Providing choice in pulmonary rehabilitation

Introduction/Aim: Pulmonary rehabilitation (PR) is a vital component in the management of chronic respiratory disorders (CRDs). New models of delivering PR are emerging to increase the uptake and completion of this important intervention. The aim of this study is to evaluate participant rate of attendance to PR delivered via two different delivery modes (centre based and mobile technology (mPR)). Secondary aims are to evaluate the patient preference for mode of delivery, and if mPR is non -inferior to centre-based PR in health outcomes. Method(s): A multi-centre, two-arm parallel preference based clinical trial was conducted. Participants with a chronic respiratory disorder referred for PR were offered the choice of centre-based or web-based (mPR) PR. Both programmes were 8 weeks in duration. The primary outcome was attendance. Result(s): 105 participants were recruited to the study with 67 opting for centre-based and 38 preferring web-based PR (mPR). The attendance rate was higher in the centre-based group than mPR. Results showed mPR was not inferior in terms of changes in symptom scores (CAT) or time spent in sedentary behaviour (SBQ) but inferiority could not be confirmed for changes in dyspnoea scores (mMRC) or health related quality of life (EQ5D-3L). Changes in exercise capacity could not be determined due to COVID-19 restrictions. Conclusion(s): This pragmatic study has shown that mPR was preferred by 38% of participants and a significant percentage were younger, working, with higher education inferring the demand will likely increase over time. The attendance rate with mPR was lower than anticipated. Further research with larger sample size is required to assess efficacy of mPR.

Navigating digital inclusion and the digital vā among Niue mamatua through the provision of mobile phones during COVID-19

Technology and digital platforms have become essential for people and communities to interact because of COVID-19. Despite its benefits, digital exclusion disproportionately affects Pacific communities living in New Zealand. This article provides insights into how Niue mamatua (older adults) used their gifted mobile phones and mobile data as part of a COVID-19 digital inclusion initiative. It begins with an overview of the digital inclusion needs of older adults, followed by a description of the digital vā (relational space) and negotiating a new way of maintaining connection in an online world. The tutala (a Niue method of conversation anchored on respect) with 12 mamatua highlighted the benefits, support factors, and challenges of how they were able to use their mobile phone. Importantly, mobile phones provided the necessary access and connectivity to interact in a digitally connected world, namely the digital vā, when in-person connections were disrupted because of COVID-19. © The Author(s) 2023.

COVID-19 humoral and T-cell mediated vaccination responses in people with multiple sclerosis

Background: For people living with MS (pwMS) the impact of disease modifying treatments (DMT) on vaccine efficacy has been a growing concern. Method(s): We used remote sampling to assess humoral response using dried blood spot (DBS) and ELISA for anti-SARS-CoV-2 IgG and performed T-cell analysis on a selection of participants. Compliance rates were maintained at ~70% post each vaccination time-point and DBS quality rates improved across the time frame of the study. Result(s): The cohort consisted of 184 participants who could be grouped by DMT into;anti-CD20 (40%), fingolimod (8%) and all other DMT/no DMT (52%).The primary vaccination course was Oxford/AstraZeneca for 61% and Pfizer-BioNTech for the remainder. Post-v2 76/110 (69%) of participants had seroconverted, increasing to 131/173 (76%) post v3. Vaccine response was influenced by DMT. After v2 13/38 (34%) of participants on anti-CD20 and 1/9 (11%) on fingolimod seroconverted compared to 63/63 (100%) of those on other/no DMT. Lower vaccine responses were seen post-v2 in those on anti- CD20;6.6 BAU/ml (IQR 63) and fingolimod;9.9 BAU/ml (IQR 9) compared to all other/no DMT;326.7 BAU/ml (IQR 535), p<0.001. In v2 responders successive vaccinations further increased response. A median of 313 BAU/ml (IQR 440) was found post v2, increasing to 936 BAU/ml (IQR 1362) at v3 and 1559 BAU/ml (IQR 1374) at v4, p<0.001. Amongst v2 non-responders third vaccinations increased seroconversion. 9/32 (28%) of v2 non-responders seroconverted after v3;3/23 (13%) of these were on anti-CD20 and 5/9 (56%) were on fingolimod. T-cell responses were found in the majority of individuals regardless of seroconversion status. All 14 anti-CD20 participants tested had a positive T-cell response at v3. Preliminary evidence suggests that T-cell response is sustained for at least 6 months post vaccination. Conclusion(s): DMT influences both seroconversion and antibody titre in response to vaccination. Additional vaccination courses post-v2 result in increased titre, and even in those who failed to seroconvert after v2, increase chance of seroconversion. Amongst those who fail to show a humoral response, a T-cell response is evident in the majority.

