• Harriet Forbes, Caroline E Morton, Seb Bacon, Helen I McDonald, Caroline Minassian, Jeremy P Brown, Christopher T Rentsch, Rohini Mathur, Anna Schultze, Nicholas J DeVito, Brian MacKenna, William J Hulme, Richard Croker, Alex J Walker, Elizabeth J Williamson, Chris Bates, Amir Mehrkar, Helen J Curtis, David Evans, Kevin Wing, Peter Inglesby, Henry Drysdale, Wong Angel Y S AYS Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK., Jonathan Cockburn, Robert McManus, John Parry, Frank Hester, Sam Harper, Ian J Douglas, Liam Smeeth, Evans Stephen J W SJW Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK., Krishnan Bhaskaran, Rosalind M Eggo, Ben Goldacre, and Laurie A Tomlinson.
• Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
• BMJ. 2021 Mar 18; 372: n628.

ObjectiveTo investigate whether risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and outcomes of coronavirus disease 2019 (covid-19) differed between adults living with and without children during the first two waves of the UK pandemic.DesignPopulation based cohort study, on behalf of NHS England.SettingPrimary care data and pseudonymously linked hospital and intensive care admissions and death records from England, during wave 1 (1 February to 31 August 2020) and wave 2 (1 September to 18 December 2020).ParticipantsTwo cohorts of adults (18 years and over) registered at a general practice on 1 February 2020 and 1 September 2020.Main Outcome MeasuresAdjusted hazard ratios for SARS-CoV-2 infection, covid-19 related admission to hospital or intensive care, or death from covid-19, by presence of children in the household.ResultsAmong 9 334 392adults aged 65 years and under, during wave 1, living with children was not associated with materially increased risks of recorded SARS-CoV-2 infection, covid-19 related hospital or intensive care admission, or death from covid-19. In wave 2, among adults aged 65 years and under, living with children of any age was associated with an increased risk of recorded SARS-CoV-2 infection (hazard ratio 1.06 (95% confidence interval 1.05 to 1.08) for living with children aged 0-11 years; 1.22 (1.20 to 1.24) for living with children aged 12-18 years) and covid-19 related hospital admission (1.18 (1.06 to 1.31) for living with children aged 0-11; 1.26 (1.12 to 1.40) for living with children aged 12-18). Living with children aged 0-11 was associated with reduced risk of death from both covid-19 and non-covid-19 causes in both waves; living with children of any age was also associated with lower risk of dying from non-covid-19 causes. For adults 65 years and under during wave 2, living with children aged 0-11 years was associated with an increased absolute risk of having SARS-CoV-2 infection recorded of 40-60 per 10 000 people, from 810 to between 850 and 870, and an increase in the number of hospital admissions of 1-5 per 10 000 people, from 160 to between 161 and 165. Living with children aged 12-18 years was associated with an increase of 160-190 per 10 000 in the number of SARS-CoV-2 infections and an increase of 2-6 per 10 000 in the number of hospital admissions.ConclusionsIn contrast to wave 1, evidence existed of increased risk of reported SARS-CoV-2 infection and covid-19 outcomes among adults living with children during wave 2. However, this did not translate into a materially increased risk of covid-19 mortality, and absolute increases in risk were small.© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. No commercial re-use. See rights and permissions. Published by BMJ.

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