Deaths) bridge; HES:Civil Registration (Deaths) bridge; Hospital Episode Statistics Admitted Patient Care (HES APC); Hospital Episode Statistics Admitted Patient Care (HES APC); Hospital Episode Statistics Critical Care (HES Critical Care); Hospital Episode Statistics Critical Care (HES Critical Care)
What changed from DARS-NIC-391959-Q3C3G-v1.1
Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.
| Field | Was | Became |
|---|---|---|
| Start date | 2021-07-29 | |
| End date | 2024-07-28 |
Datasets: + HES-ID to MPS-ID HES Admitted Patient Care
Objective for processing
[2 paragraphs unchanged]
The purpose of this study is to understand if variation exists in
[76 words unchanged]
look at the provisions to detect and manage AKI and nephrology services.
Another example is that University Hospital of Derby and Burton Foundation Trust (UHDB)’s mortality in COVID patients was in top quartile in England it was highest in Midlands, though, Birmingham was worse hit. Without case-mix study, it is not possible to attain any learning of what were the factors which led to high mortality. Without this learning there is a risk of high mortality in COVID patients
Another example is that University Hospital of Derby and Burton Foundation Trust (UHDB)’s mortality in COVID patients was in top quartile in England it was highest in Midlands, though, Birmingham was worse hit. Without case-mix study, it is not possible to attain any learning of what were the factors which led to high mortality. Without this learning there is a risk of high mortality in COVID patients
To address this gap in knowledge, University Hospital of Derby and Burton Foundation Trust wishes to undertake a two arm, retrospective, cohort study of hospitalised patients 18 years and over on 01/03/2002 identified from national data collected during routine care in the hospital settings in England between 1st March 2020 and 31st March 2021 (to end of discharge period).
To address this gap in knowledge, University Hospital of Derby and Burton Foundation Trust wishes to undertake a two arm, retrospective, cohort study of hospitalised patients 18 years and over on 01/03/2002 identified from national data collected during routine care in the hospital settings in England between 1st March 2020 and 31st August 2020.
[9 paragraphs unchanged]
All patients who are admitted to a hospital with COVID-19 infection between 1st March 2020 and 31st
August 2020
March 2021 (to end of discharge period)
and who meet following criteria will be included:
[4 paragraphs unchanged]
2) Patients with chronic kidney disease starting dialysis, exclude the following ICD-10 codes: Z99.2 – dependence on renal dialysis, L74.2 - arteriovenous fistula or L74.3 - arteriovenous shunt during the inpatient admission.]
[1 paragraph unchanged]
All patients who are admitted to a hospital with acute kidney injury (AKI) between 1st March 2020 and 31st
August 2020
March 2021 (to end of discharge period)
and who meet following criteria will be included:
[4 paragraphs unchanged]
3)
2)
Patients on chronic maintenance haemodialysis or peritoneal dialysis
The record-level pseudonymised data for both arms of the study would be in one data extract with a flag to indicate one of 3 situations:
3) Patients with chronic kidney disease starting dialysis, exclude the following ICD-10 codes: Z99.2 – dependence on renal dialysis, L74.2 - arteriovenous fistula or L74.3 - arteriovenous shunt during the inpatient admission.]
1. Positive diagnosis of Covid-19, AND AKI
2. Positive diagnosis of Covid-19, NO AKI
3. Negative diagnosis of Covid-19, AND AKI
[1 paragraph unchanged]
- for the first part of the study, NHS Digital will identify all cases of hospitalised individuals with COVID-19 between 1st March 2020 and 31st
August 2020
March 2021 (to end of discharge period)
by using validated International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code of
U07.1(COVID-19,
U07.1 (COVID-19,
virus identified) in any of the diagnoses codes, in keeping with the objective of the study. This will be the COVID-19 AKI cohort.
- For the second part of the study, NHS Digital will identify
[19 words unchanged]
any of the 20 diagnostic codes] between 1st March 2020 and 31st
August 2020
March 2021 (to end of discharge period)
will be included:
[17 paragraphs unchanged]
Processing activities
[1 paragraph unchanged]
The agreement requests
one
two
extract of record-level pseudonymised data made up from HES APC and HES
[20 words unchanged]
individuals who were admitted to hospital between 1st March 2020 and 31st
August 2020
January 2021
filtered by a
1)
diagnosis of Covid-19
and/or
and 2)diagnosis of
Acute Kidney Injury (AKI).
