Non-White Ethnicity, Male Sex, and Higher Body Mass Index, but Not Medications Acting on the Renin-Angiotensin System Are Associated With Coronavirus Disease 2019 (Covid-19) Hospitalisation: Review of the First 669 Cases From the Uk Biobank

Abstract

Background: Cardiometabolic morbidity and medications, specifically Angiotensin ConvertingEnzyme inhibitors (ACEi) and Angiotensin Receptor Blockers (ARBs), have been linked with adverse outcomes from coronavirus disease 2019 . This study aims to investigate factors associated with COVID-19 positivity for the first 669 UK Biobank participants; compared with individuals who tested negative, and with the untested, presumed negative, rest of the population. Methods:We studied 1,474 participants from the UK Biobank who had been tested for COVID-19.Given UK testing policy, this implies a hospital setting, suggesting at least moderate to severe symptoms. We considered the following exposures: age, sex, ethnicity, body mass index (BMI), diabetes, hypertension, hypercholesterolaemia, ACEi/ARB use, prior myocardial infarction (MI), and smoking. We undertook comparisons between: 1) COVID-19 positive and COVID-19 tested negative participants; and 2) COVID-19 tested positive and the remaining participants (tested negative plus untested, n=501,837). Logistic regression models were used to investigate univariate and mutually adjusted associations.Results: Among participants tested for COVID-19, non-white ethnicity, male sex, and greater BMI were independently associated with COVID-19 positive result. Non-white ethnicity, male sex, greater BMI, diabetes, hypertension, prior MI, and smoking were independently associated with COVID-19 positivity compared to the remining cohort (test negatives plus untested). However, similar associations were observed when comparing those who tested negative for COVID-19 with the untested cohort;suggesting that these factors associate with general hospitalisation rather than specifically with COVID- 19.Conclusions: Among participants tested for COVID-19 with presumed moderate to severe symptoms in a hospital setting, non-white ethnicity, male sex, and higher BMI are associated with a positive result.

Greater risk of severe COVID-19 in Black, Asian and Minority Ethnic populations is not explained by cardiometabolic, socioeconomic or behavioural factors, or by 25(OH)-vitamin D status: study of 1326 cases from the UK Biobank

“…These patterns are echoed across Europe, with Nordic countries reporting as much as 10× greater risk of COVID-19 in Somali populations 21 . We had previously documented this preponderance of cases amongst BAME individuals in our analysis of the initial UKB data release 16 ; here, we have confirmed the observation in this larger dataset, and importantly demonstrated a non-uniform impact across different BAME groups with highest rates amongst Black followed by Asian ethnicities.…”

“…UKB participants were grouped according to COVID-19 status: test positive, test negative and untested. In the analysis of an earlier data release, we demonstrated similar associations when comparing the untested cohort with both the test negatives and test positives, suggesting that comparison with the whole cohort reveals associations with general hospitalization rather than specifically with COVID-19 16 . Therefore, to avoid bias relating to hospitalization, in the present study, we limited to modelling within the tested cohort.…”

“…This study was covered by the ethics approval for UKB studies from the NHS National Research Ethics Service on 17 June 2011 (Ref 11 /NW/0382) and extended on 10 May 2016 (Ref 16 /NW/0274).…”

Individuals with obesity and COVID‐19: A global perspective on the epidemiology and biological relationships

“…Among patients with symptoms, those with severe or critical conditions had much higher BMIs and individuals with obesity prevalence than the normal population or patients who were COVID‐19 negative 32,61–70 . Two studies showed that the odds of having COVID‐19 increased by 30% (OR = 1.30; 95% CI, 1.09–1.54; p = 0.0030) 61 and by 38% (OR = 1.38; p < 0.0001), 32 respectively, among the individuals with obesity (Table 1).…”

Renin-Angiotensin System Inhibitors and COVID-19: a Systematic Review and Meta-Analysis. Evidence for Significant Geographical Disparities

“…Nine studies were conducted in Europe (UK, Italy, France, Spain, Belgium) [18][19][20][21][22][23][24][25][26], 7 studies took place in North America (the USA) [27][28][29][30][31][32][33], while 9 studies were conducted in Asia, mainly in China [31,[34][35][36][37][38][39][40][41]. Finally, we initially included in our quantitative synthesis a study utilizing data from an observational database from 169 hospitals in Asia, Europe, and North America, which was recently retracted and thus excluded from our analysis [42].…”