*OTHER*: UK Shielding criteria - produce a binary variable (1 - yes, 0 - no)

[sebbacon]

UK Shielding criteria - produce a binary variable (1 - yes, 0 - no)

Flag was given to TPP to apply but not in machine readable terms

[CarolineMorton]

@StatsFizz Am i right in thinking this is no longer in our statistical plan?

[StatsFizz]

Correct. However, we are in ongoing discussions re whether it should be somehow looked at. I would put this on slightly lower priority for now and we will feed back if we decide it needs to be back on high priority. If that's ok with you?

[CarolineMorton]

That works great. Just allows us to concentrate on higher priority covariates

[alexwalkerepi]

from @chris-tpp:

These are local codes (mapped to SNOMED CT codes) in the system. You can just use the “Y-codes” in queries:

Y228a High risk category for developing complication from coronavirus disease 19 caused by severe acute respiratory syndrome coronavirus 2 infection (finding) Y228b Moderate risk category for developing complication from coronavirus disease 19 caused by severe acute respiratory syndrome coronavirus 2 infection (finding) Y228c Low risk category for developing complication from coronavirus disease 19 caused by severe acute respiratory syndrome coronavirus 2 infection (finding)

[hmcd]

We discussed some issues with the NHS Digital mapping.

Could attempt to develop our own using subgroups of the cancer and immunosuppression variables - however, as the shielding criteria are very reliant on secondary care treatments, it'll be rather crude approximations e.g. based on time since an incident cancer diagnosis.

In case we want to return to this, set out a potential approach below from the exposures we have or are defining:

	Exposure
1	Lung cancer
2	Haematological cancer
3	Other malignant cancer
4	Bone marrow transplant
5	Aplastic anaemia
6	Chemotherapy/radiotherapy
7	Dysplenia
8	Sickle cell disease
9	HIV
10	Organ transplant
11	Genetic conditions that increase risk of infections
12	Other immunosuppression
13	Oral steroids
14	Biologics
15	Other immunosuppressants (DMARDS)

Inclusion criteria	How could we do it using the exposure categories above?
People who have had an organ transplant who remain on long term immune suppression therapy	10 ever
with cancer who are undergoing active chemotherapy or radical radiotherapy for lung cancer	1, first code within set period of time (e.g.3-6 months)
with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment	2, first code within set period of time
having immunotherapy or other continuing antibody treatments for cancer	haven’t got secondary care prescriptions
having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors	haven’t got secondary care prescriptions
who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs	4, within last 6 months
People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD. Severe asthmatics are those who are frequently prescribed high dose steroid tablets	cystic fibrosis list asthma or chronic respiratory disease who meet thresholds for oral steroids (13 above)
People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell)	11
People on immunosuppression therapies sufficient to significantly increase risk of infection	12 OR 13 OR 14 OR 15 – would need to check NHS Digital methods for whether 6 should belong here
People who are pregnant with significant congenital heart disease	Would be tricky without good indicator of pregnancy status, but Maria Peppa at LSHTM has done detailed work on congenital heart disease codes.