The United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers (UK-REACH): protocol for a prospective longitudinal cohort study of healthcare and ancillary workers in UK healthcare settings

Abstract

Introduction: The COVID-19 pandemic has resulted in significant morbidity and mortality and devastated economies globally. Among groups at increased risk are healthcare workers (HCWs) and ethnic minority groups. Emerging evidence suggests that HCWs from ethnic minority groups are at increased risk of adverse COVID-19-related outcomes. To date, there has been no large-scale analysis of these risks in UK HCWs or ancillary workers in healthcare settings, stratified by ethnicity or occupation, and adjusted for confounders. This paper reports the protocol for a prospective longitudinal questionnaire study of UK HCWs, as part of the UK-REACH programme (The United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers).

Methods and analysis: A baseline questionnaire will be administered to a national cohort of UK HCWs and ancillary workers in healthcare settings, and those registered with UK healthcare regulators, with follow-up questionnaires administered at 4 and 8 months. With consent, questionnaire data will be linked to health records with 25-year follow-up. Univariate associations between ethnicity and clinical COVID-19 outcomes, physical and mental health, and key confounders/explanatory variables will be tested. Multivariable analyses will test for associations between ethnicity and key outcomes adjusted for the confounder/explanatory variables. We will model changes over time by ethnic group, facilitating understanding of absolute and relative risks in different ethnic groups, and generalisability of findings.

Ethics and dissemination: The study is approved by Health Research Authority (reference 20/HRA/4718), and carries minimal risk. We aim to manage the small risk of participant distress about questions on sensitive topics by clearly participant information that the questionnaire covers sensitive topics and there is no obligation to answer these or any other questions, and by providing support organisation links. Results will be disseminated with reports to Government and papers submitted to pre-print servers and peer reviewed journals.

Trial registration number: ISRCTN11811602; Pre-results.

Keywords: COVID-19; mental health; public health.

Figure 1

Study flowchart. PIS, participant information sheet.

Figure 2

UK-REACH Work package 2 timeline as of 4 February 2021. Dates are shown across the bottom from October 2019 to July 2021. The COVID-19 outbreak began in the UK in January 2020 with numbers of daily hospital admissions due to COVID-19 shown by the lower orange line for Wave one and Wave two. Vaccinations began in December 2020 and are shown by the green line for daily vaccinations. Lockdowns are shown by horizontal red bars, the first national lockdown beginning on 23 March 2020, the second on 5 November and the third of 5 January 2021. Lockdowns differed somewhat in timing between England, Wales, Scotland and Northern Ireland. Tiered local restrictions were in place in various regions of the UK between lockdowns, shown in yellow. Questionnaire 1 of Work package 2 began to be distributed on 4 December onwards and is being distributed until the end of March 2021. Questionnaire 1 asks about current events and working conditions, as well as retrospectively about events and working conditions pre-Covid in 2019, about early COVID-19 responses in the first months of 2021 and about events during the first national lockdown. Questionnaire 2 will be distributed 4 months after registration for questionnaire 1 and therefore will be distributed between April and June 2021. Questionnaire 2 asks primarily about current working conditions, and changes to other aspects of participants’ lives captured in Questionnaire 1, including key measures of physical and mental health. With consent, the questionnaire data will be linked to electronic healthcare record data. UK-REACH, The United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers.

Figure 3

Data flow diagram. Solid lines with a circle indicate identifiable data flows for linkage purposes only. Solid lines with an arrow indicate anonymous outputs. Dashed lines indicate deidentified data. After consenting to join UK-REACH, participants provide limited PII which are stored in a secure location at the University of Leicester, alongside study ID. Questionnaire data (including study ID but not alongside the aforementioned PII) are stored in a different secure location at the University of Leicester. Participants provide consent for the study to follow their health by extracting information from electronic health records. Relevant PII for each participant will be securely transferred to NHS Wales Informatics Service (alongside the UK-REACH study ID) in order to acquire NHS number/CHI number (for Scotland)/Health and Care number (for Northern Ireland). NHS/CHI/H&C number will then be used to link to healthcare records by the relevant data provider across the UK. Deidentified health records will be sent directly to the Secure Anonymised Information Linkage databank (SAIL, https://saildatabank.com), retaining Study ID but excluding PII. Questionnaire data (including study ID) will be sent from the University of Leicester to SAIL. These datasets will be linked within SAIL to provide the complete dataset. Interim analysis of unlinked questionnaire data will be performed at the University of Leicester using pseudonymised datasets. All linked data analysis will take place within SAIL. The above diagram and style was interpreted by Anna Guyatt and Chris Orton from an initial data flow diagram created and provided by Andy Boyd at the University of Bristol. It has been repurposed and amended to illustrate data flows specific to the UK-REACH project. CHESS, COVID-19 Hospitalisation in England Surveillance System; CHI, Community Health Index; GPES, General Practice Extraction Service; HSCNI, Health and Social Care Northern Ireland; ICNARC, Intensive Care National Audit & Research Centre; NHS, National Health Service; PII, personal identifiable information; UK-REACH, The United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers.