Changes in potential cancer indicator reporting in primary-care during the COVID-19 pandemic

Changes in potential cancer indicator reporting in primary-care during the COVID-19 pandemic | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Changes in potential cancer indicator reporting in primary-care during the COVID-19 pandemic Lauren J Scott, Mairead Murphy, Sarah Price, Rhys Lewis, Rachel Denholm, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-123337/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 12 Dec, 2020 Read the published version in BMJ Open → Version 1 posted You are reading this latest preprint version Abstract Background In March 2020, the World Health Organisation declared COVID-19 a pandemic. Aim To investigate how the pandemic affected presentation to primary-care with features potentially indicating cancer, and explore how reporting differed by patient characteristics and in face-to-face vs. remote consultations. Design and setting Retrospective cohort study in 21 practices in South-West England. Methods Potential cancer indicators were identified using pre-defined code lists for symptoms, signs, test results and diagnoses. Negative binomial regression models compared reporting of potential cancer indicators in April-July 2020 to April-July 2019. Incidence rate ratios (IRRs), 95% confidence intervals (CIs) and p-values are reported. Results During April-July 2019 and 2020, respectively, 152,447/344,184 (44%) and 123,775/350,966 (35%) patients consulted, with 44,662/344,184 (13%) and 29,150/350,966 (8%) reporting a potential cancer indicator (IRR=0.65, 95%CI 0.62-0.68, p<0.001). Reduced indicator reporting was stable across ethnicity, deprivation and shielding status, was greater in children (0-4 years IRR=0.50, 95%CI 0.46-0.55, p<0.001; 5-17 years IRR=0.45, 95%CI 0.41-0.49, p<0.001) and males (IRR=0.61, 95%CI 0.58-0.64), and less marked in patients with mental health conditions (IRR=0.75, 95%CI 0.72-0.79, p<0.001). Indicator reporting dropped for GP face-to-face consultations (IRR=0.88, 95%CI 0.80-0.97, p=0.011) and increased for remote consultations (IRR=1.22, 95%CI 1.11-1.34, p<0.001), but despite this, remained lower in remote consulting than face-to-face in April-July 2020. Conclusion Patient consulting in general, and for potential cancer indicators specifically, reduced during the first-wave of the COVID-19 pandemic. Remote consulting may be part of the reason for the reduction in reporting of potential cancer indicators, along with the reduced spreading of viral (non-cancer) infections. General Practice COVID-19 General Practice Cancer Figures Figure 1 Figure 2 Significance What is already known Primary-care consultations reduced during UK lockdown in first-wave of the COVID-19 pandemic, and most consultations were provided remotely rather than face-to-face. GPs perceive that the pandemic has resulted in fewer patients consulting with potential cancer symptoms. What this study adds The proportion of patients presenting with symptoms, signs, test results or diagnoses which could indicate cancer reduced during the COVID-19 pandemic, compared to the same period last year. The reduction was particularly evident in children (which might indicate reductions in consultations about viral illness) and males, and less so in patients with mental health conditions. Introduction In March 2020, the World Health Organisation declared COVID-19 a pandemic 1 and the UK went into lockdown; the public were instructed to “Stay at home, protect the NHS, and save lives”. 2 In order to reduce contact and the spread of the virus, primary-care providers were advised to provide all consultations remotely, unless a face-to-face consultation was urgently required. 3 Patients at high risk of severe COVID-19 due to age or pre-existing health conditions were advised to ‘shield’ and avoid all but essential contact. GP and nurse consulting rates markedly dropped in April-May 2020 during the period of UK lockdown, but had largely returned to normal by July 2020, 4 with the majority of consultations carried out remotely (mostly via telephone). Further, there was a reduction in weekly reported incidence of asthma, intestinal infectious diseases, and upper and acute respiratory tract infections from the start of lockdown. 5 There are fears that reduced consulting during the lockdown period and changes in consultation provision may have adversely impacted on cancer detection. 6 A Cancer Research UK survey suggested GPs perceive they are receiving fewer reports of cancer symptoms, particularly from older people, than before the pandemic. 6 Coupled with the temporary suspension of cancer screening services, 7,8 reduced symptom reporting could result in late diagnoses, increased workload for cancer services, and poorer patient outcomes. 9 Aims: To investigate how the COVID-19 pandemic affected the number of people presenting to primary-care with symptoms, signs, test results or diagnoses which could potentially indicate cancer, and to explore how this reporting differed by patient characteristics and in face-to-face vs. remote consultations. Methods Design and setting A retrospective cohort study in 21 primary-care practices in South-West England. Data were extracted for the RAPCI Study (Rapid COVID-19 intelligence to improve primary-care response), a mixed-methods study on the rapid change to remote consulting in the initial months of the pandemic; primary results are reported elsewhere. 4 Data Routinely collected and anonymised data were provided by One Care, the GP federation in Bristol, North Somerset, and South Gloucestershire. All practices use the EMIS electronic medical records system. Data included demographics (age, sex, ethnicity, and deprivation), clinical characteristics (mental health and shielding status), and all consultations and clinical codes associated with consultations, added to the system by clinical staff between February 2019 and July 2020 inclusive. All patients registered in July 2020 were included. For the analyses, April-July 2020 (i.e. the period following UK lockdown) was compared to April-July 2019. Consultations Consultations were defined as an interaction between a patient and a GP, nurse, or paramedic working in general practice. Consultations recorded by administrators or other health care professionals, and any administrative tasks, were excluded. Remote consultations were those completed by telephone, video, or e-consultation; face-to-face consultations were in GP practices or visits to patients’ homes (see appendix 1). Outcomes Pre-existing code lists 10,11 were used to identify potential cancer indicators associated with a consultation. Indicators were collated from clinical features of undiagnosed cancer (symptoms, signs, abnormal test results or diagnoses) listed in the National Institute for Health and Care Excellence guidance on the recognition and referral of suspected cancer (NG12) 12 , using robust methods 11 (see appendix 1). Individual potential cancer indicator were categorised by the percentage of patients reporting them in April-July 2019: most commonly (≥0.5%), less commonly (0.1% to <0.5%), rarely (0.02% to <0.1%), and very rarely reported (<0.02%). We separate these because the most commonly reported indicators include symptoms which often indicate minor illness rather than cancer (e.g. cough), whereas the less commonly/rarely reported indicators were more likely to be associated with cancer (e.g. weight loss, lumps and masses). Explanatory variables Age (in July 2020) was categorised: 0-4, 5-17, 18-49, 50-69, 70-84, and 85+ years old. Deprivation quintiles were calculated using index of multiple deprivation score (IMD) deciles recorded in patient records, based on Lower Super Output Areas of residence. Ethnicity was derived by mapping descriptions from primary-care records to five categories: white, Asian, black, mixed, and other (see appendix 1). Presence of a mental health condition included severe mental illness (defined according to the Quality and Outcomes Framework rules 13 ), diagnosed depression, or prescribed anti-depressants (excluding tricyclics) in the three months prior to July 2020. Sex and shielding status (as of July 2020) were obtained directly from primary-care records. Statistical analysis Number and percentages of patients reporting potential cancer indicators are presented. Further, consultation rates (and percentages with indicators) are reported per 1,000 registered patients. Practice list sizes were based on July 2020 data, and adjusted to account for historic list sizes using NHS digital data 14 (‘adjusted list size’; see appendix 1). Changes in proportions of patients presenting (per practice) with any potential cancer indicator in April-July 2020 compared to April-July 2019 were investigated using negative binomial regression models; incidence rate ratios (IRRs) and 95% confidence intervals (CIs) are reported. Consultation year was fitted as a fixed effect, GP practice as a random effect, and adjusted practice list size (per level of covariate where appropriate) as the offset. Fixed effects for each categorical variable (age, sex, ethnicity, IMD quintile, mental health status, and shielding status), along with the interaction between each covariate and consultation year, were separately fitted to the model; interaction p-values are presented and results only presented separately for each level of a covariate if p<0.05. Model validity was checked using standard methods; outliers which disrupted model fit were removed. To investigate consultation provision (i.e. face-to-face vs. remote consulting), we modelled proportions of consultations with potential cancer indicators. Separate models were fitted for GPs and nurses/paramedics consultations. Negative binomial regression models were fitted with number of consultations as the outcome, a fixed effect for consultation provision and an interaction with year, GP practice as a random effect, and total numbers of consultations per practice per level of consultation provision as the offset. For individual potential cancer indicators, unadjusted IRRs comparing April-July 2020 to 2019 are presented to help interpretation, but due to large numbers of indicators and issues with multiple testing, no modelling was performed. Stata 15.1 was used for all data management and analyses. Results During April-July 2019, 152,447/344,184 (44%) patients consulted, and 44,662/344,184 (13%) reported a potential cancer indicator. In April-July 2020, 123,775/350,966 (35%) consulted and 29,150/350,966 (8%) reported an indicator. This comprised 1256 consultations per 1000 registered patients (with indicators reported in 17% of consultations) in April-July 2019 and 1118 consultations per 1000 patients (13% with indicators reported) in April-July 2020. Figures 1 and 2 demonstrate that patients consulting, and consultation rates, dramatically dropped in April 2020 (following UK lockdown), and while consultation rates had recovered by July 2020, the proportion of patients who consulted had not. Further, the percentage of patients and consultations reporting potential cancer indicators also dropped in April 2020; both had increased by July 2020, but neither recovered to pre-COVID levels. Patients who consulted in 2020 were of similar sex, IMD and ethnicity to those consulting in 2019, but were more likely to have mental health conditions and be advised to shield. Further, there were proportionally fewer patients aged 5-17 years who consulted in 2020 than in 2019 (Table 1). For further details on consultation rates, see our previous paper. 4 Patients reporting potential cancer indicators reduced in April-July 2020 compared to 2019 (IRR 0.65, 95% CI 0.62 to 0.68, p<0.001; Table 2). This reduction was stable across ethnicity (interaction p-value=0.956), IMD (p=0.955), and shielding status (p=0.090), but differed by age (p<0.001), sex (p=0.003) and mental health status (p<0.001; Table 2). The reduction was most marked in children (aged 0-4 years IRR 0.50, 95% CI 0.46 to 0.55, p<0.001; aged 5-17 years IRR 0.45, 95% CI 0.41 to 0.49, p<0.001). Among adults, the greatest reduction was in patients aged 50-69 (IRR 0.64, 95C CI 0.60 to 0.68, p<0.001) and 70-84 years (IRR 0.64, 95C CI 0.59 to 0.69, p<0.001). In both years, older patients were more likely to report indicators than younger patients (Table 2). Males had a larger reduction in indicator reporting (0.61, 95% CI 0.58 to 0.64, p<0.001) than females (0.68, 95% CI 0.64 to 0.71, p<0.001; Table 2). The reduction was less pronounced in patients with mental health conditions (IRR 0.75, 95% CI 0.72 to 0.79, p<0.001) than without (IRR 0.63, 95% CI 0.60 to 0.65, p<0.001; Table 2). Potential cancer indicator reporting differed by consultation provision for both GP and nurse/paramedic consultations (p-values <0.001 and 0.007, respectively; Table 3). Indicator reporting dropped between 2019 and 2020 for face-to-face consultations (GP IRR 0.88, 95% CI 0.80 to 0.97, p=0.011; nurse IRR 0.61, 95% CI 0.44 to 0.84, p=0.002) and increased for remote consultations (GP IRR 1.22, 95% CI 1.11 to 1.34, p<0.001; nurse IRR 1.67, 95% CI 1.16 to 2.42, p=0.006 Table 3). Despite this increase in potential cancer indicator reporting in remote consultations, reporting was still less common than in GP face-to-face consultations in both years (Table 3). Reporting of commonly reported indicators reduced between the two periods (unadjusted IRR=0.58), with the biggest reductions in chest infections (IRR=0.22), fever (IRR=0.30) throat pain (IRR=0.40) coughs (IRR=0.44) and fatigue (IRR=0.49; Table 4). For less commonly and rarely reported indicators, the reductions were less marked (IRR=0.73 and 0.78, respectively). Lymphadenopathy (IRR=0.35), vomiting (IRR=0.42), erectile dysfunction (IRR=0.42), urinary tract infections (IRR=0.49), and night sweats (IRR=0.48) saw the largest reductions in these groups, and indicators which were similar or increased were: breast lumps (IRR=0.9), lumps excluding breast (IRR=0.98), vaginal discharge (IRR=1.02), constipation (IRR=1.06), weight loss (IRR=0.95), superior vena cava syndrome (IRR=1.09), appetite loss (IRR=1.11), and abdomen masses (IRR=1.42; Table 4). Discussion Summary of findings In April 2020, following UK lockdown, the proportion of patients consulting, and those reporting potential cancer indicators, reduced substantially compared to April 2019. By July 2020, although consultation rates had returned to previous levels, the proportion of patients consulting, and the proportion reporting potential cancer indicators remained lower than the previous year. The reduction in indicator reporting was particularly evident in children and males, and less evident in patients with mental health conditions. Among adults, the greatest reduction was in patients aged 50-84. Indicator reporting increased in remote consultations in 2020 compared with 2019, and decreased in face-to-face consultations. Despite this, indicator reporting remained higher in GP face-to-face than remote consultations in 2020, suggesting the significant increase in remote consulting during the pandemic could be contributing to the reduced reporting of potential cancer indicators. Of the most commonly reported indicators, chest infections, fever, throat pain, coughs and fatigue reduced most dramatically. Strengths and limitations To our knowledge, this is the first papers to assess the effect of the COVID-19 pandemic on potential cancer symptom reporting in UK primary-care. The analysis is based on a comprehensive list of potential cancer indicators, used in previous research. 