[1 paragraph unchanged]
METHODOLOGY:
***METHODOLOGY:
NHS Digital will create one pseudonymised data extract with the following filters:
METHODOLOGY - There will be two extracts of linked record level pseudonymised HES APC, HES CC and Mortality data –
1. All Adult patients 18 years of age and upwards [those with
[10 words unchanged]
to the hospital with COVID-19 infection between 1st March 2020 and 31st
August 2020.
March 2021 (to end of discharge period).
Including Diagnostic code for COVID-19 (U07.1) in any of the 20 diagnoses
[6 words unchanged]
under 18 years of age [those with a birth date after 01/03/2002].
2. All Adult patients 18 years of age and upwards [those with
[12 words unchanged]
hospital with acute kidney injury (AKI) between 1st March 2020 and 31st
August 2020.
March 2021 (to end of discharge period).
Including Diagnostic code for AKI (N17) in any of the 20 diagnoses
[21 words unchanged]
chronic maintenance haemodialysis or peritoneal dialysis and chronic kidney disease starting dialysis.
3. the data extract will have a flag applied to indicate one of 3 situations:
AKI patients requiring dialysis – The applicant has developed a syntax to identify any acute dialysis.
1. Positive diagnosis of Covid-19, AND Positive diagnosis of AKI
To exclude patients with chronic kidney disease starting dialysis, NHS Digital will exclude patients who had following codes:
2. Positive diagnosis of Covid-19, NO Positive diagnosis of AKI
Z99.2 – dependence on renal dialysis,
3. Negative diagnosis of Covid-19, AND Positive diagnosis of AKI
L74.2 - arteriovenous fistula or
L74.3 - arteriovenous shunt during the inpatient admission.
3. There is no need for flags as it causes record duplication. The applicant will identify U071 & N17 from DIAG_3_CONCAT OR DIAG_4_CONCAT
[1 paragraph unchanged]
4.
5.
The pseudonymised data extract will be disseminated in one drop via the Secure File Transfer Service (SEFT).
The data will be analysed to find any association with regional variation in COVID mortality and AKI.***
[10 paragraphs unchanged]
Expected output
[1 paragraph unchanged]
The data will be processed and the results will be presented as
[24 words unchanged]
presented in Nephrology conferences, nationally and internationally. The results will be presented
in
to
the Renal
Association annual meeting in June 2021,
Association, the
European Renal Association
in June 2021
and American Society of Nephrology in November 2021
[6 paragraphs unchanged]
Unchanged: Expected measurable benefits.
DARS-NIC-391959-Q3C3G-v1.1 25 January 2021 to 22 November 2023
- Title
- Regional variation in epidemiology of COVID-19 in England
- Commercial
- No
- Sublicensing
- No
- Datasets
- 4
- Files released
- 6
Datasets: Civil Registrations of Death - Secondary Care Cut; HES:Civil Registration (Deaths) bridge; Hospital Episode Statistics Admitted Patient Care (HES APC); Hospital Episode Statistics Critical Care (HES Critical Care)
What changed from DARS-NIC-391959-Q3C3G-v0.6
Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.
| Field | Was | Became |
|---|---|---|
| Start date | 2021-01-25 | |
| Civil Registrations of Death - Secondary Care Cut: sensitivity | Sensitive |
Benefits reported
Stated in the previous version and removed here.
Yielded Benefits is not a requirement for new applications.
Unchanged: Objective for processing, Processing activities, Expected output, Expected measurable benefits.
Objective for processing
The coronavirus disease 2019 (COVID-19) pandemic has caused significant morbidity and mortality and has affected some countries disproportionately. It has become evident that SARS-CoV-2 has shown variation in its virulence with some regions, within a country, more severely affected than others. In England, London and West Midlands the NHS were overwhelmed in the early period of the pandemic with increased in hospitalizations for pneumonia with multiorgan disease. As of 31st July 2020, the number of confirmed cases for COVID-19 have exceeded 17 million world-wide and 300,000 in United Kingdom with 46,000 deaths in UK alone.
