Rapid Epidemiological Analysis of Comorbidities and Treatments as risk factors for COVID-19 in Scotland (REACT-SCOT): A population-based case-control study

McKeigue, Paul; Weir, Alan; Bishop, Jen; McGurnaghan, Stuart J.; Kennedy, Sharon; McAllister, David A; Robertson, Chris; Wood, Rachael; Lone, Nazir; Murray, Janet Horowitz; Caparrotta, Thomas M.; Smith‐Palmer, Alison; Goldberg, David J.; McMenamin, Jim; Ramsay, Colin N.; Hutchinson, Sharon; Colhoun, Helen M.

doi:10.1371/journal.pmed.1003374

Cited by 73 publications

(109 citation statements)

References 12 publications

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“… 26 In the English National Audit cohort, 13 , 14 the risk ratio of COVID-19 death for type 1 diabetes was 3·51 and for type 2 it was 2·03; these were attenuated in White people (3·06 for type 1 and 1·91 for type 2). In a matched case control study 27 of the total population of Scotland from earlier in the pandemic and not including cases derived solely from hospital admissions (which were not yet available), we reported slightly higher conditional ORs of 2·75 (95% CI 1·96–3·88) for type 1 diabetes and 1·60 (1·48–1·74) for type 2 diabetes. All these studies are therefore consistent in finding elevations in risk for type 1 and type 2 diabetes in the same range.…”

Section: Discussionmentioning

confidence: 75%

Risks of and risk factors for COVID-19 disease in people with diabetes: a cohort study of the total population of Scotland

McGurnaghan

Weir

Bishop

et al. 2021

The Lancet Diabetes & Endocrinology

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288

258

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Background We aimed to ascertain the cumulative risk of fatal or critical care unit-treated COVID-19 in people with diabetes and compare it with that of people without diabetes, and to investigate risk factors for and build a crossvalidated predictive model of fatal or critical care unit-treated COVID-19 among people with diabetes. MethodsIn this cohort study, we captured the data encompassing the first wave of the pandemic in Scotland, from March 1, 2020, when the first case was identified, to July 31, 2020, when infection rates had dropped sufficiently that shielding measures were officially terminated. The participants were the total population of Scotland, including all people with diabetes who were alive 3 weeks before the start of the pandemic in Scotland (estimated Feb 7, 2020). We ascertained how many people developed fatal or critical care unit-treated COVID-19 in this period from the Electronic Communication of Surveillance in Scotland database (on virology), the RAPID database of daily hospitalisations, the Scottish Morbidity Records-01 of hospital discharges, the National Records of Scotland death registrations data, and the Scottish Intensive Care Society and Audit Group database (on critical care). Among people with fatal or critical care unit-treated COVID-19, diabetes status was ascertained by linkage to the national diabetes register, Scottish Care Information Diabetes. We compared the cumulative incidence of fatal or critical care unit-treated COVID-19 in people with and without diabetes using logistic regression. For people with diabetes, we obtained data on potential risk factors for fatal or critical care unit-treated COVID-19 from the national diabetes register and other linked health administrative databases. We tested the association of these factors with fatal or critical care unit-treated COVID-19 in people with diabetes, and constructed a prediction model using stepwise regression and 20-fold cross-validation. Findings Of the total Scottish population onMarch 1, 2020 (n=5 463 300), the population with diabetes was 319 349 (5•8%), 1082 (0•3%) of whom developed fatal or critical care unit-treated COVID-19 by July 31, 2020, of whom 972 (89•8%) were aged 60 years or older. In the population without diabetes, 4081 (0•1%) of 5 143 951 people developed fatal or critical care unit-treated COVID-19. As of July 31, the overall odds ratio (OR) for diabetes, adjusted for age and sex, was 1•395 (95% CI 1•304-1•494; p<0•0001, compared with the risk in those without diabetes. The OR was 2•396 (1•815-3•163; p<0•0001) in type 1 diabetes and 1•369 (1•276-1•468; p<0•0001) in type 2 diabetes. Among people with diabetes, adjusted for age, sex, and diabetes duration and type, those who developed fatal or critical care unit-treated COVID-19 were more likely to be male, live in residential care or a more deprived area, have a COVID-19 risk condition, retinopathy, reduced renal function, or worse glycaemic control, have had a diabetic ketoacidosis or hypoglycaemia hospitalisation in the past 5 years, be on more...

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Section: Discussionmentioning

confidence: 75%

Risks of and risk factors for COVID-19 disease in people with diabetes: a cohort study of the total population of Scotland

McGurnaghan

Weir

Bishop

et al. 2021

The Lancet Diabetes & Endocrinology

Self Cite

288

258

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“…Across the entire Scottish population, 6346 hospital admissions with covid-19 occurred (table 2 and supplementary figure B). REACT-COVID-19 included clinical data on all these cases and 10 randomly selected controls for each case (supplementary figure B) 10. Of 6346 hospital admissions with covid-19 in Scotland, 33% (n=2097) occurred in the working age population (18-65 years).…”

Section: Resultsmentioning

confidence: 99%

“…In the case-control study, we did conditional logistic regression. As REACT-COVID-19 used incidence density sampling,10 the effect measure estimates derived from these case-control analysis are directly comparable to those derived from the Cox regression. To allow comparison against the general population across the cohort and case-control analyses, we used the non-patient facing role as a common reference group.…”