10,11 Our analysis included large numbers of patients (>350,000) from a diverse range of backgrounds, and as changes due to the pandemic have affected the whole country, findings are likely to be generalisable across England. Except for ethnicity, missing patient characteristics data were low. There are several limitations which pertain to the recording of potential cancer indicators. Firstly, some symptoms and signs may have been reported in free text rather than using clinical codes, 15 or may have been recorded in administration notes not associated with consultations. This may have resulted in systematic under-reporting of potential cancer indicators; however, this is likely to be similar in both years so should not affect the comparative findings. A further limitation was that new SNOMED CT codes added since the changeover from Read codes to SNOMED were not in our pre-defined lists, an issue which would affect April-July 2020 but not 2019; however, we checked this for common indicators cough and back pain, and found new codes were rarely used. Comparison with other literature Few other studies have looked at the content of primary-care consultations following UK lockdown. One analysis of primary-care data from a deprived urban population, found that diagnoses of common conditions decreased substantially between March and May 2020, suggesting patients may have undiagnosed conditions resulting from changes in access post-lockdown. 16 Further, data from the Royal College of General Practitioners research and surveillance centre showed a marked reduction in weekly reported incidence of asthma, intestinal infectious diseases, and upper and acute respiratory tract infections from week 12 of 2020. 5 Our study adds to these findings for cancer-specific indicators. Cancer screening programmes, estimated to account for about 5% of cancer diagnoses, were suspended in the wake of the pandemic, 7 making symptom-based diagnosis more important. UK lockdown could have affected symptom-based reporting via the move to remote consulting, as research suggests telephone and video consultations result in fewer problems being identified than face-to-face consultations. 17 Lockdown could also have influenced patients to only contact primary-care if they thought their problem was serious, which is likely reflected in the reduced proportion of patients consulting found in our study. Early in the pandemic, GPs predicted patients with well-recognised red-flag symptoms, such as a new lump or rectal bleeding, would continue to present to primary-care, but vaguer cancer symptoms such as fatigue, change in bowel habit, and weight loss might be dismissed by patients as trivial and not presented to primary-care. 7 This was supported by our findings, which show that common symptoms reduced more substantially than less common ones, and reporting of indicators such as weight loss and lumps were maintained. Many of the more common symptoms (such as chest infections and sore throats) will be attributable to causes such as viral infections, rather than cancer. This is likely the reason for the larger reduction of indicators observed in children, as the closure of schools and nurseries will have reduced the infection rate for viral illnesses. A recent survey from Cancer Research UK suggested GPs are particularly worried about older people not consulting with potential cancer symptoms compared to before the pandemic. 6 This was partly supported by our findings; among adults, we noted the largest drop in 50 to 84-year olds, but patients aged 85+ had less of a reduction than this group, perhaps indicating the success of increased focus on this groups by GPs during the pandemic. 4 In 2015-2017, over 50% of cancers were in people aged 70+ but only 0.2% in children aged 0-4, 18 so GPs concerns being focused on the older age groups is not surprising. Implications for policy and practice Findings suggest that patients are less likely to report potential cancer indicators than before the COVID-19 pandemic, particularly for more common symptoms such as fever and coughs. In the context of repeated lockdowns, it is therefore important that the general-public (particularly men and adults aged 50-84) are advised to still consult with primary-care for persistent symptoms. Further, GPs and nurses should be encouraged to ask more probing questions during remote consulting, as they could miss symptoms which may have previously been picked up from non-verbal cues and possibly a more open discussion face-to-face. Declarations Acknowledgements : The authors would like to thank all the participants in this study, Bristol North Somerset and South Gloucestershire Clinical Commissioning Group, One Care for providing the data extract, the NIHR Clinical Research Network for adopting the study on the NIHR portfolio, and the NIHR SPCR for funding the research. We would also like to thank Willie Hamilton for his work on developing the potential cancer indicator lists (alongside author Sarah Price). Funding : This study was funded by the National Institute for Health Research (NIHR) School for Primary Care Research. Additional funding for staff time was provided by the Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust and One Care. Professor Salisbury is a National Institute for Health Research (NIHR) Senior Investigator. The funder had no role in the study design, collection and analysis of data, or the writing of the manuscript. The views expressed are those of the authors and not necessarily those of, the NIHR or the Department of Health and Social Care. Ethical approval : This study received ethical approval from the University of Bristol Faculty of Health Sciences Research Ethics Committee (ID 103166), and Health Research Authority approval (IRAS project ID 282541; REC reference 20/HRA/2070). The study was sponsored by the University of Bristol. Competing interests : The authors declare that they have no competing interests Data sharing: Potential cancer indicator codes lists are available from the authors on request. Transparency statement: All authors affirm that the manuscript is an honest, accurate, and transparent account of the study being reported, that no important aspects of the study have been omitted, and that any discrepancies from the study as originally planned have been explained. Dissemination declaration: Results will not be disseminated to study participants as they were not directly involved or consented into the study and it would therefore not be appropriate. Contributions of authors : LS, MM, RD, JH, and CS contributed to the conception and design of the study, SP provided the potential cancer indicator code lists and interpretation of these, RL extracted the data, MM lead the project administration, and LS performed the analysis and drafted the manuscript. All authors contributed to the organisation and conduct of the study, the interpretation of study data and results, and critiqued the manuscript for important intellectual content. References WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020 [press release]. 2020. Care DoHaS. Coronavirus: stay at home, protect the NHS, save lives - web version 2020 [Available from: https://www.gov.uk/government/publications/coronavirus-covid-19-information-leaflet/coronavirus-stay-at-home-protect-the-nhs-save-lives-web-version . Andrea D. GPs urged to go digital to prevent spread of coronavirus 2020 [updated 2020/10/03/. Available from: https://www.digitalhealth.net/2020/03/gps-urged-to-go-digital-to-prevent-spread-of-coronavirus/ . Murphy M, Scott LJ, Salisbury C, et al. The implementation of remote consulting in UK primary care following the COVID-19 pandemic: a mixed-methods longitudinal study. Research Square- PRE-PRINT. 2020. Royal College of General Practitioners. Research and Surveillance Centre workload observatory 2020 [Available from: https://clininf.eu/index.php/rcgprscworkloadobservatory/ . GPs say elderly are not seeking help for potential cancer symptoms [press release]. 23/10/2020 2020. Jones D, Neal RD, Duffy SRG, Scott SE, Whitaker KL, Brain K. Impact of the COVID-19 pandemic on the symptomatic diagnosis of cancer: the view from primary care. Lancet Oncol. 2020;21(6):748-50. Richards M, Anderson M, Carter P, Ebert BL, Mossialos E. The impact of the COVID-19 pandemic on cancer care. Nat Cancer. 2020:1-3. Neal RD, Tharmanathan P, France B, et al. Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review. Br J Cancer. 2015;112 Suppl 1:S92-107. Price S, Spencer A, Zhang X, et al. Trends in time to cancer diagnosis around the period of changing national guidance on referral of symptomatic patients: A serial cross-sectional study using UK electronic healthcare records from 2006-17. Cancer Epidemiol. 2020;69:101805. Watson J, Nicholson BD, Hamilton W, Price S. Identifying clinical features in primary care electronic health record studies: methods for codelist development. BMJ Open. 2017;7(11):e019637. National Institute for Health and Care Excellence. Suspected cancer: recognition and referral. NICE guideline [NG12]. 2020. NHS Digital. Quality and Outcomes Framework (QOF) business rules v42 2019-2020 baseline release. 2019/2020. NHS Digital. Patients Registered at a GP Practice 2019-2020 [Available from: https://digital.nhs.uk/data-and-information/publications/statistical/patients-registered-at-a-gp-practice . Price SJ, Stapley SA, Shephard E, Barraclough K, Hamilton WT. Is omission of free text records a possible source of data loss and bias in Clinical Practice Research Datalink studies? A case-control study. BMJ Open. 2016;6(5):e011664. Williams R, Jenkins DA, Ashcroft DM, et al. Diagnosis of physical and mental health conditions in primary care during the COVID-19 pandemic: a retrospective cohort study. Lancet Public Health. 2020;5(10):e543-e50. Hammersley V, Donaghy E, Parker R, et al. Comparing the content and quality of video, telephone, and face-to-face consultations: a non-randomised, quasi-experimental, exploratory study in UK primary care. Br J Gen Pract. 2019;69(686):e595-e604. Cancer Research UK. Cancer incidence by age; 2015-2017 2017 [Available from: https://www.cancerresearchuk.org/health-professional/cancer-statistics/incidence/age#heading-Zero . Tables Table 1: Characteristics of registered and consulting patients in participating practices All patients registered in July 2020 (N=350,966) Patients consulting in April-July 2019 (N=152,447) Patients consulting in April-July 2020 (N=123,775) n % n % n % Age 0-4 years 18,685 5.3% 8,511 5.6% 7,669 6.2% 5-17 years 46,822 13.3% 13,796 9.0% 8,549 6.9% 18-49 years 158,993 45.3% 60,886 39.9% 51,243 41.4% 50-69 years 77,952 22.2% 38,595 25.3% 30,963 25.0% 70-84 years 35,875 10.2% 23,461 15.4% 19,109 15.4% 85+ years 12,639 3.6% 7,198 4.7% 6,242 5.0% Sex Male 175,952 50.1% 63,905 41.9% 50,539 40.8% Female 175,009 49.9% 88,539 58.1% 73,233 59.2% Missing 5 3 3 IMD quintile 1 (most deprived) 71,378 20.4% 31,263 20.6% 26,124 21.2% 2 55,002 15.7% 22,760 15.0% 19,007 15.4% 3 53,129 15.2% 22,920 15.1% 18,365 14.9% 4 73,119 20.9% 31,603 20.8% 25,510 20.7% 5 (least deprived) 96,608 27.7% 43,274 28.5% 34,263 27.8% Missing 1,730 627 506 Ethnicity* White 228,624 88.2% 104,309 89.2% 85,064 89.3% Asian 11,774 4.5% 4,703 4.0% 3,760 3.9% Black 12,234 4.7% 5,354 4.6% 4,300 4.5% Mixed 5,368 2.1% 2,146 1.8% 1,781 1.9% Other 1,210 0.5% 392 0.3% 352 0.4% Missing 91,756 35,543 28,518 Mental health (MH) status No MH conditions 318,329 90.7% 129,744 85.1% 102,015 82.4% 1+ MH condition 32,637 9.3% 22,703 14.9% 21,760 17.6% Shielding status Not advised to shield 337,758 96.2% 142,476 93.5% 113,343 91.6% Advised to shield 13,208 3.8% 9,971 6.5% 10,432 8.4% *White includes British, white British, mixed British, and other white background. Black includes African, Caribbean, Somali and black British. Asian includes Indian, British Indian, Pakistani, Chinese, and other Asian background. Mixed includes white and black Caribbean, white and Asian, white and African, other mixed white, and other mixed background. Other includes, Turkish, Arab, Iranian, other ethnic non-mixed, and any other group. See appendix 1 for further details. Table 2: Patients with any potential cancer indicator reported in April-July 2020 compared to 2019 April-July 2019 (n=344,184) April-July 2020 (n=350,966) Change in proportion of patients with potential cancer indicators (2020 vs. 2019) n % a n % a IRR 95% CI p-value Overall 44,662 13% 29,150 8% 0.65 0.62 to 0.68 <0.001 By Age <0.001 b 0-4 years 2,393 13% 1,199 6% 0.50 0.46 to 0.55 <0.001 5-17 years 3,486 8% 1,595 3% 0.45 0.41 to 0.49 <0.001 18-49 years 17,531 11% 12,527 8% 0.71 0.67 to 0.76 <0.001 50-69 years 11,615 15% 7,451 10% 0.64 0.60 to 0.68 <0.001 70-84 years 7,396 21% 4,779 13% 0.64 0.59 to 0.69 <0.001 85+ years 2,241 18% 1,599 13% 0.69 0.63 to 0.76 <0.001 By Sex 0.003 b Male 18,019 10% 11,072 6% 0.61 0.58 to 0.64 <0.001 Female 26,643 16% 18,078 10% 0.68 0.64 to 0.71 <0.001 By Ethnicity c 0.956 b White 30,354 14% 20,051 9% Asian 1,782 15% 1,147 10% Black 2,002 17% 1,363 11% Mixed 629 12% 401 7% Other 141 12% 94 8% By IMD quintile 0.955 b 1 (most deprived) 10,314 15% 6,943 10% 2 7,088 13% 4,701 9% 3 6,628 13% 4,303 8% 4 9,247 13% 5,965 8% 5 (least deprived) 11,168 12% 7,091 7% By Mental health status <0.001 b No MH conditions 37,354 12% 23,603 7% 0.63 0.60 to 0.65 <0.001 1+ MH condition 7,308 23% 5,547 17% 0.75 0.72 to 0.79 <0.001 By Shielding status 0.090 b Not advised to shield 40,661 12% 26,376 8% Advised to shield 4,001 31% 2,774 21% IRR=incidence rate ratio. CI=Confidence interval. MH=Mental health. IRRs and corresponding 95% CIs and p-values are from negative binomial models. a Percentages are calculated out of all patients in each category. b P-values presented on the blue rows are the p-values for the interaction between year and the given characteristic; incidence rate ratios only presented by each level of a characteristic if this p<0.05. c White includes British, white British, mixed British, and other white background. Black includes African, Caribbean, Somali and black British. Asian includes Indian, British Indian, Pakistani, Chinese, and other Asian background. Mixed includes white and black Caribbean, white and Asian, white and African, other mixed white, and other mixed background. Other includes, Turkish, Arab, Iranian, other ethnic non-mixed, and any other group. See appendix 1 for further details. Table 3: Consultations (per 1000 patients) with potential cancer indicators reported in April-July 2020 compared to 2019 April-July 2019 April-July 2020 Change in rates of consultations with potential cancer indicators (2020 vs. 2019) GP CONSULTATIONS n % a n % a IRR 95% CI p-value Overall 171.5 19% 128.3 16% 0.81 0.77 to 0.86 <0.001 By consultation provision <0.001 b Face-to-face 134.2 22% 19.1 18% 0.88 0.80 to 0.97 0.011 Remote 37.3 14% 109.2 15% 1.22 1.11 to 1.34 <0.001 NURSE/PARAMEDIC CONSULTATIONS n % n % IRR 95% CI p-value Overall 36.7 10% 20.9 7% 0.72 0.57 to 0.92 0.007 By consultation provision <0.001 b Face-to-face 34.4 10% 10.2 6% 0.61 0.44 to 0.84 0.002 Remote 2.3 8% 10.7 9% 1.67 1.16 to 2.42 0.006 IRR=incidence rate ratio. CI=Confidence interval. IRRs and corresponding 95% CIs and p-values from negative binomial models. a Percentages are calculated out of all consultations in each category. b P-values presented on the blue rows are the p-values for the interaction between year and