In UK, the pandemic reached its peak in mid-April with confirmed cases decreasing by end of May 2020. One of the most serious complications of COVID-19 has been kidney involvement, in the form of acute kidney injury (AKI) but the incidence of this has ranged widely in reports from different centres, between 5% to 57%. In the only report from UK, the incidence of AKI in COVID-19 was 26.2% which was much higher than a comparable cohort of people admitted with non-COVID acute illnesses (12.4%). However, no data have been published regarding variation in the incidence of COVID associated AKI within the UK. The medical community rapidly learnt lessons in the first wave of the pandemic, for example regarding the use of continuous positive pressure ventilation (CPAP) in case of respiratory distress and the use of regional anticoagulation in AKI needing continuous renal replacement therapy (CRRT). There was no effective treatment available at the start of the pandemic and this resulted in death rate rising sharply in England as well as many other countries. It has now become evident that there has been considerable variation in mortality in individual hospitals and there is urgent need to understand the reasons for this unwanted variation. As the country tries to recover from the pandemic, it becomes more important to learn lessons with regards to its strategy of tackling the disease. This learning can then be applied to a possible second spike of COVID-19 to help mitigate the impact and improve outcomes.
The purpose of this study is to understand if variation exists in incidence and mortality in COVID patients and its complication namely, acute kidney injury, in England. The adjusted analysis will also focus on what are the causes of this variation from routinely collected data from rich source of hospital episode statistics (HES). This will help highlight areas of improvement and learning, for example, if the mortality in AKI in COVID patient is high in a particular District General Hospital (DGH), the analysis may help the DGH to look at the provisions to detect and manage AKI and nephrology services.
Another example is that University Hospital of Derby and Burton Foundation Trust (UHDB)’s mortality in COVID patients was in top quartile in England it was highest in Midlands, though, Birmingham was worse hit. Without case-mix study, it is not possible to attain any learning of what were the factors which led to high mortality. Without this learning there is a risk of high mortality in COVID patients
To address this gap in knowledge, University Hospital of Derby and Burton Foundation Trust wishes to undertake a two arm, retrospective, cohort study of hospitalised patients 18 years and over on 01/03/2002 identified from national data collected during routine care in the hospital settings in England between 1st March 2020 and 31st August 2020.
The University Hospital of Derby and Burton Foundation Trust (UHDB) wishes to combine national data base of Hospital Episode Statistics (HES) for Admitted Patient Care (APC) with Critical Care (CC) and Mortality data over a period of four months to determine the regional incidence and case fatality (epidemiology) of hospitalised patients with COVID-19 disease in England. The UHDB will also investigate the association between patient characteristics and patient outcomes in patients admitted with COVID-19 and Acute Kidney Failure (AKI) and explore the various determinants of mortality.
The primary outcome will be to determine in-hospital mortality in patients with COVID-19 disease and AKI in COVID-19.
The secondary outcomes will include all-cause mortality, need for ventilatory support, admission to Intensive Care Unit (ICU), length of stay.
PLEASE NOTE: Acute renal failure (ARF) has been replaced by new terminology, acute kidney injury (AKI), but due to lack of ICD-10 codes* for AKI, the ICD10 codes for acute renal failure will be requested and will be referred to as AKI in this agreement.
*What are ICD-10 codes? ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. A handy look-up tool for ICD-10 codes can be found here: https://icdcodelookup.com/icd-10/codes
DATA MINIMISATION USING ICD-10 CODES
N17.0 for acute renal failure with tubular necrosis, N17.1 for acute renal failure with acute cortical necrosis, N17.2 for acute renal failure with medullary necrosis, N17.8 for other acute renal failure and N17.9 for acute renal failure, unspecified. The severity of AKI requiring dialysis will be identified by additional procedure code of X40.2 for peritoneal dialysis, X40.3 for haemodialysis, or X40.4 for hemofiltration, X40.5 for automated peritoneal dialysis and X40.6 for continuous ambulatory peritoneal dialysis in any of the 25 procedure codes. These codes have established biological and clinical plausibility and are widely used in acute kidney injury research.
The study will consist of two arms of study:
First arm: Epidemiology of COVID-19 in England
All patients who are admitted to a hospital with COVID-19 infection between 1st March 2020 and 31st August 2020 and who meet following criteria will be included:
1) Diagnostic code for COVID-19 (U07.1) in any of the 20 diagnoses codes
2) Adult patients 18 years of age and upwards [those with a birth date on or before 01/03/2002].
Exclusion criteria:
1) Paediatric patients under 18 years of age [those with a birth date after 01/03/2002].
