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

  1. Zahra Raisi-Estabragh
  2. Celeste McCracken
  3. Maddalena Ardissino
  4. Mae S Bethell
  5. Jackie Cooper
  6. Cyrus Cooper
  7. Nicholas C Harvey
  8. Steffen E Petersen

Reviewed by

Read the full article See related articles

Listed in

Log in to save this article

Abstract

Background: Cardiometabolic morbidity and medications, specifically Angiotensin Converting Enzyme inhibitors (ACEi) and Angiotensin Receptor Blockers (ARBs), have been linked with adverse outcomes from coronavirus disease 2019 (COVID-19). 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. Other cardiometabolic morbidities confer increased risk of hospitalisation, without specificity for COVID-19. Notably, ACE/ARB use did not associate with COVID-19 status.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2020.05.10.20096925: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    URL https://www.R-project.org/], and RStudio Version 1.2.5019
    RStudio
    suggested: (RStudio, RRID:SCR_000432)

    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:
    Strengths and Limitations: The UK Biobank is a comprehensive data source, incorporating a large sample with linkages to prospectively tracked health outcomes recorded in a standardised manner using ICD codes, enabling reliable and up-to-date definition of morbidities. The rapid release of COVID-19 testing data provides a huge opportunity to examine association of a large number of exposures with COVID-19 status and outcomes. As this was the very first release of this data, the COVID-19 positive caseload was low; this dataset is continuously updated and there may be opportunity in the future to consider a wider range of exposures in larger samples. The low number of COVID-19 cases reflects both the UK national testing policy, in accordance with which individuals not requiring hospital admission were not tested, and the novelty of the disease that precludes any sources of long-term data collection. Due to the observational study design, we cannot comment on causal relationships from the results, however, the prospective nature of the study ensures confident temporal separation of exposure and outcome. Finally, the aforementioned testing policy in act during the time of data collection presents a further limitation to the study. Individuals who were infected with COVID-19 will only have been tested if they were unwell enough to present to hospital; the ‘positive’ cohort thus mostly represents cases of moderate or high severity. Therefore, whilst this selective approach to testin...

    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

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.05.10.20096925v1 on medRxiv