consultation provision. Table 4: Patients with individual potential cancer indicator reported in April-July 2020 compared to 2019 April-July 2019 (N=344,184) April-July 2020 (N=350,966) n % n % IRR Any potential cancer indicator 44,662 12.98% 29,150 8.31% 0.64 Most commonly reported indicators (≥0.5% of patients in 2019) Any commonly reported indicator 32,705 9.50% 19,270 5.49% 0.58 Chest infection 2,188 0.64% 502 0.14% 0.22 Fever 3,193 0.93% 988 0.28% 0.30 Pain in throat (e.g. tonsilitis) 1,861 0.54% 768 0.22% 0.40 Cough 5,722 1.66% 2,547 0.73% 0.44 Fatigue 2,865 0.83% 1,424 0.41% 0.49 Diarrhoea 2,204 0.64% 1,225 0.35% 0.55 Pain in shoulder 1,987 0.58% 1,222 0.35% 0.60 Pain in abdomen 4,704 1.37% 3,192 0.91% 0.67 Back pain/backache 5,107 1.48% 3,599 1.03% 0.69 Lower urinary tract symptoms 2,184 0.63% 1,660 0.47% 0.75 Shortness of breath 2,822 0.82% 2,155 0.61% 0.75 Pain in chest 2,147 0.62% 1,662 0.47% 0.76 Gynaecological abnormalities (e.g. menstrual disorders) 1,823 0.53% 1,535 0.44% 0.83 Less commonly reported indicators (0.1% - <0.5% of patients in 2019) Any less commonly reported indicator 16,556 4.81% 12,332 3.51% 0.73 Lymphadenopathy 572 0.17% 206 0.06% 0.35 Vomiting 1,149 0.33% 489 0.14% 0.42 Erectile dysfunction 482 0.14% 208 0.06% 0.42 Urinary tract infection 1,230 0.36% 610 0.17% 0.49 Bruising 368 0.11% 205 0.06% 0.55 Irritable Bowel Syndrome 580 0.17% 336 0.10% 0.57 Iron deficiency/anaemia 772 0.22% 455 0.13% 0.58 Non-visible haematuria 1,518 0.44% 927 0.26% 0.60 Change in bowel habit 346 0.10% 218 0.06% 0.62 Proteinuria 1,072 0.31% 687 0.20% 0.63 Mass in neck 400 0.12% 257 0.07% 0.63 Haematuria 1,401 0.41% 904 0.26% 0.63 Pain in breast 478 0.14% 320 0.09% 0.66 Pruritus 651 0.19% 488 0.14% 0.74 Dysuria 474 0.14% 362 0.10% 0.75 Compressed trachea 1,156 0.34% 903 0.26% 0.77 Pain in pelvis 963 0.28% 770 0.22% 0.78 Dyspepsia 1,068 0.31% 858 0.24% 0.79 Recurring infections 562 0.16% 463 0.13% 0.81 Nausea 380 0.11% 324 0.09% 0.84 Rectal bleeding 744 0.22% 656 0.19% 0.86 Reflux 1,128 0.33% 1,020 0.29% 0.89 Lump in breast 697 0.20% 639 0.18% 0.90 Lump (excluding breast) 1,014 0.29% 1,012 0.29% 0.98 Vaginal discharge 754 0.22% 781 0.22% 1.02 Constipation 1,254 0.36% 1,351 0.38% 1.06 Rarely reported indicators (0.02% - <0.1% of patients in 2019) Any rarely reported indicator 2,575 0.75% 2,052 0.58% 0.78 Night sweats 133 0.04% 65 0.02% 0.48 Hoarseness of voice 163 0.05% 87 0.02% 0.52 Haemoptysis 94 0.03% 51 0.01% 0.53 Pain in testis 251 0.07% 170 0.05% 0.66 Pain in bones 213 0.06% 147 0.04% 0.68 Prostate specific antigen raised/abnormal 175 0.05% 123 0.04% 0.69 Postmenopausal bleeding 147 0.04% 106 0.03% 0.71 Distension of abdomen 292 0.08% 232 0.07% 0.78 Dysphagia 277 0.08% 222 0.06% 0.79 Mass in testis 247 0.07% 209 0.06% 0.83 Weight loss 314 0.09% 304 0.09% 0.95 Superior vena cava syndrome 81 0.02% 90 0.03% 1.09 Appetite loss 115 0.03% 130 0.04% 1.11 Mass in abdomen 111 0.03% 161 0.05% 1.42 Very rarely reported indicators (<0.02% of patients in 2019) Any very rarely reported indicator* 458 0.13% 342 0.10% 0.73 IRR=Incidence rate ratio. Note. Indicators are ordered from largest to smallest reduction (by IRR) within each commonality grouping. These figures only include indicators coded in routinely collected records using SNOMED codes. In some cases, GPs/nurses may enter symptoms in free text, and/or only code their diagnosis, which may lead to under-reporting here; this under-recording is likely to be similar in both years. * Very rare indicators affecting <0.02% of patients (69 individuals) in April-July 2019 included Limp/ gait abnormalities, Testis swelling/abnormalities, Haematemesis, Possible bone and soft tissue sarcoma symptoms (e.g. abnormal x-ray), Mass in thyroid, Nipple discharge, Abnormal chest x-ray, Chest/breathing abnormalities, Ulceration of vulva, Jaundice and 20 additional indicators with incidence < 20 patients in April-July 2019. Supplementary Files Appendix1.docx Appendix 1: Data rules Cite Share Download PDF Status: Published Journal Publication published 12 Dec, 2020 Read the published version in BMJ Open → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-123337","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":5967678,"identity":"99fcd2db-9104-4fe5-a05e-d238906a439d","order_by":0,"name":"Lauren J Scott","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABD0lEQVRIie2RsUoDQRCGZzk4m02uXUG8V1g5EATNvsoeB1axSmtx4WBTxbRe5SsINleOHJzNim8gAcHK4tIIKQxOomlCNqa02K+Y2Sk+5h8WwOP5h8jfrlZ1lgOnxnA18d1KmkPAhuVSCQH2UjSQUnRyev6pHNjTdlaBjkaTp7eL6vUovisQ4boH0uJ2hfeTsrSghK1ZcWUHXDahRmgykM+5I1g/CToG2L3ISDGay5BLhBBBvjiCRR9J8LVWzkiJzVJZ7FAEbWFrhZECDSnMoDuYeB+wsRHpra1PyrGlYM2lxvQm44eO89Uke4C5OVfRaDht55VWcVE/TtvP3nHX6u3JfhAbs3b+isfj8Xj24RsUJ1pB4rYGnAAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0003-3129-5123","institution":"University of Bristol","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Lauren","middleName":"J","lastName":"Scott","suffix":""},{"id":5967679,"identity":"00aaf101-555d-4821-9050-a8cd0fbde2e7","order_by":1,"name":"Mairead Murphy","email":"","orcid":"https://orcid.org/0000-0002-3550-2727","institution":"University of Bristol","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mairead","middleName":"","lastName":"Murphy","suffix":""},{"id":5967680,"identity":"b76bb678-23db-4576-8992-bdcccc2056ba","order_by":2,"name":"Sarah Price","email":"","orcid":"","institution":"University of Exeter","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Sarah","middleName":"","lastName":"Price","suffix":""},{"id":5967681,"identity":"d8e6bd7d-5b35-495e-a966-7fa705da7e4b","order_by":3,"name":"Rhys Lewis","email":"","orcid":"","institution":"One Care","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Rhys","middleName":"","lastName":"Lewis","suffix":""},{"id":5967682,"identity":"41fd75b7-07e0-43c1-96b1-dd754a5f75cd","order_by":4,"name":"Rachel Denholm","email":"","orcid":"https://orcid.org/0000-0002-8067-5440","institution":"University of Bristol","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Rachel","middleName":"","lastName":"Denholm","suffix":""},{"id":5967683,"identity":"dbe9dc15-4893-431b-a1da-d9926b6334f2","order_by":5,"name":"Jeremy Horwood","email":"","orcid":"https://orcid.org/0000-0001-7092-4960","institution":"University of Bristol","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jeremy","middleName":"","lastName":"Horwood","suffix":""},{"id":5967684,"identity":"cb0dede5-974e-4839-b3dc-429f6863337c","order_by":6,"name":"Chris Salisbury","email":"","orcid":"https://orcid.org/0000-0002-4378-3960","institution":"University of Bristol","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Chris","middleName":"","lastName":"Salisbury","suffix":""}],"badges":[],"createdAt":"2020-12-07 10:01:22","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":true,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false,"coiExplicitlySet":false},"doi":"10.21203/rs.3.rs-123337/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-123337/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1136/bmjopen-2021-050131","type":"published","date":"2020-12-12T18:11:54+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":4212335,"identity":"b292b8fd-fd0b-487b-8960-980f11b57695","added_by":"auto","created_at":"2020-12-12 00:13:28","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":84280,"visible":true,"origin":"","legend":"Percentage of patients who consulted per month and the percentage of patients who reported potential cancer indicators within a consultation","description":"","filename":"Figure1Patientsovertime.jpg","url":"https://assets-eu.researchsquare.com/files/rs-123337/v1/a20ff1a54abe08cdf5672d10.jpg"},{"id":4212336,"identity":"3b2726ef-bc38-461d-96f3-73514028a351","added_by":"auto","created_at":"2020-12-12 00:13:28","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":97246,"visible":true,"origin":"","legend":"Consultations (per 1,000 patients) per month and the percentage of these consultations where potential cancer indicators were reported","description":"","filename":"Figure2Consultationsovertime.jpg","url":"https://assets-eu.researchsquare.com/files/rs-123337/v1/cde0aa7b6d7a194aa47bff4c.jpg"},{"id":23197011,"identity":"796b4c12-fc0d-41b3-906e-47548f121acc","added_by":"auto","created_at":"2022-06-28 18:12:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":515157,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-123337/v1/96f864aa-f4ce-4ebb-be40-b8ab14ca185f.pdf"},{"id":4212334,"identity":"3c2399e8-8352-42e4-93e0-81b380448acb","added_by":"auto","created_at":"2020-12-12 00:13:28","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":28482,"visible":true,"origin":"","legend":"Appendix 1: Data rules","description":"","filename":"Appendix1.docx","url":"https://assets-eu.researchsquare.com/files/rs-123337/v1/dd62950c0f7fb33c40a8e80f.docx"}],"financialInterests":"","formattedTitle":"\u003cp\u003eChanges in potential cancer indicator reporting in primary-care during the COVID-19 pandemic\u003c/p\u003e","fulltext":[{"header":"Significance ","content":"\u003cp\u003e\u003cstrong\u003eWhat is already known\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003ePrimary-care consultations reduced during UK lockdown in first-wave of the COVID-19 pandemic, and most consultations were provided remotely rather than face-to-face.\u003c/li\u003e\n\u003cli\u003eGPs perceive that the pandemic has resulted in fewer patients consulting with potential cancer symptoms.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWhat this study adds\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003eThe proportion of patients presenting with symptoms, signs, test results or diagnoses which could indicate cancer reduced during the COVID-19 pandemic, compared to the same period last year.\u003c/li\u003e\n\u003cli\u003eThe reduction was particularly evident in children (which might indicate reductions in consultations about viral illness) and males, and less so in patients with mental health conditions.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eIn March 2020, the World Health Organisation declared COVID-19 a pandemic\u003csup\u003e1\u003c/sup\u003e and the UK went into lockdown; the public were instructed to \u0026ldquo;Stay at home, protect the NHS, and save lives\u0026rdquo;.\u003csup\u003e2\u003c/sup\u003e In order to reduce contact and the spread of the virus, primary-care providers were advised to provide all consultations remotely, unless a face-to-face consultation was urgently required.\u003csup\u003e3\u003c/sup\u003e Patients at high risk of severe COVID-19 due to age or pre-existing health conditions were advised to \u0026lsquo;shield\u0026rsquo; and avoid all but essential contact.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGP and nurse consulting rates markedly dropped in April-May 2020 during the period of UK lockdown, but had largely returned to normal by July 2020,\u003csup\u003e4\u003c/sup\u003e with the majority of consultations carried out remotely (mostly via telephone). Further, there was a reduction in weekly reported incidence of asthma, intestinal infectious diseases, and upper and acute respiratory tract infections from the start of lockdown.\u003csup\u003e5\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThere are fears that reduced consulting during the lockdown period and changes in consultation provision may have adversely impacted on cancer detection.\u003csup\u003e6\u003c/sup\u003e A Cancer Research UK survey suggested GPs perceive they are receiving fewer reports of cancer symptoms, particularly from older people, than before the pandemic.\u003csup\u003e6\u003c/sup\u003e Coupled with the temporary suspension of cancer screening services,\u003csup\u003e7,8\u003c/sup\u003e reduced symptom reporting could result in late diagnoses, increased workload for cancer services, and poorer patient outcomes.\u003csup\u003e9\u003c/sup\u003e \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAims: To investigate how the COVID-19 pandemic affected the number of people presenting to primary-care with symptoms, signs, test results or diagnoses which could potentially indicate cancer, and to explore how this reporting differed by patient characteristics and in face-to-face vs. remote consultations.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003eDesign and setting\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA retrospective cohort study in 21 primary-care practices in South-West England. Data were extracted for the RAPCI Study (Rapid COVID-19 intelligence to improve primary-care response), a mixed-methods study on the rapid change to remote consulting in the initial months of the pandemic; primary results are reported elsewhere.\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eRoutinely collected and anonymised data were provided by One Care, the GP federation in Bristol, North Somerset, and South Gloucestershire. All practices use the EMIS electronic medical records system. Data included demographics (age, sex, ethnicity, and deprivation), clinical characteristics (mental health and shielding status), and all consultations and clinical codes associated with consultations, added to the system by clinical staff between February 2019 and July 2020 inclusive. All patients registered in July 2020 were included. For the analyses, April-July 2020 (i.e. the period following UK lockdown) was compared to April-July 2019.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsultations\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eConsultations were defined as an interaction between a patient and a GP, nurse, or paramedic working in general practice. Consultations recorded by administrators or other health care professionals, and any administrative tasks, were excluded. Remote consultations were those completed by telephone, video, or e-consultation; face-to-face consultations were in GP practices or visits to patients\u0026rsquo; homes (see appendix 1).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eOutcomes\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePre-existing code lists\u003csup\u003e10,11\u003c/sup\u003e were used to identify potential cancer indicators associated with a consultation. Indicators were collated from clinical features of undiagnosed cancer (symptoms, signs, abnormal test results or diagnoses) listed in the National Institute for Health and Care Excellence guidance on the recognition and referral of suspected cancer (NG12)\u003csup\u003e12\u003c/sup\u003e, using robust methods\u003csup\u003e11\u003c/sup\u003e (see appendix 1).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIndividual potential cancer indicator were categorised by the percentage of patients reporting them in April-July 2019: most commonly (\u0026ge;0.5%), less commonly (0.1% to \u0026lt;0.5%), rarely (0.02% to \u0026lt;0.1%), and very rarely reported (\u0026lt;0.02%). We separate these because the most commonly reported indicators include symptoms which often indicate minor illness rather than cancer (e.g. cough), whereas the less commonly/rarely reported indicators were more likely to be associated with cancer (e.g. weight loss, lumps and masses).