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COVID-19 mortality in the UK Biobank cohort: revisiting and evaluating risk factors
Joshua Elliott1,2,3, Barbara Bodinier1,2, Matthew Whitaker1,2
1Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Hospital, Norfolk Place, London, W21PG, UK.
Insights
Age, male sex, and Black ethnicity are key risk factors for COVID-19 mortality. Comorbidities like cardiovascular disease, hypertension, and diabetes, along with oral steroid use, also significantly increase the risk of fatal COVID-19 outcomes.
Area of Science:
- Epidemiology
- Public Health
- Genetics
Background:
- Limited understanding of severe/fatal COVID-19 risk factors due to reliance on routine data.
- Need for detailed pre-morbid characterization in COVID-19 mortality studies.
Purpose of the Study:
- Investigate demographic, social, lifestyle, biological, medical, and environmental risk factors for COVID-19 mortality.
- Compare risk factors for COVID-19 mortality versus non-COVID-19 mortality.
- Identify key predictors of fatal COVID-19 outcomes.
Main Methods:
- Utilized the community-based UK Biobank cohort (N=473,550).
- Analyzed demographic, social, lifestyle, biological, medical, and environmental data.
- Employed univariate, multivariable, and penalized regression models.
- Examined 459 COVID-19 deaths and 2626 non-COVID-19 deaths up to September 21, 2020.
Main Results:
- Age, male sex, and Black ethnicity were independently associated with increased COVID-19 mortality risk.
- Healthcare worker status, current smoking, cardiovascular disease, hypertension, diabetes, autoimmune disease, and oral steroid use were linked to higher COVID-19 mortality.
- Penalized regression identified income, cardiovascular disease, hypertension, diabetes, cystatin C, and oral steroid use as significant contributors.
- Black ethnicity, hypertension, and oral steroid use specifically predicted COVID-19 mortality, not general mortality.
Conclusions:
- Demographic factors (age, male sex, Black ethnicity), comorbidities (cardiovascular disease, hypertension, diabetes), and oral steroid use are significant predictors of COVID-19 mortality.
- Findings suggest previously reported associations with BMI, vitamin D, air pollution, and certain medications may be explained by these identified factors.
- Emphasizes the importance of comprehensive pre-morbid characterization in understanding severe COVID-19 outcomes.
Abstract:
Most studies of severe/fatal COVID-19 risk have used routine/hospitalisation data without detailed pre-morbid characterisation. Using the community-based UK Biobank cohort, we investigate risk factors for COVID-19 mortality in comparison with non-COVID-19 mortality. We investigated demographic, social (education, income, housing, employment), lifestyle (smoking, drinking, body mass index), biological (lipids, cystatin C, vitamin D), medical (comorbidities, medications) and environmental (air pollution) data from UK Biobank (N = 473,550) in relation to 459 COVID-19 and 2626 non-COVID-19 deaths to 21 September 2020. We used univariate, multivariable and penalised regression models. Age (OR = 2.76 [2.18-3.49] per S.D. [8.1 years], p = 2.6 × 10-17), male sex (OR = 1.47 [1.26-1.73], p = 1.3 × 10-6) and Black versus White ethnicity (OR = 1.21 [1.12-1.29], p = 3.0 × 10-7) were independently associated with and jointly explanatory of (area under receiver operating characteristic curve, AUC = 0.79) increased risk of COVID-19 mortality. In multivariable regression, alongside demographic covariates, being a healthcare worker, current smoker, having cardiovascular disease, hypertension, diabetes, autoimmune disease, and oral steroid use at enrolment were independently associated with COVID-19 mortality. Penalised regression models selected income, cardiovascular disease, hypertension, diabetes, cystatin C, and oral steroid use as jointly contributing to COVID-19 mortality risk; Black ethnicity, hypertension and oral steroid use contributed to COVID-19 but not non-COVID-19 mortality. Age, male sex and Black ethnicity, as well as comorbidities and oral steroid use at enrolment were associated with increased risk of COVID-19 death. Our results suggest that previously reported associations of COVID-19 mortality with body mass index, low vitamin D, air pollutants, renin-angiotensin-aldosterone system inhibitors may be explained by the aforementioned factors.
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