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. 2020 Nov 19;10(11):e040402.
doi: 10.1136/bmjopen-2020-040402.

Modifiable and non-modifiable risk factors for COVID-19, and comparison to risk factors for influenza and pneumonia: results from a UK Biobank prospective cohort study

Frederick K Ho  1 , Carlos A Celis-Morales  1   2 , Stuart R Gray  2 , S Vittal Katikireddi  1 , Claire L Niedzwiedz  1 , Claire Hastie  1 , Lyn D Ferguson  2 , Colin Berry  2 , Daniel F Mackay  1 , Jason Mr Gill  2 , Jill P Pell  1 , Naveed Sattar  2 , Paul Welsh  3
Affiliations

Modifiable and non-modifiable risk factors for COVID-19, and comparison to risk factors for influenza and pneumonia: results from a UK Biobank prospective cohort study

Frederick K Ho et al. BMJ Open. .

Abstract

Objectives: We aimed to investigate demographic, lifestyle, socioeconomic and clinical risk factors for COVID-19, and compared them to risk factors for pneumonia and influenza in UK Biobank.

Design: Cohort study.

Setting: UK Biobank.

Participants: 49-83 year olds (in 2020) from a general population study.

Main outcome measures: Confirmed COVID-19 infection (positive SARS-CoV-2 test). Incident influenza and pneumonia were obtained from primary care data. Poisson regression was used to study the association of exposure variables with outcomes.

Results: Among 235 928 participants, 397 had confirmed COVID-19. After multivariable adjustment, modifiable risk factors were higher body mass index and higher glycated haemoglobin (HbA1C) (RR 1.28 and RR 1.14 per SD increase, respectively), smoking (RR 1.39), slow walking pace as a proxy for physical fitness (RR 1.53), and use of blood pressure medications as a proxy for hypertension (RR 1.33). Higher forced expiratory volume in 1 s (FEV1) and high-density lipoprotein (HDL) cholesterol were both associated with lower risk (RR 0.84 and RR 0.83 per SD increase, respectively). Non-modifiable risk factors included male sex (RR 1.72), black ethnicity (RR 2.00), socioeconomic deprivation (RR 1.17 per SD increase in Townsend Index), and high cystatin C (RR 1.13 per SD increase). The risk factors overlapped with pneumonia somewhat, less so for influenza. The associations with modifiable risk factors were generally stronger for COVID-19, than pneumonia or influenza.

Conclusion: These findings suggest that modification of lifestyle may help to reduce the risk of COVID-19 and could be a useful adjunct to other interventions, such as social distancing and shielding of high risk.

Keywords: cardiology; diabetes & endocrinology; epidemiology.

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Conflict of interest statement

Competing interests: PW has received research grants from Roche Diagnostics, AstraZeneca and Boehringer Ingelheim outside the submitted work, and NS has received grant and personal fees from Boehringer Ingelheim, and personal fees from Amgen, AstraZeneca, Eli Lilly, Novo Nordisk, Pfizer, and Sanofi outside the submitted work. All authors declare no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1
Non-linear associations of significant continuous variables with COVID-19 and pneumonia. BMI, bodty mass index; FEV1, forced expiratory volume in one second.
Figure 2
Figure 2
Risk factors for COVID-19 and pneumonia in the UK Biobank cohort. Data presented as risk ratios (RR) and their 95% CI. Analyses were adjusted for age, sex, ethnicity, deprivation, body mass index (BMI), forced expiratory volume in 1 s (FEV1) and walking pace (and diastolic blood pressure for COVID-19 only). Continuous exposures were standardised and presented per 1-SD increment (deprivation index SD=3.01, cystatin C SD=0.14, BMI SD=4.59, HbA1c SD=5.80, FEV1 SD=0.77 and HDL cholesterol SD=0.37). BP, blood pressure.
See this image and copyright information in PMC

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