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eExplanatory variables\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAge (in July 2020) was categorised: 0-4, 5-17, 18-49, 50-69, 70-84, and 85+ years old. Deprivation quintiles were calculated using index of multiple deprivation score (IMD) deciles recorded in patient records, based on Lower Super Output Areas of residence. Ethnicity was derived by mapping descriptions from primary-care records to five categories: white, Asian, black, mixed, and other (see appendix 1). Presence of a mental health condition included severe mental illness (defined according to the Quality and Outcomes Framework rules\u003csup\u003e13\u003c/sup\u003e), diagnosed depression, or prescribed anti-depressants (excluding tricyclics) in the three months prior to July 2020. Sex and shielding status (as of July 2020) were obtained directly from primary-care records.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStatistical analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNumber and percentages of patients reporting potential cancer indicators are presented. Further, consultation rates (and percentages with indicators) are reported per 1,000 registered patients. Practice list sizes were based on July 2020 data, and adjusted to account for historic list sizes using NHS digital data\u003csup\u003e14\u003c/sup\u003e (\u0026lsquo;adjusted list size\u0026rsquo;; see appendix 1).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eChanges in proportions of patients presenting (per practice) with any potential cancer indicator in April-July 2020 compared to April-July 2019 were investigated using negative binomial regression models; incidence rate ratios (IRRs) and 95% confidence intervals (CIs) are reported. Consultation year was fitted as a fixed effect, GP practice as a random effect, and adjusted practice list size (per level of covariate where appropriate) as the offset. Fixed effects for each categorical variable (age, sex, ethnicity, IMD quintile, mental health status, and shielding status), along with the interaction between each covariate and consultation year, were separately fitted to the model; interaction p-values are presented and results only presented separately for each level of a covariate if p\u0026lt;0.05. Model validity was checked using standard methods; outliers which disrupted model fit were removed.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo investigate consultation provision (i.e. face-to-face vs. remote consulting), we modelled proportions of consultations with potential cancer indicators. Separate models were fitted for GPs and nurses/paramedics consultations. Negative binomial regression models were fitted with number of consultations as the outcome, a fixed effect for consultation provision and an interaction with year, GP practice as a random effect, and total numbers of consultations per practice per level of consultation provision as the offset.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor individual potential cancer indicators, unadjusted IRRs comparing April-July 2020 to 2019 are presented to help interpretation, but due to large numbers of indicators and issues with multiple testing, no modelling was performed.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStata 15.1 was used for all data management and analyses.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDuring April-July 2019, 152,447/344,184 (44%) patients consulted, and 44,662/344,184 (13%) reported a potential cancer indicator. In April-July 2020, 123,775/350,966 (35%) consulted and 29,150/350,966 (8%) reported an indicator. This comprised 1256 consultations per 1000 registered patients (with indicators reported in 17% of consultations) in April-July 2019 and 1118 consultations per 1000 patients (13% with indicators reported) in April-July 2020. Figures 1 and 2 demonstrate that patients consulting, and consultation rates, dramatically dropped in April 2020 (following UK lockdown), and while consultation rates had recovered by July 2020, the proportion of patients who consulted had not. Further, the percentage of patients and consultations reporting potential cancer indicators also dropped in April 2020; both had increased by July 2020, but neither recovered to pre-COVID levels.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatients who consulted in 2020 were of similar sex, IMD and ethnicity to those consulting in 2019, but were more likely to have mental health conditions and be advised to shield. Further, there were proportionally fewer patients aged 5-17 years who consulted in 2020 than in 2019 (Table 1). For further details on consultation rates, see our previous paper.\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatients reporting potential cancer indicators reduced in April-July 2020 compared to 2019 (IRR 0.65, 95% CI 0.62 to 0.68, p\u0026lt;0.001; Table 2). This reduction was stable across ethnicity (interaction p-value=0.956), IMD (p=0.955), and shielding status (p=0.090), but differed by age (p\u0026lt;0.001), sex (p=0.003) and mental health status (p\u0026lt;0.001; Table 2). The reduction was most marked in children (aged 0-4 years IRR 0.50, 95% CI 0.46 to 0.55, p\u0026lt;0.001; aged 5-17 years IRR 0.45, 95% CI 0.41 to 0.49, p\u0026lt;0.001). Among adults, the greatest reduction was in patients aged 50-69 (IRR 0.64, 95C CI 0.60 to 0.68, p\u0026lt;0.001) and 70-84 years (IRR 0.64, 95C CI 0.59 to 0.69, p\u0026lt;0.001). In both years, older patients were more likely to report indicators than younger patients (Table 2). Males had a larger reduction in indicator reporting (0.61, 95% CI 0.58 to 0.64, p\u0026lt;0.001) than females (0.68, 95% CI 0.64 to 0.71, p\u0026lt;0.001; Table 2). The reduction was less pronounced in patients with mental health conditions (IRR 0.75, 95% CI 0.72 to 0.79, p\u0026lt;0.001) than without (IRR 0.63, 95% CI 0.60 to 0.65, p\u0026lt;0.001; Table 2).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePotential cancer indicator reporting differed by consultation provision for both GP and nurse/paramedic consultations (p-values \u0026lt;0.001 and 0.007, respectively; Table 3). Indicator reporting dropped between 2019 and 2020 for face-to-face consultations (GP IRR 0.88, 95% CI 0.80 to 0.97, p=0.011; nurse IRR 0.61, 95% CI 0.44 to 0.84, p=0.002) and increased for remote consultations (GP IRR 1.22, 95% CI 1.11 to 1.34, p\u0026lt;0.001; nurse IRR 1.67, 95% CI 1.16 to 2.42, p=0.006 Table 3). Despite this increase in potential cancer indicator reporting in remote consultations, reporting was still less common than in GP face-to-face consultations in both years (Table 3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eReporting of commonly reported indicators reduced between the two periods (unadjusted IRR=0.58), with the biggest reductions in chest infections (IRR=0.22), fever (IRR=0.30) throat pain (IRR=0.40) coughs (IRR=0.44) and fatigue (IRR=0.49; Table 4). For less commonly and rarely reported indicators, the reductions were less marked (IRR=0.73 and 0.78, respectively). Lymphadenopathy (IRR=0.35), vomiting (IRR=0.42), erectile dysfunction (IRR=0.42), urinary tract infections (IRR=0.49), and night sweats (IRR=0.48) saw the largest reductions in these groups, and indicators which were similar or increased were: breast lumps (IRR=0.9), lumps excluding breast (IRR=0.98), vaginal discharge (IRR=1.02), constipation (IRR=1.06), weight loss (IRR=0.95), superior vena cava syndrome (IRR=1.09), appetite loss (IRR=1.11), and abdomen masses (IRR=1.42; Table 4).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cem\u003eSummary of findings\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn April 2020, following UK lockdown, the proportion of patients consulting, and those reporting potential cancer indicators, reduced substantially compared to April 2019. By July 2020, although consultation rates had returned to previous levels, the proportion of patients consulting, and the proportion reporting potential cancer indicators remained lower than the previous year. The reduction in indicator reporting was particularly evident in children and males, and less evident in patients with mental health conditions. Among adults, the greatest reduction was in patients aged 50-84. Indicator reporting increased in remote consultations in 2020 compared with 2019, and decreased in face-to-face consultations. Despite this, indicator reporting remained higher in GP face-to-face than remote consultations in 2020, suggesting the significant increase in remote consulting during the pandemic could be contributing to the reduced reporting of potential cancer indicators. Of the most commonly reported indicators, chest infections, fever, throat pain, coughs and fatigue reduced most dramatically.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStrengths and limitations\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTo our knowledge, this is the first papers to assess the effect of the COVID-19 pandemic on potential cancer symptom reporting in UK primary-care. The analysis is based on a comprehensive list of potential cancer indicators, used in previous research.\u003csup\u003e10,11\u003c/sup\u003e Our analysis included large numbers of patients (\u0026gt;350,000) from a diverse range of backgrounds, and as changes due to the pandemic have affected the whole country, findings are likely to be generalisable across England. Except for ethnicity, missing patient characteristics data were low. There are several limitations which pertain to the recording of potential cancer indicators. Firstly, some symptoms and signs may have been reported in free text rather than using clinical codes,\u003csup\u003e15\u003c/sup\u003e or may have been recorded in administration notes not associated with consultations. This may have resulted in systematic under-reporting of potential cancer indicators; however, this is likely to be similar in both years so should not affect the comparative findings. A further limitation was that new SNOMED CT codes added since the changeover from Read codes to SNOMED were not in our pre-defined lists, an issue which would affect April-July 2020 but not 2019; however, we checked this for common indicators cough and back pain, and found new codes were rarely used.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eComparison with other literature\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFew other studies have looked at the content of primary-care consultations following UK lockdown. One analysis of primary-care data from a deprived urban population, found that diagnoses of common conditions decreased substantially between March and May 2020, suggesting patients may have undiagnosed conditions resulting from changes in access post-lockdown.\u003csup\u003e16\u003c/sup\u003e Further, data from the Royal College of General Practitioners research and surveillance centre showed a marked reduction in weekly reported incidence of asthma, intestinal infectious diseases, and upper and acute respiratory tract infections from week 12 of 2020.\u003csup\u003e5\u003c/sup\u003e Our study adds to these findings for cancer-specific indicators.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCancer screening programmes, estimated to account for about 5% of cancer diagnoses, were suspended in the wake of the pandemic,\u003csup\u003e7\u003c/sup\u003e making symptom-based diagnosis more important. UK lockdown could have affected symptom-based reporting via the move to remote consulting, as research suggests telephone and video consultations result in fewer problems being identified than face-to-face consultations.\u003csup\u003e17\u003c/sup\u003e Lockdown could also have influenced patients to only contact primary-care if they thought their problem was serious, which is likely reflected in the reduced proportion of patients consulting found in our study.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEarly in the pandemic, GPs predicted patients with well-recognised red-flag symptoms, such as a new lump or rectal bleeding, would continue to present to primary-care, but vaguer cancer symptoms such as fatigue, change in bowel habit, and weight loss might be dismissed by patients as trivial and not presented to primary-care.\u003csup\u003e7\u003c/sup\u003e This was supported by our findings, which show that common symptoms reduced more substantially than less common ones, and reporting of indicators such as weight loss and lumps were maintained. Many of the more common symptoms (such as chest infections and sore throats) will be attributable to causes such as viral infections, rather than cancer. This is likely the reason for the larger reduction of indicators observed in children, as the closure of schools and nurseries will have reduced the infection rate for viral illnesses. A recent survey from Cancer Research UK suggested GPs are particularly worried about older people not consulting with potential cancer symptoms compared to before the pandemic.\u003csup\u003e6\u003c/sup\u003e This was partly supported by our findings; among adults, we noted the largest drop in 50 to 84-year olds, but patients aged 85+ had less of a reduction than this group, perhaps indicating the success of increased focus on this groups by GPs during the pandemic.\u003csup\u003e4\u003c/sup\u003e In 2015-2017, over 50% of cancers were in people aged 70+ but only 0.2% in children aged 0-4,\u003csup\u003e18\u003c/sup\u003e so GPs concerns being focused on the older age groups is not surprising.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eImplications for policy and practice\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFindings suggest that patients are less likely to report potential cancer indicators than before the COVID-19 pandemic, particularly for more common symptoms such as fever and coughs. In the context of repeated lockdowns, it is therefore important that the general-public (particularly men and adults aged 50-84) are advised to still consult with primary-care for persistent symptoms. Further, GPs and nurses should be encouraged to ask more probing questions during remote consulting, as they could miss symptoms which may have previously been picked up from non-verbal cues and possibly a more open discussion face-to-face. \u003cstrong\u003e\u003cbr /\u003e \u003c/strong\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e: The authors would like to thank all the participants in this study, Bristol North Somerset and South Gloucestershire Clinical Commissioning Group, One Care for providing the data extract, the NIHR Clinical Research Network for adopting the study on the NIHR portfolio, and the NIHR SPCR for funding the research.\u0026nbsp;We would also like to thank\u0026nbsp;Willie Hamilton for his work on developing the potential cancer indicator lists (alongside author Sarah Price).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: This study was funded by the National Institute for Health Research (NIHR) School for Primary Care Research. Additional funding for staff time was provided by the Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust and One Care. Professor Salisbury is a National Institute for Health Research (NIHR) Senior Investigator. The funder had no role in the study design, collection and analysis of data, or the writing of the manuscript. The views expressed are those of the authors and not necessarily those of, the NIHR or the Department of Health and Social Care.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e: This study received ethical approval from the University of Bristol Faculty of Health Sciences Research Ethics Committee (ID 103166), and Health Research Authority approval (IRAS project ID 282541; REC reference 20/HRA/2070). The study was sponsored by the University of Bristol.