Risk factors for SARS-CoV-2 among patients in the Oxford Royal College of General Practitioners Research and Surveillance Centre primary care network: a cross-sectional study

Abstract

Background There are few primary care studies of the COVID-19 pandemic. We aimed to identify demographic and clinical risk factors for testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within the Oxford Royal College of General Practitioners (RCGP) Research and Surveillance Centre primary care network. MethodsWe analysed routinely collected, pseudonymised data for patients in the RCGP Research and Surveillance Centre primary care sentinel network who were tested for SARS-CoV-2 between Jan 28 and April 4, 2020. We used multivariable logistic regression models with multiple imputation to identify risk factors for positive SARS-CoV-2 tests within this surveillance network. Findings We identified 3802 SARS-CoV-2 test results, of which 587 were positive. In multivariable analysis, male sex was independently associated with testing positive for SARS-CoV-2 (296 [18•4%] of 1612 men vs 291 [13•3%] of 2190 women; adjusted odds ratio [OR] 1•55, 95% CI 1•27-1•89). Adults were at increased risk of testing positive for SARS-CoV-2 compared with children, and people aged 40-64 years were at greatest risk in the multivariable model (243 [18•5%] of 1316 adults aged 40-64 years vs 23 [4•6%] of 499 children; adjusted OR 5•36, 95% CI 3•28-8•76). Compared with white people, the adjusted odds of a positive test were greater in black people (388 [15•5%] of 2497 white people vs 36 [62•1%] of 58 black people; adjusted OR 4•75, 95% CI 2•65-8•51). People living in urban areas versus rural areas (476 [26•2%] of 1816 in urban areas vs 111 [5•6%] of 1986 in rural areas; adjusted OR 4•59, 95% CI 3•57-5•90) and in more deprived areas (197 [29•5%] of 668 in most deprived vs 143 [7•7%] of 1855 in least deprived; adjusted OR 2•03, 95% CI 1•51-2•71) were more likely to test positive. People with chronic kidney disease were more likely to test positive in the adjusted analysis (68 [32•9%] of 207 with chronic kidney disease vs 519 [14•4%] of 3595 without; adjusted OR 1•91, 95% CI 1•31-2•78), but there was no significant association with other chronic conditions in that analysis. We found increased odds of a positive test among people who are obese (142 [20•9%] of 680 people with obesity vs 171 [13•2%] of 1296 normal-weight people; adjusted OR 1•41, 95% CI 1•04-1•91). Notably, active smoking was linked with decreased odds of a positive test result (47 [11•4%] of 413 active smokers vs 201 [17•9%] of 1125 non-smokers; adjusted OR 0•49, 95% CI 0•34-0•71). Interpretation A positive SARS-CoV-2 test result in this primary care cohort was associated with similar risk factors as observed for severe outcomes of COVID-19 in hospital settings, except for smoking. We provide evidence of potential sociodemographic factors associated with a positive test, including deprivation, population density, ethnicity, and chronic kidney disease. Funding Wellcome Trust.

Prior presumed coronavirus infection reduces COVID-19 risk: A cohort study

“…In accordance, our analysis identified several diagnostic categories that are significantly positively associated with a positive SARS-CoV-2 PCR test result, including diabetes, heart disease, obesity, and anemia, all of which others have also found to be associated with increased risk of COVID-19 hospitalizations ( Figure 2 A and Supplementary Table 1). 25 Relevant to our hypothesis, we observed several diagnostic categories negatively associated with positive SARS-CoV-2 PCR test results, including actinic keratosis, ear and upper respiratory tract infection, and anxiety disorders ( Figure 2 A). When we analyzed specific ICD-10 codes, we found that conditions sometimes caused by CCC, including acute sinusitis and acute bronchitis and acute pharyngitis, were most significant ( Figure 2 B and Supplementary Table 2).…”

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

“…We identified 20 studies that assessed the association between individuals with obesity and COVID‐19, all but two of which showed that individuals with obesity significantly increase the risk of COVID‐19 (Table S3). 25–43 One study in Denmark showed that the prevalence of overweight and individuals with obesity was lower in SARS‐CoV‐2 positive cases than SARS‐CoV‐2 test‐negative individuals (8.6% vs. 9.9%) 44 . The results may be biased because body weight status was determined at hospital discharge.…”

Excess mortality in the first COVID pandemic peak: cross-sectional analyses of the impact of age, sex, ethnicity, household size, and long-term conditions in people of known SARS-CoV-2 status in England

“…Other variables included: age; sex; socioeconomic status using the index of multiple deprivation (IMD), based on lower super output area (LSOA) — a geographical subunit with a minimum population of 1000 — divided into quintiles; 13 ethnicity divided into white, Asian, black, mixed, and others; 14 and household size; determined using a pseudonymised household key based on identical address, this has been used in other studies. 10 , 15 , 16 smoking status (comparing current, ex- and non-smokers); obesity (using the World Health Organization categorisation of overweight [body mass index {BMI} = 25–29 kg/m 2 ]; obese [BMI = 30–34 kg/m 2 ]; and severely obese [BMI≥35 kg/m 2 ]; and population density (based on ONS locality data). 17 The highest population density was in ‘conurbations’, medium levels in ‘city and town’, and lowest density in ‘rural areas’.…”

“…household size; determined using a pseudonymised household key based on identical address, this has been used in other studies. 10 , 15 , 16 …”

“… 8 The role of Oxford RCGP RSC has evolved to support SARS-CoV-2 surveillance during the pandemic. 9 Across the whole sentinel network ( n = 4 413 734) between 28 January and 4 April 2020, 3802 tests were recorded, 10 with the number rising to >11 000 by the end of this study period. Establishing SARS-CoV-2 status has become progressively easier as more testing has become available.…”