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

Elliott, Joshua; Bodinier, Barbara; Whitaker, Matthew; Delpierre, Cyrille; Vermeulen, Roel; Tzoulaki, Ioanna; Elliott, Paul; Chadeau‐Hyam, Marc

doi:10.1007/s10654-021-00722-y

Cited by 109 publications

(113 citation statements)

References 43 publications

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“…27 Our findings of an association of persistent symptoms with deprivation, and with smoking or vaping, are not well described in the literature, although smokers have been found to have a higher risk of severe COVID-19. 28 Our identification of two stable and well-differentiated symptom clusters at 12 weeks supports the characterisation of Long COVID as a diverse set of overlapping conditions.…”

Section: Discussionsupporting

confidence: 73%

Persistent symptoms following SARS-CoV-2 infection in a random community sample of 508,707 people

Whitaker

Elliott

Chadeau‐Hyam

et al. 2021

Preprint

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Introduction Long COVID, describing the long-term sequelae after SARS-CoV-2 infection, remains a poorly defined syndrome. There is uncertainty about its predisposing factors and the extent of the resultant public health burden, with estimates of prevalence and duration varying widely. Methods Within rounds 3-5 of the REACT-2 study, 508,707 people in the community in England were asked about a prior history of COVID-19 and the presence and duration of 29 different symptoms. We used uni- and multivariable models to identify predictors of persistence of symptoms (12 weeks or more). We estimated the prevalence of symptom persistence at 12 weeks, and used unsupervised learning to cluster individuals by symptoms experienced. Results Among the 508,707 participants, the weighted prevalence of self-reported COVID-19 was 19.2% (95% CI: 19.1,19.3). 37.7% of 76,155 symptomatic people post COVID-19 experienced at least one symptom, while 14.8% experienced three or more symptoms, lasting 12 weeks or more. This gives a weighted population prevalence of persistent symptoms of 5.75% (5.68, 5.81) for one and 2.22% (2.1, 2.26) for three or more symptoms. Almost a third of people 8,771/28,713 (30.5%) with at least one symptom lasting 12 weeks or more reported having had severe COVID-19 symptoms ('significant effect on my daily life') at the time of their illness, giving a weighted prevalence overall for this group of 1.72% (1.69,1.76). The prevalence of persistent symptoms was higher in women than men (OR: 1.51 [1.46,1.55]) and, conditional on reporting symptoms, risk of persistent symptoms increased linearly with age by 3.5 percentage points per decade of life. Obesity, smoking or vaping, hospitalisation , and deprivation were also associated with a higher probability of persistent symptoms, while Asian ethnicity was associated with a lower probability. Two stable clusters were identified based on symptoms that persisted for 12 weeks or more: in the largest cluster, tiredness predominated, while in the second there was a high prevalence of respiratory and related symptoms. Interpretation A substantial proportion of people with symptomatic COVID-19 go on to have persistent symptoms for 12 weeks or more, which is age-dependent. Clinicians need to be aware of the differing manifestations of Long COVID which may require tailored therapeutic approaches. Managing the long-term sequelae of SARS-CoV-2 infection in the population will remain a major challenge for health services in the next stage of the pandemic.

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Section: Discussionsupporting

confidence: 73%

Persistent symptoms following SARS-CoV-2 infection in a random community sample of 508,707 people

Whitaker

Elliott

Chadeau‐Hyam

et al. 2021

Preprint

Self Cite

124

131

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“…In line with previous (i.e., early and recent) analysis of COVID-19 risk [7,8,16,17], we found that age and underlying conditions such as diabetes, arterial hypertension, and cardiovascular diseases signi cantly contributed to the risk of severe disease outcomes, particularly hospital admission. However, rather than individual diagnoses, the comorbidity burden was a stronger predictor of hospital admissions and deaths.…”

Section: Discussionsupporting

confidence: 91%

Development and performance of a population-based risk stratification model for COVID-19