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003ca href=\"http://bjgp.org/authors/bjgp-ethical-guidelines\"\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/a\u003e: The authors declare that they have no competing interests\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData sharing: \u003c/strong\u003ePotential cancer indicator codes lists are available from the authors on request.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTransparency statement:\u003c/strong\u003e All authors affirm that the manuscript is an honest, accurate, and transparent account of the study being reported, that no important aspects of the study have been omitted, and that any discrepancies from the study as originally planned have been explained.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDissemination declaration:\u003c/strong\u003e Results will not be disseminated to study participants as they were not directly involved or consented into the study and it would therefore not be appropriate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions of authors\u003c/strong\u003e: LS, MM, RD, JH, and CS contributed to the conception and design of the study, SP provided the potential cancer indicator code lists and interpretation of these, RL extracted the data, MM lead the project administration, and LS performed the analysis and drafted the manuscript. All authors contributed to the organisation and conduct of the study, the interpretation of study data and results, and critiqued the manuscript for important intellectual content.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020 [press release]. 2020.\u003c/li\u003e\n\u003cli\u003eCare DoHaS. Coronavirus: stay at home, protect the NHS, save lives - web version 2020 [Available from: \u003ca href=\"https://www.gov.uk/government/publications/coronavirus-covid-19-information-leaflet/coronavirus-stay-at-home-protect-the-nhs-save-lives-web-version\"\u003ehttps://www.gov.uk/government/publications/coronavirus-covid-19-information-leaflet/coronavirus-stay-at-home-protect-the-nhs-save-lives-web-version\u003c/a\u003e.\u003c/li\u003e\n\u003cli\u003eAndrea D. GPs urged to go digital to prevent spread of coronavirus 2020 [updated 2020/10/03/. Available from: \u003ca href=\"https://www.digitalhealth.net/2020/03/gps-urged-to-go-digital-to-prevent-spread-of-coronavirus/\"\u003ehttps://www.digitalhealth.net/2020/03/gps-urged-to-go-digital-to-prevent-spread-of-coronavirus/\u003c/a\u003e.\u003c/li\u003e\n\u003cli\u003eMurphy M, Scott LJ, Salisbury C, et al. The implementation of remote consulting in UK primary care following the COVID-19 pandemic: a mixed-methods longitudinal study. Research Square- PRE-PRINT. 2020.\u003c/li\u003e\n\u003cli\u003eRoyal College of General Practitioners. Research and Surveillance Centre workload observatory 2020 [Available from: \u003ca href=\"https://clininf.eu/index.php/rcgprscworkloadobservatory/\"\u003ehttps://clininf.eu/index.php/rcgprscworkloadobservatory/\u003c/a\u003e.\u003c/li\u003e\n\u003cli\u003eGPs say elderly are not seeking help for potential cancer symptoms [press release]. 23/10/2020 2020.\u003c/li\u003e\n\u003cli\u003eJones D, Neal RD, Duffy SRG, Scott SE, Whitaker KL, Brain K. Impact of the COVID-19 pandemic on the symptomatic diagnosis of cancer: the view from primary care. Lancet Oncol. 2020;21(6):748-50.\u003c/li\u003e\n\u003cli\u003eRichards M, Anderson M, Carter P, Ebert BL, Mossialos E. The impact of the COVID-19 pandemic on cancer care. Nat Cancer. 2020:1-3.\u003c/li\u003e\n\u003cli\u003eNeal RD, Tharmanathan P, France B, et al. Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review. Br J Cancer. 2015;112 Suppl 1:S92-107.\u003c/li\u003e\n\u003cli\u003ePrice S, Spencer A, Zhang X, et al. Trends in time to cancer diagnosis around the period of changing national guidance on referral of symptomatic patients: A serial cross-sectional study using UK electronic healthcare records from 2006-17. Cancer Epidemiol. 2020;69:101805.\u003c/li\u003e\n\u003cli\u003eWatson J, Nicholson BD, Hamilton W, Price S. Identifying clinical features in primary care electronic health record studies: methods for codelist development. BMJ Open. 2017;7(11):e019637.\u003c/li\u003e\n\u003cli\u003eNational Institute for Health and Care Excellence. Suspected cancer: recognition and referral. NICE guideline [NG12]. 2020.\u003c/li\u003e\n\u003cli\u003eNHS Digital. Quality and Outcomes Framework (QOF) business rules v42 2019-2020 baseline release. 2019/2020.\u003c/li\u003e\n\u003cli\u003eNHS Digital. Patients Registered at a GP Practice 2019-2020 [Available from: \u003ca href=\"https://digital.nhs.uk/data-and-information/publications/statistical/patients-registered-at-a-gp-practice\"\u003ehttps://digital.nhs.uk/data-and-information/publications/statistical/patients-registered-at-a-gp-practice\u003c/a\u003e.\u003c/li\u003e\n\u003cli\u003ePrice SJ, Stapley SA, Shephard E, Barraclough K, Hamilton WT. Is omission of free text records a possible source of data loss and bias in Clinical Practice Research Datalink studies? A case-control study. BMJ Open. 2016;6(5):e011664.\u003c/li\u003e\n\u003cli\u003eWilliams R, Jenkins DA, Ashcroft DM, et al. Diagnosis of physical and mental health conditions in primary care during the COVID-19 pandemic: a retrospective cohort study. Lancet Public Health. 2020;5(10):e543-e50.\u003c/li\u003e\n\u003cli\u003eHammersley V, Donaghy E, Parker R, et al. Comparing the content and quality of video, telephone, and face-to-face consultations: a non-randomised, quasi-experimental, exploratory study in UK primary care. Br J Gen Pract. 2019;69(686):e595-e604.\u003c/li\u003e\n\u003cli\u003eCancer Research UK. Cancer incidence by age; 2015-2017 2017 [Available from: \u003ca href=\"https://www.cancerresearchuk.org/health-professional/cancer-statistics/incidence/age#heading-Zero\"\u003ehttps://www.cancerresearchuk.org/health-professional/cancer-statistics/incidence/age#heading-Zero\u003c/a\u003e.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1: Characteristics of registered and consulting patients in participating practices\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"32\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"140\"\u003e\n\u003cp\u003e\u003cstrong\u003eAll patients registered in July 2020\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(N=350,966)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"142\"\u003e\n\u003cp\u003e\u003cstrong\u003ePatients consulting in April-July 2019\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(N=152,447)\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"149\"\u003e\n\u003cp\u003e\u003cstrong\u003ePatients consulting in April-July 2020\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(N=123,775)\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"32\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"170\"\u003e\n\u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"32\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e0-4 years\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e18,685\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e5.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e8,511\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e5.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e7,669\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e6.2%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"32\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e5-17 years\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e46,822\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e13.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e13,796\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e9.0%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e8,549\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e6.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"32\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e18-49 years\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e158,993\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e45.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e60,886\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e39.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e51,243\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e41.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"32\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e50-69 years\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e77,952\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e22.2%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e38,595\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e25.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e30,963\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e25.0%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"32\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e70-84 years\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e35,875\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e10.2%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e23,461\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e15.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e19,109\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e15.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"32\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e85+ years\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e12,639\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e3.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e7,198\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e4.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e6,242\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e5.0%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"170\"\u003e\n\u003cp\u003eSex\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"32\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e175,952\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e50.1%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e63,905\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e41.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e50,539\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e40.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"32\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e175,009\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e49.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e88,539\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e58.1%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e73,233\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e59.2%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"32\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e\u003cem\u003eMissing\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u003cem\u003e5\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u003cem\u003e3\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e\u003cem\u003e3\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"170\"\u003e\n\u003cp\u003eIMD quintile\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"32\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e1 (most deprived)\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e71,378\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e20.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e31,263\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e20.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e26,124\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e21.2%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"32\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e2\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e55,002\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e15.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e22,760\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e15.0%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e19,007\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e15.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"32\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e3\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e53,129\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e15.2%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e22,920\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e15.1%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e18,365\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e14.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"32\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e4\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e73,119\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e20.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e31,603\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e20.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e25,510\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e20.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"32\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e5 (least deprived)\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e96,608\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e27.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e43,274\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e28.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e34,263\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e27.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"32\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e\u003cem\u003eMissing\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u003cem\u003e1,730\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u003cem\u003e627\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e\u003cem\u003e506\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"170\"\u003e\n\u003cp\u003eEthnicity*\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"32\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003eWhite\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e228,624\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e88.2%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e104,309\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e89.2%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e85,064\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e89.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"32\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003eAsian\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e11,774\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e4.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e4,703\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e4.0%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e3,760\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e3.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"32\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003eBlack\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e12,234\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e4.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e5,354\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e4.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e4,300\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e4.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"32\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003eMixed\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e5,368\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e2.1%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e2,146\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e1.