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COVID-19 mortality in the UK Biobank cohort: revisiting and evaluating risk factors

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Title: COVID-19 mortality in the UK Biobank cohort: revisiting and evaluating risk factors
Authors: Elliott, J
Bodinier, B
Whitaker, M
Delpierre, C
Vermeulen, R
Tzoulaki, I
Elliott, P
Chadeau, M
Item Type: Journal Article
Abstract: Background: Most studies of severe/fatal COVID-19 risk have used routine/hospitalisation data without detailed pre-morbid characterisation. Using the community-based UK Biobank ohort, we investigate risk factors for COVID-19 mortality in comparison withnon-COVID-19mortality.MethodsWe 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 2,626 non-COVID-19 deaths to 21 September 2020. We used univariate, multivariable and penalised regression models. Results: Age (OR=2.76[2.18-3.49]per S.D. [8.1 years], p=2.6x10-17), male sex (OR=1.47[1.26-1.73], p=1.3x10-6) and Black versus White ethnicity (OR=1.21[1.12-1.29], p=3.0x10-7) 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. Conclusions: 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 maybe explained by the aforementioned factors.
Issue Date: 1-Mar-2021
Date of Acceptance: 19-Jan-2021
URI: http://hdl.handle.net/10044/1/85562
DOI: 10.1007/s10654-021-00722-y
ISSN: 0393-2990
Publisher: Springer
Start Page: 299
End Page: 309
Journal / Book Title: European Journal of Epidemiology
Volume: 36
Copyright Statement: © The Author(s) 2021. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Sponsor/Funder: Cancer Research UK
Health Data Research Uk
Commission of the European Communities
Commission of the European Communities
Funder's Grant Number: ‘Mechanomics’ PRC project grant 22184
Health Data Research UK
874627
874739
Keywords: Science & Technology
Life Sciences & Biomedicine
Public, Environmental & Occupational Health
COVID-19 mortality
SARS-CoV-2
Prospective cohort
UK biobank
Risk factor
COVID-19 mortality
Prospective cohort
Risk factor
SARS-CoV-2
UK biobank
1117 Public Health and Health Services
Epidemiology
Publication Status: Published
Online Publication Date: 2021-02-15
Appears in Collections:Faculty of Medicine
Imperial College London COVID-19
School of Public Health



This item is licensed under a Creative Commons License Creative Commons