Humoral and T- cell response to multiple COVID-19 booster vaccinations in people with MS

Introduction: People with multiple sclerosis (PwMS) treated with anti-CD20 therapies and fingolimod are less likely to successfully produce a humoral response to COVID-19 vaccines 1 and 2. Objective(s): To measure the humoral and/or cellular response to COVID-19 booster vaccinations in a cohort of PwMS who were previously seronegative after their initial COVID vaccine course. Aim(s): To determine whether there is a benefit of COVID-19 booster vaccinations for people with MS who are known to have had an attenuated response to initial vaccines. Method(s): We studied a cohort of PwMS all of whom were seronegative for anti-SARS-CoV-2 spike protein IgG after the 1st and 2nd COVID-19 vaccines, including PwMS treated with ocrelizumab (n=53), fingolimod (n=15), other DMTs (n=9) and no DMT (n=2). Dried blood spot +/- whole blood samples were obtained from participants at 2-8 weeks after their 3rd (n=79) and 4th (n=40) COVID-19 vaccines. Samples were used to measure anti-SARS-CoV-2 spike protein IgG (ELISA) and T-cell response (IFN-g release assay measured on whole blood). Result(s): Overall 27/79 (34%) who were seronegative after COVID vaccine 2 seroconverted after vaccine 3. Seroconversion rates were 17% for PwMS treated with ocrelizumab, 47% for fingolimod and 100% for other DMTs. A further 2/30 (7%) of those who remained seronegative after vaccine 3 seroconverted after vaccine 4. Anti-SARS-CoV-2 T-cell responses were measurable in 26/40 (65%) after vaccine 3 and 13/19 (68%) after vaccine 4 but were conspicuously absent in people treated with fingolimod. Overall, 75% of participants showed either humoral or cellular response after receiving 4 COVID vaccinations. PwMS with laboratory evidence of prior COVID-19 infection had higher measurable T-cell responses. Conclusion(s): Booster vaccinations for COVID-19 are associated with incremental benefits in measurable immunity in those with attenuated responses to the initial vaccine course. Overall, three quarters of those who were seronegative after COVID vaccines 1 & 2 had a measurable immune response after COVID vaccine 4. This data supports the use of booster vaccinations in pwMS at risk of attenuated vaccine response.

Capturing qualitative follow up data in a "real-world" study to assess disease modifying therapy use in the multiple sclerosis population before the pandemic and after: an update from the OPTIMISE:MS pharmacovigilance study