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e1,781\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e1.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"32\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003eOther\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e1,210\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e392\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e0.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e352\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e0.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"32\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e\u003cem\u003eMissing\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u003cem\u003e91,756\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u003cem\u003e35,543\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e\u003cem\u003e28,518\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"170\"\u003e\n\u003cp\u003eMental health (MH) status\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"32\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003eNo MH conditions\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e318,329\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e90.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e129,744\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e85.1%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e102,015\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e82.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"32\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e1+ MH condition\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e32,637\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e9.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e22,703\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e14.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e21,760\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e17.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"170\"\u003e\n\u003cp\u003eShielding status\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"32\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003eNot advised to shield\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e337,758\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e96.2%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e142,476\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e93.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e113,343\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e91.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"32\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003eAdvised to shield\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"71\"\u003e\n\u003cp\u003e13,208\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e3.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e9,971\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e6.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"80\"\u003e\n\u003cp\u003e10,432\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e8.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;*White includes British, white British, mixed British, and other white background. Black includes African, Caribbean, Somali and black British. Asian includes Indian, British Indian, Pakistani, Chinese, and other Asian background. Mixed includes white and black Caribbean, white and Asian, white and African, other mixed white, and other mixed background. Other includes, Turkish, Arab, Iranian, other ethnic non-mixed, and any other group. See appendix 1 for further details.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Patients with any potential cancer indicator reported in April-July 2020 compared to 2019\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" width=\"662\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"132\"\u003e\n\u003cp\u003e\u003cstrong\u003eApril-July 2019\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(n=344,184)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"132\"\u003e\n\u003cp\u003e\u003cstrong\u003eApril-July 2020\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(n=350,966)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"227\"\u003e\n\u003cp\u003e\u003cstrong\u003eChange in proportion of patients with potential cancer indicators \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(2020 vs. 2019)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003en\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e% \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003en\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e%\u003csup\u003e a\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eIRR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e95% CI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003ep-value\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eOverall\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e44,662\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e13%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e29,150\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e8%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e0.62 to 0.68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eBy Age\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e0-4 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e2,393\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e13%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e1,199\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e6%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e0.46 to 0.55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e5-17 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e3,486\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e8%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e1,595\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e3%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e0.41 to 0.49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e18-49 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e17,531\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e11%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e12,527\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e8%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.71\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e0.67 to 0.76\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e50-69 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e11,615\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e15%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e7,451\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e10%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.64\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e0.60 to 0.68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e70-84 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e7,396\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e21%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e4,779\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e13%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.64\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e0.59 to 0.69\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e85+ years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e2,241\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e18%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e1,599\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e13%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.69\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e0.63 to 0.76\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eBy Sex\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.003\u003csup\u003e b\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e18,019\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e10%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e11,072\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e6%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.61\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e0.58 to 0.64\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e26,643\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e16%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e18,078\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e10%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e0.64 to 0.71\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eBy Ethnicity \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.956\u003csup\u003e b\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eWhite\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e30,354\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e14%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e20,051\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e9%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eAsian\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e1,782\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e15%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e1,147\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e10%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eBlack\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e2,002\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e17%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e1,363\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e11%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eMixed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e629\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e12%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e401\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e7%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eOther\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e141\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e12%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e94\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e8%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eBy IMD quintile\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.955\u003csup\u003e b\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e1 (most deprived)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e10,314\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e15%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e6,943\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e10%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e7,088\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e13%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e4,701\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e9%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e6,628\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e13%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e4,303\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e8%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e9,247\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e13%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e5,965\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e8%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e5 (least deprived)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e11,168\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e12%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e7,091\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e7%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eBy Mental health status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003csup\u003e b\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eNo MH conditions\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e37,354\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e12%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e23,603\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e7%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.63\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e0.60 to 0.65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e1+ MH condition\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e7,308\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e23%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e5,547\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e17%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e0.72 to 0.79\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eBy Shielding status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.090\u003csup\u003e b\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eNot advised to shield\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e40,661\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e12%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e26,376\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e8%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eAdvised to shield\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e4,001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e31%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e2,774\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e21%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIRR=incidence rate ratio. CI=Confidence interval. MH=Mental health.\u003c/p\u003e\n\u003cp\u003eIRRs and corresponding 95% CIs and p-values are from negative binomial models.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e Percentages are calculated out of all patients in each category.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e P-values presented on the blue rows are the p-values for the interaction between year and the given characteristic; incidence rate ratios only presented by each level of a characteristic if this p\u0026lt;0.05.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003csup\u003ec\u003c/sup\u003e White includes British, white British, mixed British, and other white background. Black includes African, Caribbean, Somali and black British. Asian includes Indian, British Indian, Pakistani, Chinese, and other Asian background. Mixed includes white and black Caribbean, white and Asian, white and African, other mixed white, and other mixed background. Other includes, Turkish, Arab, Iranian, other ethnic non-mixed, and any other group. See appendix 1 for further details.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Consultations (per 1000 patients) with potential cancer indicators reported in April-July 2020 compared to 2019\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" width=\"671\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"132\"\u003e\n\u003cp\u003e\u003cstrong\u003eApril-July 2019\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"132\"\u003e\n\u003cp\u003e\u003cstrong\u003eApril-July 2020\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"227\"\u003e\n\u003cp\u003e\u003cstrong\u003eChange in rates of consultations with potential cancer indicators \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(2020 vs. 2019)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eGP CONSULTATIONS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003en\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e%\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003en\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e%\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eIRR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e95% CI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003ep-value\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eOverall\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e171.