In total, 17,278,392 adults were included (Fig. 1; cohort description in Table 1). Eleven per cent of individuals (1,851,868) had ethnicity recorded as mixed, South Asian, Black or other (hereafter referred to

Background COVID-19 has disproportionately affected minority ethnic populations in the UK. Our aim was to quantify ethnic differences in SARS-CoV-2 infection and COVID-19 outcomes during the first and second waves of the COVID-19 pandemic in England. MethodsWe conducted an observational cohort study of adults (aged ≥18 years) registered with primary care practices in England for whom electronic health records were available through the OpenSAFELY platform, and who had at least 1 year of continuous registration at the start of each study period (Feb 1 to Aug 3, 2020 [wave 1], and Sept 1 to Dec 31, 2020 [wave 2]). Individual-level primary care data were linked to data from other sources on the outcomes of interest: SARS-CoV-2 testing and positive test results and COVID-19-related hospital admissions, intensive care unit (ICU) admissions, and death. The exposure was self-reported ethnicity as captured on the primary care record, grouped into five high-level census categories (White, South Asian, Black, other, and mixed) and 16 subcategories across these five categories, as well as an unknown ethnicity category. We used multivariable Cox regression to examine ethnic differences in the outcomes of interest. Models were adjusted for age, sex, deprivation, clinical factors and comorbidities, and household size, with stratification by geographical region. FindingsOf 17 288 532 adults included in the study (excluding care home residents), 10 877 978 (62•9%) were White, 1 025 319 (5•9%) were South Asian, 340 912 (2•0%) were Black, 170 484 (1•0%) were of mixed ethnicity, 320 788 (1•9%) were of other ethnicity, and 4 553 051 (26•3%) were of unknown ethnicity. In wave 1, the likelihood of being tested for SARS-CoV-2 infection was slightly higher in the South Asian group (adjusted hazard ratio 1•08 [95% CI 1•07-1•09]), Black group (1•08 [1•06-1•09]), and mixed ethnicity group (1•04 [1•02-1•05]) and was decreased in the other ethnicity group (0•77 [0•76-0•78]) relative to the White group. The risk of testing positive for SARS-CoV-2 infection was higher in the South Asian group (1•99 [1•94-2•04]), Black group (1•69 [1•62-1•77]), mixed ethnicity group (1•49 [1•39-1•59]), and other ethnicity group (1•20 [1•14-1•28]). Compared with the White group, the four remaining high-level ethnic groups had an increased risk of COVID-19-related hospitalisation (

Background Whether HIV infection is associated with risk of death due to COVID-19 is unclear. We aimed to investigate this association in a large-scale population-based study in England. MethodsWe did a retrospective cohort study. Working on behalf of NHS England, we used the OpenSAFELY platform to analyse routinely collected electronic primary care data linked to national death registrations. We included all adults (aged ≥18 years) alive and in follow-up on Feb 1, 2020, and with at least 1 year of continuous registration with a general practitioner before this date. People with a primary care record for HIV infection were compared with people without HIV. The outcome was COVID-19 death, defined as the presence of International Classification of Diseases 10 codes U07.1 or U07.2 anywhere on the death certificate. Cox regression models were used to estimate the association between HIV infection and COVID-19 death; they were initially adjusted for age and sex, then we added adjustment for index of multiple deprivation and ethnicity, and then for a broad range of comorbidities. Interaction terms were added to assess effect modification by age, sex, ethnicity, comorbidities, and calendar time.Results 17 282 905 adults were included, of whom 27 480 (0•16%) had HIV recorded. People living with HIV were more likely to be male, of Black ethnicity, and from a more deprived geographical area than the general population. 14 882 COVID-19 deaths occurred during the study period, with 25 among people with HIV. People living with HIV had higher risk of COVID-19 death than those without HIV after adjusting for age and sex: hazard ratio (HR) 2•90 (95% CI 1•96-4•30; p<0•0001). The association was attenuated, but risk remained high, after adjustment for deprivation, ethnicity, smoking and obesity: adjusted HR 2•59 (95% CI 1•74-3•84; p<0•0001). There was some evidence that the association was larger among people of Black ethnicity: HR 4•31 (95% CI 2•42-7•65) versus 1•84 (1•03-3•26) in non-Black individuals (p-interaction=0•044).Interpretation People with HIV in the UK seem to be at increased risk of COVID-19 mortality. Targeted policies should be considered to address this raised risk as the pandemic response evolves.

Using electronic health records, we assessed the early impact of coronavirus disease (COVID-19) on routine childhood vaccination in England by 26 April 2020. Measles-mumps-rubella vaccination counts fell from February 2020, and in the 3 weeks after introduction of physical distancing measures were 19.8% lower (95% confidence interval: −20.7 to −18.9) than the same period in 2019, before improving in mid-April. A gradual decline in hexavalent vaccination counts throughout 2020 was not accentuated by physical distancing.