Vela

Carot-Sans

Clèries

et al. 2021

Preprint

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The shortage of recently approved vaccines against the severe acute respiratory syndrome coronavirus (SARS-CoV-2) has highlighted the need for evidence-based tools to prioritize healthcare resources for people at higher risk of severe coronavirus disease 2019 (COVID-19). Current evidence indicates that age is far from accurate in identifying the risk of severe illness; furthermore, the count of individual risk factors has limited applicability to population-based “stratify-and-shield” strategies. We developed a COVID-19 risk stratification system that allows allocating people into four mutually-exclusive risk categories based on multivariate models for hospital admissions, transfer to intensive care unit (ICU), and mortality among the general population. The model was developed using clinical, hospital, and epidemiological data from the entire population of Catalonia (North-East Spain; 7.5 million people) and validated using an independent dataset of 218,329 individuals with PCR-confirmed COVID-19, who were infected after developing the model. This showed high discrimination capacity, with an area under the curve of the receiving operating characteristics of 0.85 (95% CI 0.85–0.85) for hospital admissions, 0.86 (0.86–0.97) for ICU transfers, and 0.96 (0.96–0.96) for deaths. Our results provide clinicians and policymakers with an evidence-based tool for prioritizing COVID-19 healthcare resources other population groups aside from those with higher exposure to SARS-CoV-2 and frontline workers.

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“…It has been demonstrated that individual-level and neighborhood-level variables provide complementary information about the contribution of socioeconomic conditions to health outcomes, 65 and both will be available to be tested as potentially significant factors associated with COVID-19 outcomes in our sample. The use of such variables should allow us to investigate the extent to which the vulnerability to more severe COVID-19 might be predicted not only by age, ethnicity and medical factors (eg, number of comorbidities) 71 but also socially determined factors such as poor housing conditions, unstable income and delayed access to health services. 72 Once our analyses will be carried out in a large urban LMIC setting, unique information may be gathered regarding the influence of disadvantaged socioeconomic status on specific long-term COVID-19 manifestations.…”

Section: Discussionmentioning

confidence: 99%

Post-acute sequelae of SARS-CoV-2 infection (PASC): a protocol for a multidisciplinary prospective observational evaluation of a cohort of patients surviving hospitalisation in Sao Paulo, Brazil

et al. 2021

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IntroductionCOVID-19 may lead to persistent and potentially incapacitating clinical manifestations (post-acute sequelae of SARS-CoV-2 infection (PASC)). Using easy-to-apply questionnaires and scales (often by telephone interviewing), several studies evaluated samples of COVID-19 inpatients from 4 weeks to several months after discharge. However, studies conducting systematic multidisciplinary assessments of PASC manifestations are scarce, with thorough in-person objective evaluations restricted to modestly sized subsamples presenting greatest disease severity.Methods and analysesWe will conduct a prospective observational study of surviving individuals (above 18 years of age) from a cohort of over 3000 subjects with laboratory-confirmed COVID-19 who were treated as inpatients at the largest academic health centre in Sao Paulo, Brazil (Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo). All eligible subjects will be consecutively invited to undergo a 1–2-day series of multidisciplinary assessments at 2 time-points, respectively, at 6–9 months and 12–15 months after discharge. Assessment schedules will include detailed multidomain questionnaires applied by medical research staff, self-report scales, objective evaluations of cardiopulmonary functioning, physical functionality and olfactory status, standardised neurological, psychiatric and cognitive examinations, as well as diagnostic laboratory, muscle ultrasound and chest imaging exams. Remaining material from blood tests will be incorporated by a local biobank for use in future investigations on inflammatory markers, genomics, transcriptomics, peptidomics and metabolomics.Ethics and disseminationAll components of this programme have been approved by local research ethics committees. We aim to provide insights into the frequency and severity of chronic/post-COVID multiorgan symptoms, as well as their interrelationships and associations with acute disease features, sociodemographic variables and environmental exposures. Findings will be disseminated in peer-reviewed journals and at scientific meetings. Additionally, we aim to provide a data repository to allow future pathophysiological investigations relating clinical PASC features to biomarker data extracted from blood samples.Trial registration numberRBR-8z7v5wc; Pre-results.

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

Cited by 109 publications

References 43 publications

Persistent symptoms following SARS-CoV-2 infection in a random community sample of 508,707 people

Persistent symptoms following SARS-CoV-2 infection in a random community sample of 508,707 people

Development and performance of a population-based risk stratification model for COVID-19

Post-acute sequelae of SARS-CoV-2 infection (PASC): a protocol for a multidisciplinary prospective observational evaluation of a cohort of patients surviving hospitalisation in Sao Paulo, Brazil

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