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e19%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e128.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e16%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.81\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e0.77 to 0.86\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eBy consultation provision\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026lt;0.001 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eFace-to-face\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e134.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e22%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e19.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e18%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.88\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e0.80 to 0.97\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.011\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eRemote\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e37.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e14%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e109.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e15%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e1.22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e1.11 to 1.34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eNURSE/PARAMEDIC CONSULTATIONS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003en\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003en\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eIRR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e95% CI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003ep-value\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eOverall\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e36.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e10%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e20.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e7%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.72\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e0.57 to 0.92\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.007\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eBy consultation provision\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026lt;0.001 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eFace-to-face\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e34.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e10%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e10.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e6%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.61\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e0.44 to 0.84\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.002\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eRemote\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e2.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e8%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e10.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e9%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e1.67\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e1.16 to 2.42\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.006\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIRR=incidence rate ratio. CI=Confidence interval.\u0026nbsp; IRRs and corresponding 95% CIs and p-values from negative binomial models.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e Percentages are calculated out of all consultations in each category.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eb \u003c/sup\u003eP-values presented on the blue rows are the p-values for the interaction between year and consultation provision.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Patients with individual potential cancer indicator reported in April-July 2020 compared to 2019\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" width=\"625\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"137\"\u003e\n\u003cp\u003e\u003cstrong\u003eApril-July 2019\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(N=344,184)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"144\"\u003e\n\u003cp\u003e\u003cstrong\u003eApril-July 2020\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(N=350,966)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e\u003cstrong\u003eIRR \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eAny potential cancer indicator\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e44,662\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e12.98%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e29,150\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e8.31%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.64\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\" width=\"625\"\u003e\n\u003cp\u003eMost commonly reported indicators (\u0026ge;0.5% of patients in 2019)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003e\u003cem\u003eAny commonly reported indicator\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cem\u003e32,705\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e\u003cem\u003e9.50%\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cem\u003e19,270\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u003cem\u003e5.49%\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e\u003cem\u003e0.58\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eChest infection\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e2,188\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.64%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e502\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.14%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.22\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eFever\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e3,193\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.93%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e988\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.28%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.30\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003ePain in throat (e.g. tonsilitis)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1,861\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.54%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e768\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.22%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.40\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eCough\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e5,722\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e1.66%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e2,547\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.73%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.44\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eFatigue\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e2,865\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.83%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1,424\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.41%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.49\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eDiarrhoea\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e2,204\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.64%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1,225\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.35%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.55\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003ePain in shoulder\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1,987\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.58%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1,222\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.35%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.60\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003ePain in abdomen\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e4,704\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e1.37%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e3,192\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.91%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.67\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eBack pain/backache\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e5,107\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e1.48%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e3,599\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e1.03%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.69\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eLower urinary tract symptoms\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e2,184\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.63%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1,660\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.47%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.75\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eShortness of breath\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e2,822\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.82%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e2,155\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.61%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.75\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003ePain in chest\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e2,147\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.62%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1,662\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.47%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.76\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eGynaecological abnormalities (e.g. menstrual disorders)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1,823\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.53%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1,535\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.44%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.83\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\" width=\"625\"\u003e\n\u003cp\u003eLess commonly reported indicators (0.1% - \u0026lt;0.5% of patients in 2019)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003e\u003cem\u003eAny less commonly reported indicator\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cem\u003e16,556\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e\u003cem\u003e4.81%\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cem\u003e12,332\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u003cem\u003e3.51%\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e\u003cem\u003e0.73\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eLymphadenopathy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e572\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.17%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e206\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.06%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.35\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eVomiting\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1,149\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.33%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e489\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.14%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.42\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eErectile dysfunction\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e482\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.14%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e208\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.06%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.42\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eUrinary tract infection\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1,230\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.36%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e610\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.17%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.49\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eBruising\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e368\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.11%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e205\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.06%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.55\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eIrritable Bowel Syndrome\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e580\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.17%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e336\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.10%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.57\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eIron deficiency/anaemia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e772\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.22%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e455\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.13%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.58\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eNon-visible haematuria\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1,518\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.44%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e927\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.26%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.60\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eChange in bowel habit\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e346\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.10%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e218\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.06%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.62\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eProteinuria\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1,072\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.31%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e687\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.20%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.63\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eMass in neck\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e400\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.12%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e257\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.07%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.63\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eHaematuria\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1,401\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.41%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e904\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.26%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.63\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003ePain in breast\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e478\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.14%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e320\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.09%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.66\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003ePruritus\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e651\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.19%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e488\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.14%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.74\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eDysuria\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e474\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.14%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e362\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.10%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.75\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eCompressed trachea\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1,156\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.34%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e903\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.26%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.77\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003ePain in pelvis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e963\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.28%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e770\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.22%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.78\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eDyspepsia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1,068\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.31%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e858\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.24%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.79\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eRecurring infections\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e562\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.16%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e463\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.13%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.81\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eNausea\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e380\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.11%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e324\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.09%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.84\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eRectal bleeding\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e744\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.22%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e656\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.19%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.86\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eReflux\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1,128\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.33%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1,020\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.29%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.89\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eLump in breast\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e697\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.20%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e639\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.18%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.90\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eLump (excluding breast)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1,014\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.29%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1,012\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.29%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.98\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eVaginal discharge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e754\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.22%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e781\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.22%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e1.02\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eConstipation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1,254\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.36%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e1,351\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.38%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e1.06\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\" width=\"625\"\u003e\n\u003cp\u003eRarely reported indicators (0.02% - \u0026lt;0.1% of patients in 2019)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003e\u003cem\u003eAny rarely reported indicator\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cem\u003e2,575\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e\u003cem\u003e0.75%\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cem\u003e2,052\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u003cem\u003e0.58%\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e\u003cem\u003e0.78\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eNight sweats\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e133\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.04%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.02%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.48\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eHoarseness of voice\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e163\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.05%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e87\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.02%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.52\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eHaemoptysis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e94\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.03%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.01%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.53\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003ePain in testis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e251\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.07%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e170\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.05%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.66\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003ePain in bones\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e213\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.06%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e147\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.04%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.68\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eProstate specific antigen raised/abnormal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e175\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.05%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e123\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.04%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.69\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003ePostmenopausal bleeding\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e147\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.04%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e106\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.03%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.71\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eDistension of abdomen\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e292\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.08%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e232\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.07%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.78\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eDysphagia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e277\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.08%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e222\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.06%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.79\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eMass in testis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e247\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.07%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e209\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.06%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.83\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eWeight loss\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e314\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.09%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e304\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.09%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.95\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eSuperior vena cava syndrome\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e81\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.02%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e90\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.03%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e1.09\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eAppetite loss\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e115\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.03%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e130\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.04%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e1.11\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003eMass in abdomen\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e111\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e0.03%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e161\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e0.05%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e1.42\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\" width=\"625\"\u003e\n\u003cp\u003eVery rarely reported indicators (\u0026lt;0.02% of patients in 2019)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"257\"\u003e\n\u003cp\u003e\u003cem\u003eAny very rarely reported indicator*\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cem\u003e458\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"61\"\u003e\n\u003cp\u003e\u003cem\u003e0.13%\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cem\u003e342\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u003cem\u003e0.10%\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e\u003cem\u003e0.73\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIRR=Incidence rate ratio.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNote. Indicators are ordered from largest to smallest reduction (by IRR) within each commonality grouping. These figures only include indicators coded in routinely collected records using SNOMED codes. In some cases, GPs/nurses may enter symptoms in free text, and/or only code their diagnosis, which may lead to under-reporting here; this under-recording is likely to be similar in both years.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e* Very rare indicators affecting \u0026lt;0.02% of patients (69 individuals) in April-July 2019 included Limp/ gait abnormalities, Testis swelling/abnormalities, Haematemesis, Possible bone and soft tissue sarcoma symptoms (e.g. abnormal x-ray), Mass in thyroid, Nipple discharge, Abnormal chest x-ray, Chest/breathing abnormalities, Ulceration of vulva, Jaundice and 20 additional indicators with incidence \u0026lt; 20 patients in April-July 2019.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"COVID-19, General Practice, Cancer","lastPublishedDoi":"10.21203/rs.3.rs-123337/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-123337/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground \u003c/strong\u003eIn March 2020, the World Health Organisation declared COVID-19 a pandemic.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAim \u003c/strong\u003eTo investigate how the pandemic affected presentation to primary-care with features potentially indicating cancer, and explore how reporting differed by patient characteristics and in face-to-face vs. remote consultations.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eDesign and setting \u003c/strong\u003eRetrospective cohort study in 21 practices in South-West England.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003ePotential cancer indicators were identified using pre-defined code lists for symptoms, signs, test results and diagnoses. Negative binomial regression models compared reporting of potential cancer indicators in April-July 2020 to April-July 2019. Incidence rate ratios (IRRs), 95% confidence intervals (CIs) and p-values are reported.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eDuring April-July 2019 and 2020, respectively, 152,447/344,184 (44%) and 123,775/350,966 (35%) patients consulted, with 44,662/344,184 (13%) and 29,150/350,966 (8%) reporting a potential cancer indicator (IRR=0.65, 95%CI 0.62-0.68, p\u0026lt;0.001). Reduced indicator reporting was stable across ethnicity, deprivation and shielding status, was greater in children (0-4 years IRR=0.50, 95%CI 0.46-0.55, p\u0026lt;0.001; 5-17 years IRR=0.45, 95%CI 0.41-0.49, p\u0026lt;0.001) and males (IRR=0.61, 95%CI 0.58-0.64), and less marked in patients with mental health conditions (IRR=0.75, 95%CI 0.72-0.79, p\u0026lt;0.001). Indicator reporting dropped for GP face-to-face consultations (IRR=0.88, 95%CI 0.80-0.97, p=0.011) and increased for remote consultations (IRR=1.22, 95%CI 1.11-1.34, p\u0026lt;0.001), but despite this, remained lower in remote consulting than face-to-face in April-July 2020.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion \u003c/strong\u003ePatient consulting in general, and for potential cancer indicators specifically, reduced during the first-wave of the COVID-19 pandemic. Remote consulting may be part of the reason for the reduction in reporting of potential cancer indicators, along with the reduced spreading of viral (non-cancer) infections.\u003c/p\u003e","manuscriptTitle":"Changes in potential cancer indicator reporting in primary-care during the COVID-19 pandemic","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-12-12 00:13:27","doi":"10.21203/rs.3.rs-123337/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"df8c3b64-e88c-4751-8df7-595f35492d2b","owner":[],"postedDate":"December 12th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":1358996,"name":"General Practice"}],"tags":[],"updatedAt":"2022-06-28T18:12:10+00:00","versionOfRecord":{"articleIdentity":"rs-123337","link":"https://doi.org/10.1136/bmjopen-2021-050131","journal":{"identity":"bmj-open","isVorOnly":true,"title":"BMJ Open"},"publishedOn":"2020-12-12 18:11:54","publishedOnDateReadable":"December 12th, 2020"},"versionCreatedAt":"2020-12-12 00:13:27","video":"","vorDoi":"10.1136/bmjopen-2021-050131","vorDoiUrl":"https://doi.org/10.1136/bmjopen-2021-050131","workflowStages":[]},"version":"v1","identity":"rs-123337","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-123337","identity":"rs-123337","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}