Second arm: Epidemiology of AKI in COVID-19 in England
All patients who are admitted to a hospital with acute kidney injury (AKI) between 1st March 2020 and 31st August 2020 and who meet following criteria will be included:
1) Diagnostic code for AKI (N17) in any of the 20 diagnoses codes
2) Adult patients 18 years of age and upwards [those with a birth date on or before 01/03/2002].
Exclusion criteria:
1) Paediatric patients under 18 years of age [those with a birth date after 01/03/2002].
3) Patients on chronic maintenance haemodialysis or peritoneal dialysis
The record-level pseudonymised data for both arms of the study would be in one data extract with a flag to indicate one of 3 situations:
1. Positive diagnosis of Covid-19, AND AKI
2. Positive diagnosis of Covid-19, NO AKI
3. Negative diagnosis of Covid-19, AND AKI
All episodes for each cohort individual will be required to ensure there is no survival bias in the analysis.
- for the first part of the study, NHS Digital will identify all cases of hospitalised individuals with COVID-19 between 1st March 2020 and 31st August 2020 by using validated International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code of U07.1(COVID-19, virus identified) in any of the diagnoses codes, in keeping with the objective of the study. This will be the COVID-19 AKI cohort.
- For the second part of the study, NHS Digital will identify hospitalised individuals with following ICD-10 codes for acute kidney injury (AKI) [as identified by ICD-10 code of N17 in any of the 20 diagnostic codes] between 1st March 2020 and 31st August 2020 will be included:
N17.0 for acute renal failure with tubular necrosis,
N17.1 for acute renal failure with acute cortical necrosis,
N17.2 for acute renal failure with medullary necrosis,
N17.8 for other acute renal failure and
N17.9 for acute renal failure, unspecified.
AKI patients requiring dialysis will be identified by additional procedure code of X40.2 for peritoneal dialysis, X40.3 for haemodialysis, or X40.4 for hemofiltration, X40.5 for automated peritoneal dialysis and X40.6 for continuous ambulatory peritoneal dialysis in any of the 25 procedures.
The AKI cohort without COVID-19 will serve as AKI control.
To exclude patients with chronic kidney disease starting dialysis, NHS Digital will exclude patients who had following codes:
Z99.2 – dependence on renal dialysis,
L74.2 - arteriovenous fistula or
L74.3 - arteriovenous shunt during the inpatient admission.
This algorithm has been shown to be sensitive and specific, with a high positive and negative predictive value (all >90%).
For both arms of the study, the UHDB will obtain data on patient demographics, admissions and discharge details, hospital characteristics, in-hospital mortality, disposition, length of stay (LOS), deprivation decile and up to 20 diagnosis and 25 procedure codes that are based on the ICD-10-CM and OPCS-4 from the HES database.
Data for critical care admission, discharge and organ support will be obtained from the linked HES Admitted Patient Care and Critical Care data set. Patients status at 30-day will be obtained from mortality data via the Civil Registrations (Deaths) - Secondary Care Cut data set.
Patients will not be contacted. Data requested will be pseudonymised and no attempt will be made to re-identify patients.
LEGAL BASIS
The General Data Protection Regulation Article 6 (1) (e) and Article 9 (2) (j) are the legal basis for the processing of the data. Article 6 (1) (e) states that processing is necessary for the public interest. The purpose of this application is to determine the regional incidence and case fatality (epidemiology) of hospitalised patients with COVID-19 disease in England. The understanding gained from this data analysis will help to prevent this unwanted variation in second spike of COVID-19. This data will not be used for commercial purposes, will not be provided in record level form to any third party and will not be used for direct marketing. Only patients residing in England and Wales have been included in this study.
Expected output
The University Hospital of Derby and Burton Foundation Trust (UHDB) hope to identify crude mortality rate and mortality rate adjusted for age, gender, ethnicity and comorbidities for each region in England for AKI and COVID-19. Determinants of mortality will be examined for trusts of the same size and population served as University Hospital of Derby and Burton Foundation Trust. The analysis will be completed within 60 days of receiving the data from NHS Digital, with the study manuscript prepared 6 months from receiving the data.
The data will be processed and the results will be presented as a report to the University Hospital of Derby and Burton Foundation Trust Board. The data analysis will also be submitted to peer-reviewed journals and presented in Nephrology conferences, nationally and internationally. The results will be presented in the Renal Association annual meeting in June 2021, European Renal Association in June 2021 and American Society of Nephrology in November 2021
The data analysis will generate aggregate data with statistical inferences. All outputs will be aggregated with small numbers suppressed in line with the HES Analysis Guide.
The results of the research analysis will be disseminated to stakeholders during the project and after its completion. The target of this dissemination will be NHS stake holders, like UHDB, policy makers, medical fraternity, patients and researchers. The portal of dissemination of the results will be:
- Conferences (as above),
- briefing document to the UHDB Trust board,
- peer-reviewed journals (Open access / free journals are preferred as they are well read and are not restricted to subscription), which advertise the findings via social media such as Twitter.
- oral presentations in grand rounds and teaching sessions.
DARS-NIC-391959-Q3C3G-v0.6 23 November 2020 to 22 November 2023
- Title
- Regional variation in epidemiology of COVID-19 in England
- Commercial
- No
- Sublicensing
- No
- Datasets
- 4
- Files released
- 0
Datasets: Civil Registrations of Death - Secondary Care Cut; HES:Civil Registration (Deaths) bridge; Hospital Episode Statistics Admitted Patient Care (HES APC); Hospital Episode Statistics Critical Care (HES Critical Care)
Objective for processing
The coronavirus disease 2019 (COVID-19) pandemic has caused significant morbidity and mortality and has affected some countries disproportionately. It has become evident that SARS-CoV-2 has shown variation in its virulence with some regions, within a country, more severely affected than others. In England, London and West Midlands the NHS were overwhelmed in the early period of the pandemic with increased in hospitalizations for pneumonia with multiorgan disease. As of 31st July 2020, the number of confirmed cases for COVID-19 have exceeded 17 million world-wide and 300,000 in United Kingdom with 46,000 deaths in UK alone.
In UK, the pandemic reached its peak in mid-April with confirmed cases decreasing by end of May 2020. One of the most serious complications of COVID-19 has been kidney involvement, in the form of acute kidney injury (AKI) but the incidence of this has ranged widely in reports from different centres, between 5% to 57%. In the only report from UK, the incidence of AKI in COVID-19 was 26.2% which was much higher than a comparable cohort of people admitted with non-COVID acute illnesses (12.4%). However, no data have been published regarding variation in the incidence of COVID associated AKI within the UK. The medical community rapidly learnt lessons in the first wave of the pandemic, for example regarding the use of continuous positive pressure ventilation (CPAP) in case of respiratory distress and the use of regional anticoagulation in AKI needing continuous renal replacement therapy (CRRT). There was no effective treatment available at the start of the pandemic and this resulted in death rate rising sharply in England as well as many other countries. It has now become evident that there has been considerable variation in mortality in individual hospitals and there is urgent need to understand the reasons for this unwanted variation. As the country tries to recover from the pandemic, it becomes more important to learn lessons with regards to its strategy of tackling the disease. This learning can then be applied to a possible second spike of COVID-19 to help mitigate the impact and improve outcomes.
The purpose of this study is to understand if variation exists in incidence and mortality in COVID patients and its complication namely, acute kidney injury, in England. The adjusted analysis will also focus on what are the causes of this variation from routinely collected data from rich source of hospital episode statistics (HES). This will help highlight areas of improvement and learning, for example, if the mortality in AKI in COVID patient is high in a particular District General Hospital (DGH), the analysis may help the DGH to look at the provisions to detect and manage AKI and nephrology services.
Another example is that University Hospital of Derby and Burton Foundation Trust (UHDB)’s mortality in COVID patients was in top quartile in England it was highest in Midlands, though, Birmingham was worse hit. Without case-mix study, it is not possible to attain any learning of what were the factors which led to high mortality. Without this learning there is a risk of high mortality in COVID patients
To address this gap in knowledge, University Hospital of Derby and Burton Foundation Trust wishes to undertake a two arm, retrospective, cohort study of hospitalised patients 18 years and over on 01/03/2002 identified from national data collected during routine care in the hospital settings in England between 1st March 2020 and 31st August 2020.
