Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
[Preprint]. 2020 May 13:2020.05.09.20096438.
doi: 10.1101/2020.05.09.20096438.

Lifestyle Risk Factors for Cardiovascular Disease in Relation to COVID-19 Hospitalization: A Community-Based Cohort Study of 387,109 Adults in UK

Mark Hamer  1 , Mika Kivimäki  2 , Catharine R Gale  3   4 , G David Batty  2
Affiliations

Lifestyle Risk Factors for Cardiovascular Disease in Relation to COVID-19 Hospitalization: A Community-Based Cohort Study of 387,109 Adults in UK

Mark Hamer et al. medRxiv. .

Update in

Abstract

Aims: It is important to identify characteristics of people who may be most at risk of COVID-19 to inform policy and intervention. Little is known about the impact of unhealthy lifestyles including smoking, physical inactivity, obesity, and excessive alcohol intake. We conducted the first large-scale general population study on lifestyle risk factors for COVID-19.

Methods: Prospective cohort study with national registry linkage to hospitalisation for COVID-19. Participants were 387,109 men and women (56.4 ±8.8 yr; 55.1% women) residing in England from UK Biobank study. Physical activity, smoking, and alcohol intake, were assessed by questionnaire at baseline (2006-2010). Body mass index, from measured height and weight, was used as an indicator of overall obesity. Outcome was cases of COVID-19 serious enough to warrant a hospital admission from 16-March-2020 to 26-April-2020.

Results: There were 760 COVID-19 cases. After adjustment for age, sex and mutually for each lifestyle factor, physical inactivity (Relative risk, 1.32, 95% confidence interval, 1.10, 1.58), smoking (1.42;1.12, 1.79) and obesity (2.05 ;1.68, 2.49) but not heavy alcohol consumption (1.12; 0.93, 1.35) were all related to COVID-19. We also found a dose-dependent increase in risk of COVID-19 with less favourable lifestyle scores, such that participants in the most adverse category had 4-fold higher risk (4.41; 2.52 - 7.71) compared to people with the most optimal lifestyle. This gradient was little affected after adjustment for a wide range of covariates. Based on UK risk factor prevalence estimates, unhealthy behaviours in combination accounted for up to 51% of the population attributable fraction of severe COVID-19.

Conclusions and relevance: Our findings suggest that an unhealthy lifestyle synonymous with an elevated risk of non-communicable disease is also a risk factor for COVID-19 hospital admission, accounting for up to half of severe cases. Adopting simple lifestyle changes could lower the risk of severe infection.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: None

References

    1. Colpani V, Baena CP, Jaspers L, van Dijk GM, Farajzadegan Z, Dhana K, Tielemans MJ, Voortman T, Freak-Poli R, Veloso GGV, Chowdhury R, Kavousi M, Muka T, Franco OH. Lifestyle factors, cardiovascular disease and all-cause mortality in middle-aged and elderly women: a systematic review and meta-analysis. Eur J Epidemiol. 2018. September;33(9):831–845. - PubMed
    1. Schlesinger S, Neuenschwander M, Ballon A, Nöthlings U, Barbaresko J. Adherence to healthy lifestyles and incidence of diabetes and mortality among individuals with diabetes: a systematic review and meta-analysis of prospective studies. J Epidemiol Community Health. 2020. May;74(5):481–487. - PubMed
    1. Nyberg ST, Singh-Manoux A, Pentti J, Madsen IEH, Sabia S, Alfredsson L, Bjorner JB, Borritz M, Burr H, Goldberg M, Heikkilä K, Jokela M, Knutsson A, Lallukka T, Lindbohm JV, Nielsen ML, Nordin M, Oksanen T, Pejtersen JH, Rahkonen O, Rugulies R, Shipley MJ, Sipilä PN, Stenholm S, Suominen S, Vahtera J, Virtanen M, Westerlund H, Zins M, Hamer M, Batty GD, Kivimäki M. Association of Healthy Lifestyle With Years Lived Without Major Chronic Diseases. JAMA Intern Med. 2020. April 6. doi: 10.1001/jamainternmed.2020.0618 [Epub ahead of print] - DOI - PMC - PubMed
    1. Li Y, Schoufour J, Wang DD, Dhana K, Pan A, Liu X, Song M, Liu G, Shin HJ, Sun Q, Al-Shaar L, Wang M, Rimm EB, Hertzmark E, Stampfer MJ, Willett WC, Franco OH, Hu FB. Healthy lifestyle and life expectancy free of cancer, cardiovascular disease, and type 2 diabetes: prospective cohort study. BMJ. 2020. January 8;368:l6669. doi: 10.1136/bmj.l6669 - DOI - PMC - PubMed
    1. Wang HE, Baddley J, Griffin RL, et al. Physical inactivity and long-term rates of community-acquired sepsis. Prev Med 2014; 65: 58–64. - PMC - PubMed

Publication types