Section: Methodsmentioning

confidence: 96%

“…Finally, we appended selected variables from the healthcare worker and household member data to an existing Scottish case-control study, REACT-COVID-19 10. REACT-COVID-19 included linked patient data (excluding healthcare worker and household member status) of all cases with a positive SARS-CoV-2 test or covid-19 as a cause of death on certification in Scotland.…”

Section: Methodsmentioning

confidence: 99%

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Risk of hospital admission with coronavirus disease 2019 in healthcare workers and their households: nationwide linkage cohort study

Shah

Wood

Gribben

et al. 2020

BMJ

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302

282

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ObjectiveTo assess the risk of hospital admission for coronavirus disease 2019 (covid-19) among patient facing and non-patient facing healthcare workers and their household members.DesignNationwide linkage cohort study.SettingScotland, UK, 1 March to 6 June 2020.ParticipantsHealthcare workers aged 18-65 years, their households, and other members of the general population.Main outcome measureAdmission to hospital with covid-19.ResultsThe cohort comprised 158 445 healthcare workers, most of them (90 733; 57.3%) being patient facing, and 229 905 household members. Of all hospital admissions for covid-19 in the working age population (18-65 year olds), 17.2% (360/2097) were in healthcare workers or their households. After adjustment for age, sex, ethnicity, socioeconomic deprivation, and comorbidity, the risk of admission due to covid-19 in non-patient facing healthcare workers and their households was similar to the risk in the general population (hazard ratio 0.81 (95% confidence interval 0.52 to 1.26) and 0.86 (0.49 to 1.51), respectively). In models adjusting for the same covariates, however, patient facing healthcare workers, compared with non-patient facing healthcare workers, were at higher risk (hazard ratio 3.30, 2.13 to 5.13), as were household members of patient facing healthcare workers (1.79, 1.10 to 2.91). After sub-division of patient facing healthcare workers into those who worked in “front door,” intensive care, and non-intensive care aerosol generating settings and other, those in front door roles were at higher risk (hazard ratio 2.09, 1.49 to 2.94). For most patient facing healthcare workers and their households, the estimated absolute risk of hospital admission with covid-19 was less than 0.5%, but it was 1% and above in older men with comorbidity.ConclusionsHealthcare workers and their households contributed a sixth of covid-19 cases admitted to hospital. Although the absolute risk of admission was low overall, patient facing healthcare workers and their household members had threefold and twofold increased risks of admission with covid-19.

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“…In initial analysis of a matched case-control study of risk factors for severe COVID-19 in Scotland (REACT-SCOT), we reported a strong association of severe COVID-19 with dispensing of at least one prescription in the past year [ 3 ]. The univariate rate ratios associated with at least one prescription varied from 3.8 in those aged under 60 years to 2.3 in those aged 75 years and over.…”

Section: Introductionmentioning

confidence: 99%

Relation of severe COVID-19 to polypharmacy and prescribing of psychotropic drugs: the REACT-SCOT case-control study

Kennedy

Weir

Bishop

et al. 2021

BMC Med

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Background The objective of this study was to investigate the relation of severe COVID-19 to prior drug prescribing. Methods Severe cases were defined by entry to critical care or fatal outcome. For this matched case-control study (REACT-SCOT), all 4251 cases of severe COVID-19 in Scotland since the start of the epidemic were matched for age, sex and primary care practice to 36,738 controls from the population register. Records were linked to hospital discharges since June 2015 and dispensed prescriptions issued in primary care during the last 240 days. Results Severe COVID-19 was strongly associated with the number of non-cardiovascular drug classes dispensed. This association was strongest in those not resident in a care home, in whom the rate ratio (95% CI) associated with dispensing of 12 or more drug classes versus none was 10.8 (8.8, 13.3), and in those without any of the conditions designated as conferring increased risk of COVID-19. Of 17 drug classes postulated at the start of the epidemic to be “medications compromising COVID”, all were associated with increased risk of severe COVID-19 and these associations were present in those without any of the designated risk conditions. The fraction of cases in the population attributable to exposure to these drug classes was 38%. The largest effect was for antipsychotic agents: rate ratio 4.18 (3.42, 5.11). Other drug classes with large effects included proton pump inhibitors (rate ratio 2.20 (1.72, 2.83) for = 2 defined daily doses/day), opioids (3.66 (2.68, 5.01) for = 50 mg morphine equivalent/day) and gabapentinoids. These associations persisted after adjusting for covariates and were stronger with recent than with non-recent exposure. Conclusions Severe COVID-19 is associated with polypharmacy and with drugs that cause sedation, respiratory depression, or dyskinesia; have anticholinergic effects; or affect the gastrointestinal system. These associations are not easily explained by co-morbidity. Measures to reduce the burden of mortality and morbidity from COVID-19 should include reinforcing existing guidance on reducing overprescribing of these drug classes and limiting inappropriate polypharmacy. Registration ENCEPP number https://EUPAS35558

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Rapid Epidemiological Analysis of Comorbidities and Treatments as risk factors for COVID-19 in Scotland (REACT-SCOT): A population-based case-control study

Cited by 73 publications

References 12 publications

Risks of and risk factors for COVID-19 disease in people with diabetes: a cohort study of the total population of Scotland

Risks of and risk factors for COVID-19 disease in people with diabetes: a cohort study of the total population of Scotland

Risk of hospital admission with coronavirus disease 2019 in healthcare workers and their households: nationwide linkage cohort study

Relation of severe COVID-19 to polypharmacy and prescribing of psychotropic drugs: the REACT-SCOT case-control study

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