Risk factors for positive and negative COVID-19 tests: a cautious and in-depth analysis of UK biobank data.
Identifieur interne : 000712 ( Main/Exploration ); précédent : 000711; suivant : 000713Risk factors for positive and negative COVID-19 tests: a cautious and in-depth analysis of UK biobank data.
Auteurs : Marc Chadeau-Hyam [Royaume-Uni] ; Barbara Bodinier [Royaume-Uni] ; Joshua Elliott [Royaume-Uni] ; Matthew D. Whitaker [Royaume-Uni] ; Ioanna Tzoulaki [Royaume-Uni, Grèce] ; Roel Vermeulen [Pays-Bas] ; Michelle Kelly-Irving [France] ; Cyrille Delpierre [France] ; Paul Elliott [Royaume-Uni]Source :
- International journal of epidemiology [ 1464-3685 ] ; 2020.
Abstract
BACKGROUND
The recent COVID-19 outbreak has generated an unprecedented public health crisis, with millions of infections and hundreds of thousands of deaths worldwide. Using hospital-based or mortality data, several COVID-19 risk factors have been identified, but these may be confounded or biased.
METHODS
Using SARS-CoV-2 infection test data (n = 4509 tests; 1325 positive) from Public Health England, linked to the UK Biobank study, we explored the contribution of demographic, social, health risk, medical and environmental factors to COVID-19 risk. We used multivariable and penalized logistic regression models for the risk of (i) being tested, (ii) testing positive/negative in the study population and, adopting a test negative design, (iii) the risk of testing positive within the tested population.
RESULTS
In the fully adjusted model, variables independently associated with the risk of being tested for COVID-19 with odds ratio >1.05 were: male sex; Black ethnicity; social disadvantage (as measured by education, housing and income); occupation (healthcare worker, retired, unemployed); ever smoker; severely obese; comorbidities; and greater exposure to particulate matter (PM) 2.5 absorbance. Of these, only male sex, non-White ethnicity and lower educational attainment, and none of the comorbidities or health risk factors, were associated with testing positive among tested individuals.
CONCLUSIONS
We adopted a careful and exhaustive approach within a large population-based cohort, which enabled us to triangulate evidence linking male sex, lower educational attainment and non-White ethnicity with the risk of COVID-19. The elucidation of the joint and independent effects of these factors is a high-priority area for further research to inform on the natural history of COVID-19.
DOI: 10.1093/ije/dyaa134
PubMed: 32814959
PubMed Central: PMC7454561
Affiliations:
- France, Grèce, Pays-Bas, Royaume-Uni
- Angleterre, Grand Londres, Midi-Pyrénées, Occitanie (région administrative), Utrecht (province)
- Londres, Toulouse, Utrecht
- Université d'Utrecht
Links toward previous steps (curation, corpus...)
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type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation><affiliation wicri:level="3"><nlm:affiliation>MRC Centre for Environment and Health, Imperial College, London, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>MRC Centre for Environment and Health, Imperial College, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Bodinier, Barbara" sort="Bodinier, Barbara" uniqKey="Bodinier B" first="Barbara" last="Bodinier">Barbara Bodinier</name><affiliation wicri:level="3"><nlm:affiliation>Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation><affiliation wicri:level="3"><nlm:affiliation>MRC Centre for Environment and Health, Imperial College, London, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>MRC Centre for Environment and Health, Imperial College, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Elliott, Joshua" sort="Elliott, Joshua" uniqKey="Elliott J" first="Joshua" last="Elliott">Joshua Elliott</name><affiliation wicri:level="3"><nlm:affiliation>Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation><affiliation wicri:level="3"><nlm:affiliation>MRC Centre for Environment and Health, Imperial College, London, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>MRC Centre for Environment and Health, Imperial College, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation><affiliation wicri:level="1"><nlm:affiliation>Royal Surrey County Hospital, Guildford, Surrey, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Royal Surrey County Hospital, Guildford, Surrey</wicri:regionArea><wicri:noRegion>Surrey</wicri:noRegion></affiliation></author><author><name sortKey="Whitaker, Matthew D" sort="Whitaker, Matthew D" uniqKey="Whitaker M" first="Matthew D" last="Whitaker">Matthew D. Whitaker</name><affiliation wicri:level="3"><nlm:affiliation>Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation><affiliation wicri:level="3"><nlm:affiliation>MRC Centre for Environment and Health, Imperial College, London, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>MRC Centre for Environment and Health, Imperial College, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Tzoulaki, Ioanna" sort="Tzoulaki, Ioanna" uniqKey="Tzoulaki I" first="Ioanna" last="Tzoulaki">Ioanna Tzoulaki</name><affiliation wicri:level="3"><nlm:affiliation>Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation><affiliation wicri:level="3"><nlm:affiliation>MRC Centre for Environment and Health, Imperial College, London, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>MRC Centre for Environment and Health, Imperial College, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation><affiliation wicri:level="1"><nlm:affiliation>Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece.</nlm:affiliation><country xml:lang="fr">Grèce</country><wicri:regionArea>Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina</wicri:regionArea><wicri:noRegion>Ioannina</wicri:noRegion></affiliation></author><author><name sortKey="Vermeulen, Roel" sort="Vermeulen, Roel" uniqKey="Vermeulen R" first="Roel" last="Vermeulen">Roel Vermeulen</name><affiliation wicri:level="4"><nlm:affiliation>Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands.</nlm:affiliation><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht</wicri:regionArea><placeName><settlement type="city">Utrecht</settlement><region nuts="2" type="province">Utrecht (province)</region></placeName><orgName type="university">Université d'Utrecht</orgName></affiliation></author><author><name sortKey="Kelly Irving, Michelle" sort="Kelly Irving, Michelle" uniqKey="Kelly Irving M" first="Michelle" last="Kelly-Irving">Michelle Kelly-Irving</name><affiliation wicri:level="3"><nlm:affiliation>UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse</wicri:regionArea><placeName><region type="region">Occitanie (région administrative)</region><region type="old region">Midi-Pyrénées</region><settlement type="city">Toulouse</settlement></placeName></affiliation></author><author><name sortKey="Delpierre, Cyrille" sort="Delpierre, Cyrille" uniqKey="Delpierre C" first="Cyrille" last="Delpierre">Cyrille Delpierre</name><affiliation wicri:level="3"><nlm:affiliation>UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse</wicri:regionArea><placeName><region type="region">Occitanie (région administrative)</region><region type="old region">Midi-Pyrénées</region><settlement type="city">Toulouse</settlement></placeName></affiliation></author><author><name sortKey="Elliott, Paul" sort="Elliott, Paul" uniqKey="Elliott P" first="Paul" last="Elliott">Paul Elliott</name><affiliation wicri:level="3"><nlm:affiliation>Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation><affiliation wicri:level="3"><nlm:affiliation>MRC Centre for Environment and Health, Imperial College, London, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>MRC Centre for Environment and Health, Imperial College, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author></analytic><series><title level="j">International journal of epidemiology</title><idno type="eISSN">1464-3685</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>The recent COVID-19 outbreak has generated an unprecedented public health crisis, with millions of infections and hundreds of thousands of deaths worldwide. Using hospital-based or mortality data, several COVID-19 risk factors have been identified, but these may be confounded or biased.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>Using SARS-CoV-2 infection test data (n = 4509 tests; 1325 positive) from Public Health England, linked to the UK Biobank study, we explored the contribution of demographic, social, health risk, medical and environmental factors to COVID-19 risk. We used multivariable and penalized logistic regression models for the risk of (i) being tested, (ii) testing positive/negative in the study population and, adopting a test negative design, (iii) the risk of testing positive within the tested population.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>In the fully adjusted model, variables independently associated with the risk of being tested for COVID-19 with odds ratio >1.05 were: male sex; Black ethnicity; social disadvantage (as measured by education, housing and income); occupation (healthcare worker, retired, unemployed); ever smoker; severely obese; comorbidities; and greater exposure to particulate matter (PM) 2.5 absorbance. Of these, only male sex, non-White ethnicity and lower educational attainment, and none of the comorbidities or health risk factors, were associated with testing positive among tested individuals.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>We adopted a careful and exhaustive approach within a large population-based cohort, which enabled us to triangulate evidence linking male sex, lower educational attainment and non-White ethnicity with the risk of COVID-19. The elucidation of the joint and independent effects of these factors is a high-priority area for further research to inform on the natural history of COVID-19.</p></div></front></TEI><pubmed><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">32814959</PMID><DateRevised><Year>2020</Year><Month>09</Month><Day>01</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1464-3685</ISSN><JournalIssue CitedMedium="Internet"><PubDate><Year>2020</Year><Month>Aug</Month><Day>20</Day></PubDate></JournalIssue><Title>International journal of epidemiology</Title><ISOAbbreviation>Int J Epidemiol</ISOAbbreviation></Journal><ArticleTitle>Risk factors for positive and negative COVID-19 tests: a cautious and in-depth analysis of UK biobank data.</ArticleTitle><ELocationID EIdType="pii" ValidYN="Y">dyaa134</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1093/ije/dyaa134</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">The recent COVID-19 outbreak has generated an unprecedented public health crisis, with millions of infections and hundreds of thousands of deaths worldwide. Using hospital-based or mortality data, several COVID-19 risk factors have been identified, but these may be confounded or biased.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">Using SARS-CoV-2 infection test data (n = 4509 tests; 1325 positive) from Public Health England, linked to the UK Biobank study, we explored the contribution of demographic, social, health risk, medical and environmental factors to COVID-19 risk. We used multivariable and penalized logistic regression models for the risk of (i) being tested, (ii) testing positive/negative in the study population and, adopting a test negative design, (iii) the risk of testing positive within the tested population.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">In the fully adjusted model, variables independently associated with the risk of being tested for COVID-19 with odds ratio >1.05 were: male sex; Black ethnicity; social disadvantage (as measured by education, housing and income); occupation (healthcare worker, retired, unemployed); ever smoker; severely obese; comorbidities; and greater exposure to particulate matter (PM) 2.5 absorbance. Of these, only male sex, non-White ethnicity and lower educational attainment, and none of the comorbidities or health risk factors, were associated with testing positive among tested individuals.</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">We adopted a careful and exhaustive approach within a large population-based cohort, which enabled us to triangulate evidence linking male sex, lower educational attainment and non-White ethnicity with the risk of COVID-19. The elucidation of the joint and independent effects of these factors is a high-priority area for further research to inform on the natural history of COVID-19.</AbstractText><CopyrightInformation>© The Author(s) 2020. Published by Oxford University Press on behalf of the International Epidemiological Association.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Chadeau-Hyam</LastName><ForeName>Marc</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>MRC Centre for Environment and Health, Imperial College, London, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Bodinier</LastName><ForeName>Barbara</ForeName><Initials>B</Initials><AffiliationInfo><Affiliation>Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>MRC Centre for Environment and Health, Imperial College, London, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Elliott</LastName><ForeName>Joshua</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>MRC Centre for Environment and Health, Imperial College, London, UK.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Royal Surrey County Hospital, Guildford, Surrey, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Whitaker</LastName><ForeName>Matthew D</ForeName><Initials>MD</Initials><AffiliationInfo><Affiliation>Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>MRC Centre for Environment and Health, Imperial College, London, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Tzoulaki</LastName><ForeName>Ioanna</ForeName><Initials>I</Initials><AffiliationInfo><Affiliation>Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>MRC Centre for Environment and Health, Imperial College, London, UK.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Vermeulen</LastName><ForeName>Roel</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kelly-Irving</LastName><ForeName>Michelle</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Delpierre</LastName><ForeName>Cyrille</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Elliott</LastName><ForeName>Paul</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>MRC Centre for Environment and Health, Imperial College, London, UK.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>08</Month><Day>20</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Int J Epidemiol</MedlineTA><NlmUniqueID>7802871</NlmUniqueID><ISSNLinking>0300-5771</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">COVID-19</Keyword><Keyword MajorTopicYN="N">SARS-CoV-2</Keyword><Keyword MajorTopicYN="N">UK Biobank</Keyword><Keyword MajorTopicYN="N">infection</Keyword><Keyword MajorTopicYN="N">prospective cohort</Keyword><Keyword MajorTopicYN="N">test data</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="accepted"><Year>2020</Year><Month>07</Month><Day>02</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>8</Month><Day>21</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate 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