Introduction: Therapeutic disease modifying therapy options in the Multiple Sclerosis population have increased rapidly, but qualitative "real-world" follow up data is limited across many clinical trials being conducted. The OPTIMISE:MS pharmacovigilance study follows patients up for 7 years. Aim(s): "Real-world" observational data was collected from 14 participating sites located in the UK and Scotland. Participating study centres aimed to recruit all patients who are able and willing to provide consent to the inclusion criteria of the study. We wanted to determine what proportion of patients had completed follow up visits and had their data entered onto the study database pre and post the COVID-19 pandemic to date. Method(s): OPTIMISE:MS is a "real-world" longitudinal 7 year observational study recruiting 4000 patients with Multiple Sclerosis nationally from the UK and Scotland.All patients enrolled as of 30th April 2022 completed their baseline (n=2507) and at least 1 follow up visit (n=1254) for the study. Result(s): 1852 (73%) participants in OPTIMISE:MS are female with age range 18-82 (mean 43.8, SD 10.96) and 671 (27%) participants were male. The majority are of White ethnicity (1970, 78%), with a substantial minority from other ethnic groups. 2346 (94%) have RRMS with a mean time since diagnosis 8.5 years (SD 7.62). The DMT class history at baseline for all patients enrolled onto the study showed that 1130 (45%) were on second generation DMTs when compared to 807 (32%) of patients with no currently taking a DMT. The time (years) since the diagnosis of MS was <5 years in n=1029 (41%) patients. The highest prescribed DMTs documented at the first follow up visit of patients between 2019 and 2022 was Natalizumab (Tysabri) (n=10385) and Dimethyl fumarate (Tecfidera) (n=5406) that was the second highest.When assessing the lowest prescribed DMT for the same time period, Siponimod (n=6) and Interferon beta-1b (Betaferon (n=35) were documented. Conclusion(s): The results showed the frequency of follow up visits that had been carried out on the OPTIMISE:MS study for patients recruited to date.The data showed that more work has to be done to ensure that participating sites consistently update the follow up records of their patient cohorts in a timely manner.The OPTIMISE:MS study remained open throughout the pandemic and it was encouraging to see that the DMT prescribing methods for MS patients remained consistently high before, during and after the pandemic.

The performance of wearable sensors in the detection of SARS-CoV-2 infection: a systematic review

Containing the COVID-19 pandemic requires rapidly identifying infected individuals. Subtle changes in physiological parameters (such as heart rate, respiratory rate, and skin temperature), discernible by wearable devices, could act as early digital biomarkers of infections. Our primary objective was to assess the performance of statistical and algorithmic models using data from wearable devices to detect deviations compatible with a SARS-CoV-2 infection. We searched MEDLINE, Embase, Web of Science, the Cochrane Central Register of Controlled Trials (known as CENTRAL), International Clinical Trials Registry Platform, and ClinicalTrials.gov on July 27, 2021 for publications, preprints, and study protocols describing the use of wearable devices to identify a SARS-CoV-2 infection. Of 3196 records identified and screened, 12 articles and 12 study protocols were analysed. Most included articles had a moderate risk of bias, as per the National Institute of Health Quality Assessment Tool for Observational and Cross-Sectional Studies. The accuracy of algorithmic models to detect SARS-CoV-2 infection varied greatly (area under the curve 0.52-0.92). An algorithm's ability to detect presymptomatic infection varied greatly (from 20% to 88% of cases), from 14 days to 1 day before symptom onset. Increased heart rate was most frequently associated with SARS-CoV-2 infection, along with increased skin temperature and respiratory rate. All 12 protocols described prospective studies that had yet to be completed or to publish their results, including two randomised controlled trials. The evidence surrounding wearable devices in the early detection of SARS-CoV-2 infection is still in an early stage, with a limited overall number of studies identified. However, these studies show promise for the early detection of SARS-CoV-2 infection. Large prospective, and preferably controlled, studies recruiting and retaining larger and more diverse populations are needed to provide further evidence.

Did it hurt? COVID-19 vaccination experience in people with multiple sclerosis.

BACKGROUND: Current guidelines recommend vaccination against SARS-CoV2 for people with multiple sclerosis (pwMS). The long-term review of the safety and effectiveness of COVID-19 vaccines in pwMS is limited. METHODS: Service re-evaluation. PwMS using the MS service at Barts Health National Health Service Trust were sent questionnaires via email to report symptoms following first and second COVID-19 vaccinations (n = 570). A retrospective review of electronic health records was conducted for clinical and safety data post-vaccination(s); cut-off was end of September 2021. Separate logistic regressions were carried out for symptoms experienced at each vaccination. Two sets of regressions were fitted with covariates: (i) Disease-modifying therapy type and (ii) patient characteristics for symptoms experienced. RESULTS: 193/570 pwMS responded. 184 pwMS had both vaccinations. 144 received the AZD1222 and 49 the BNT162b2 vaccine. 87% and 75% of pwMS experienced any symptoms at first and second vaccinations, respectively. The majority of symptoms resolved within a short timeframe. No severe adverse effects were reported. Two pwMS subsequently died; one due to COVID-19 and one due to aspiration pneumonia. Males were at a reduced risk of reporting symptoms at first vaccination. There was evidence that pwMS in certain treatment groups were at reduced risk of reporting symptoms at second vaccination only. CONCLUSIONS: Findings are consistent with our preliminary data. Symptoms post-vaccination were similar to the non-MS population and were mostly temporary. It is important to inform the MS community of vaccine safety data.