The University Hospital of Derby and Burton Foundation Trust (UHDB) wishes to combine national data base of Hospital Episode Statistics (HES) for Admitted Patient Care (APC) with Critical Care (CC) and Mortality data over a period of four months to determine the regional incidence and case fatality (epidemiology) of hospitalised patients with COVID-19 disease in England. The UHDB will also investigate the association between patient characteristics and patient outcomes in patients admitted with COVID-19 and Acute Kidney Failure (AKI) and explore the various determinants of mortality.
The primary outcome will be to determine in-hospital mortality in patients with COVID-19 disease and AKI in COVID-19.
The secondary outcomes will include all-cause mortality, need for ventilatory support, admission to Intensive Care Unit (ICU), length of stay.
PLEASE NOTE: Acute renal failure (ARF) has been replaced by new terminology, acute kidney injury (AKI), but due to lack of ICD-10 codes* for AKI, the ICD10 codes for acute renal failure will be requested and will be referred to as AKI in this agreement.
*What are ICD-10 codes? ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. A handy look-up tool for ICD-10 codes can be found here: https://icdcodelookup.com/icd-10/codes
DATA MINIMISATION USING ICD-10 CODES
N17.0 for acute renal failure with tubular necrosis, N17.1 for acute renal failure with acute cortical necrosis, N17.2 for acute renal failure with medullary necrosis, N17.8 for other acute renal failure and N17.9 for acute renal failure, unspecified. The severity of AKI requiring dialysis will be identified by additional procedure code of X40.2 for peritoneal dialysis, X40.3 for haemodialysis, or X40.4 for hemofiltration, X40.5 for automated peritoneal dialysis and X40.6 for continuous ambulatory peritoneal dialysis in any of the 25 procedure codes. These codes have established biological and clinical plausibility and are widely used in acute kidney injury research.
The study will consist of two arms of study:
First arm: Epidemiology of COVID-19 in England
All patients who are admitted to a hospital with COVID-19 infection between 1st March 2020 and 31st August 2020 and who meet following criteria will be included:
1) Diagnostic code for COVID-19 (U07.1) in any of the 20 diagnoses codes
2) Adult patients 18 years of age and upwards [those with a birth date on or before 01/03/2002].
Exclusion criteria:
1) Paediatric patients under 18 years of age [those with a birth date after 01/03/2002].
Second arm: Epidemiology of AKI in COVID-19 in England
All patients who are admitted to a hospital with acute kidney injury (AKI) between 1st March 2020 and 31st August 2020 and who meet following criteria will be included:
1) Diagnostic code for AKI (N17) in any of the 20 diagnoses codes
2) Adult patients 18 years of age and upwards [those with a birth date on or before 01/03/2002].
Exclusion criteria:
1) Paediatric patients under 18 years of age [those with a birth date after 01/03/2002].
3) Patients on chronic maintenance haemodialysis or peritoneal dialysis
The record-level pseudonymised data for both arms of the study would be in one data extract with a flag to indicate one of 3 situations:
1. Positive diagnosis of Covid-19, AND AKI
2. Positive diagnosis of Covid-19, NO AKI
3. Negative diagnosis of Covid-19, AND AKI
All episodes for each cohort individual will be required to ensure there is no survival bias in the analysis.
- for the first part of the study, NHS Digital will identify all cases of hospitalised individuals with COVID-19 between 1st March 2020 and 31st August 2020 by using validated International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code of U07.1(COVID-19, virus identified) in any of the diagnoses codes, in keeping with the objective of the study. This will be the COVID-19 AKI cohort.
- For the second part of the study, NHS Digital will identify hospitalised individuals with following ICD-10 codes for acute kidney injury (AKI) [as identified by ICD-10 code of N17 in any of the 20 diagnostic codes] between 1st March 2020 and 31st August 2020 will be included:
N17.0 for acute renal failure with tubular necrosis,
N17.1 for acute renal failure with acute cortical necrosis,
N17.2 for acute renal failure with medullary necrosis,
N17.8 for other acute renal failure and
N17.9 for acute renal failure, unspecified.
AKI patients requiring dialysis will be identified by additional procedure code of X40.2 for peritoneal dialysis, X40.3 for haemodialysis, or X40.4 for hemofiltration, X40.5 for automated peritoneal dialysis and X40.6 for continuous ambulatory peritoneal dialysis in any of the 25 procedures.
The AKI cohort without COVID-19 will serve as AKI control.
To exclude patients with chronic kidney disease starting dialysis, NHS Digital will exclude patients who had following codes:
Z99.2 – dependence on renal dialysis,
L74.2 - arteriovenous fistula or
L74.3 - arteriovenous shunt during the inpatient admission.
This algorithm has been shown to be sensitive and specific, with a high positive and negative predictive value (all >90%).
For both arms of the study, the UHDB will obtain data on patient demographics, admissions and discharge details, hospital characteristics, in-hospital mortality, disposition, length of stay (LOS), deprivation decile and up to 20 diagnosis and 25 procedure codes that are based on the ICD-10-CM and OPCS-4 from the HES database.
Data for critical care admission, discharge and organ support will be obtained from the linked HES Admitted Patient Care and Critical Care data set. Patients status at 30-day will be obtained from mortality data via the Civil Registrations (Deaths) - Secondary Care Cut data set.
Patients will not be contacted. Data requested will be pseudonymised and no attempt will be made to re-identify patients.
LEGAL BASIS
The General Data Protection Regulation Article 6 (1) (e) and Article 9 (2) (j) are the legal basis for the processing of the data. Article 6 (1) (e) states that processing is necessary for the public interest. The purpose of this application is to determine the regional incidence and case fatality (epidemiology) of hospitalised patients with COVID-19 disease in England. The understanding gained from this data analysis will help to prevent this unwanted variation in second spike of COVID-19. This data will not be used for commercial purposes, will not be provided in record level form to any third party and will not be used for direct marketing. Only patients residing in England and Wales have been included in this study.
Expected output
The University Hospital of Derby and Burton Foundation Trust (UHDB) hope to identify crude mortality rate and mortality rate adjusted for age, gender, ethnicity and comorbidities for each region in England for AKI and COVID-19. Determinants of mortality will be examined for trusts of the same size and population served as University Hospital of Derby and Burton Foundation Trust. The analysis will be completed within 60 days of receiving the data from NHS Digital, with the study manuscript prepared 6 months from receiving the data.
The data will be processed and the results will be presented as a report to the University Hospital of Derby and Burton Foundation Trust Board. The data analysis will also be submitted to peer-reviewed journals and presented in Nephrology conferences, nationally and internationally. The results will be presented in the Renal Association annual meeting in June 2021, European Renal Association in June 2021 and American Society of Nephrology in November 2021
The data analysis will generate aggregate data with statistical inferences. All outputs will be aggregated with small numbers suppressed in line with the HES Analysis Guide.
The results of the research analysis will be disseminated to stakeholders during the project and after its completion. The target of this dissemination will be NHS stake holders, like UHDB, policy makers, medical fraternity, patients and researchers. The portal of dissemination of the results will be:
- Conferences (as above),
- briefing document to the UHDB Trust board,
- peer-reviewed journals (Open access / free journals are preferred as they are well read and are not restricted to subscription), which advertise the findings via social media such as Twitter.
- oral presentations in grand rounds and teaching sessions.
Benefits reported
Yielded Benefits is not a requirement for new applications.
Register history
When this agreement appeared in, or was edited in, each monthly edition of the register. Built by comparing every edition this site holds, the earliest of which is July 2021.
-
July 2021 —
already listed in the earliest edition this site holds, so it may be older. 2 versions: DARS-NIC-391959-Q3C3G-v0.6, DARS-NIC-391959-Q3C3G-v1.1
-
September 2021
1 version added: DARS-NIC-391959-Q3C3G-v2.2
-
October 2021
Amended DARS-NIC-391959-Q3C3G-v2.2
- Datasets: + HES-ID to MPS-ID HES Admitted Patient Care
"Amended in place" means NHS England changed the record without issuing a new version number. The register publishes no changelog for those edits; this site infers them by comparing editions. An edit is attributed to the edition it first appears in, not to the date it was made.
Cite this page
NHS England (2026) Data Uses Register, September 2026 edition, agreement DARS-NIC-391959-Q3C3G, “Regional variation in epidemiology of COVID-19 in England”. Read via NHS Data Access Explorer (unofficial), https://healthdatauses.uk/agreements/dars-nic-391959-q3c3g/ (accessed [date]).
This address stays the same, but the page is rebuilt with each monthly edition, so the citation names the edition it shows. Every edition's data is kept in the facts store.
Source: datausesregister_september2026.xlsx, September 2026 edition of the NHS England Data Uses Register. Search that workbook for DARS-NIC-391959-Q3C3G to see the original rows.