COVID-19 and associations with frailty and multimorbidity: a prospective analysis of UK Biobank participants

  1. S. J. Woolford
  2. S. D’Angelo
  3. E. M. Curtis
  4. C. M. Parsons
  5. K. A. Ward
  6. E. M. Dennison
  7. H. P. Patel
  8. C. Cooper
  9. N. C. Harvey

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Abstract

Background

Frailty and multimorbidity have been suggested as risk factors for severe COVID-19 disease.

Aims

We investigated, in the UK Biobank, whether frailty and multimorbidity were associated with risk of hospitalisation with COVID-19.

Methods

502,640 participants aged 40–69 years at baseline (54–79 years at COVID-19 testing) were recruited across UK during 2006–10. A modified assessment of frailty using Fried’s classification was generated from baseline data. COVID-19 test results (England) were available for 16/03/2020–01/06/2020, mostly taken in hospital settings. Logistic regression was used to discern associations between frailty, multimorbidity and COVID-19 diagnoses, after adjusting for sex, age, BMI, ethnicity, education, smoking and number of comorbidity groupings, comparing COVID-19 positive, COVID-19 negative and non-tested groups.

Results

4510 participants were tested for COVID-19 (positive = 1326, negative = 3184). 497,996 participants were not tested. Compared to the non-tested group, after adjustment, COVID-19 positive participants were more likely to be frail (OR = 1.4 [95%CI = 1.1, 1.8]), report slow walking speed (OR = 1.3 [1.1, 1.6]), report two or more falls in the past year (OR = 1.3 [1.0, 1.5]) and be multimorbid (≥ 4 comorbidity groupings vs 0–1: OR = 1.9 [1.5, 2.3]). However, similar strength of associations were apparent when comparing COVID-19 negative and non-tested groups. However, frailty and multimorbidity were not associated with COVID-19 diagnoses, when comparing COVID-19 positive and COVID-19 negative participants.

Discussion and conclusions

Frailty and multimorbidity do not appear to aid risk stratification, in terms of positive versus negative results of COVID-19 testing. Investigation of the prognostic value of these markers for adverse clinical sequelae following COVID-19 disease is urgently needed.

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  1. Version published to 10.1007/s40520-020-01653-6
  2. ScreenIT

    SciScore for 10.1101/2020.06.09.20126292: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: All UK Biobank participants gave written informed consent for data collection, analysis, and linkage at study recruitment.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All analyses were performed with Stata v 15.1 (StataCorp, College Station, Texas, USA).
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are several limitations to this study. Firstly, the characteristics of participants used to calculate frailty and multimorbidity status for this study were recorded at recruitment into the UK Biobank, between 2006 and 2010. As such, participants may have accumulated markers of frailty or additional comorbidities after initial data collection, and so may be misclassified in the present analysis. The population studied was also relatively young, in terms of the wider frail population, when age was recorded at baseline [21]. However, given that such attributes develop over time, participants were substantially older (50-84 years) at time of COVID-19 testing, and we additionally analysed by age strata. Secondly, the COVID-19 test results used in this study, which are only from England, are also subject to limitations. Given that the majority of tests were undertaken in hospital, we cannot comment on the associations for asymptomatic or low severity COVID-19 cases within the community. Furthermore, the sensitivity of PCR-based testing has been reported as lower than chest CT imaging, potentially due to low viral load at the time of testing or inappropriate testing technique [22,23]. Therefore, the number of COVID-19 positive diagnoses within our sample may be underrepresented. Thirdly, at the time of manuscript preparation, mortality data for those tested for COVID-19 are not yet available within the UK Biobank resource. As such, we cannot comment on the associations for fra...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.06.09.20126292v1 on medRxiv