The May 19, 2020, Failure of Edenville Dam near Midland, Michigan

On May 19, 2020, after several days of heavy precipitation, two earth dams failed (Edenville and Sanford) and two other dams were damaged (Secord and Smallwood), north of the town of Midland, MI. The failures resulted in about $100M in damages and the evacuation of about 11,000 people during the COVID-19 pandemic. In response to this destructive event, the Geo-Institute Embankment, Dams, and Slopes Technical Committee organized a team with the main objective of capturing perishable data. The Edenville Dam site was of interest because the slope failure was captured on video and occurred prior to the dam being overtopped. Based on our observations, investigation and analyses, two failure mechanisms were considered likely for Edenville Dam: (1) static liquefaction (similar to 2019 failure of Brumadinho Dam in Brazil);and (2) slope instability, where the slide debris which was contractive in nature, expelled pore water in the form of water jets and flowed as it became liquefied along the toe of the dam. © 2021 American Society of Civil Engineers (ASCE). All rights reserved.

Self-diagnosed COVID-19 in people with multiple sclerosis: a community-based cohort of the UK MS Register

The COVID-19 study (clinicaltrials.gov:NCT04354519) is a prospective observational cohort launched on 17 March 2020 as part of the UKMSR. As of 24 April, out of 3910 participants, 237 (6.1% (95% CI 5.3% to 6.8%)) reported self-diagnosed COVID-19 among whom 54 (22.8% (17.5% to 28.2%)) also had a diagnosis by a healthcare professional based on symptoms and 37 (15.6% (11.2% to 20.6%)) a confirmed diagnosis by testing. Three participants reported hospitalisation due to COVID-19. No deaths were reported. Among 1283 siblings without MS, 79 (6.2%) had a reported diagnosis of COVID-19. Adjusting for age and gender, the likelihood of contracting COVID-19 in pwMS was similar to siblings (OR 1.180 (0.888 to 1.569)). Seven hundred and fifty-nine of 3812 participants reported that they were self-isolating and that they had been self-isolating for at least 2 weeks before symptom onset if they had COVID-19. Of these, 2 (0.3% (0% to 0.7%)) had self-diagnosed COVID-19 whereas 137 of 3053 participants not self-isolating (4.5% (3.8% to 5.2%)) had the disease. Participants on DMTs were less likely to have self-diagnosed COVID-19 (OR 0.640 (CI 0.428 to 0.957)), which remained significant after removing self-isolating participants (OR 0.633 (0.402 to 0.998)). High-efficacy DMTs reduced the likelihood of self-diagnosed COVID-19 compared with no DMTs (OR 0.540 (0.311 to 0.938)) but not compared with moderate-efficacy DMTs. Including webEDSS (n=2808) and physical MSIS-29v2 (n=3192) as additional predictors in the analysis showed no significant association with the likelihood of contracting COVID-19. The gender distribution was similar between participants with and without COVID-19. More participants with self-diagnosed COVID-19 reported themselves as having any ethnicity other than white compared with those without the disease (6.9% (3.9% to 10.1%) vs 3.8% (3.2% to 4.4%), p=0.019). Gender and ethnicity did not affect the likelihood of having COVID-19.

Updated results of the COVID-19 in MS global data sharing initiative validate consistent associations of anti-CD20 and other reported risk factors with severe COVID-19 outcomes

Background: As the COVID-19 pandemic continues, evidencebased clinical guidance for managing the care of people with multiple sclerosis (MS) is an ongoing concern. In recent months, data from cohorts of people with MS has indicated that certain demographic and clinical characteristics, including use of some disease- modifying therapies (DMTs), leads to worse outcomes from SARS-CoV-2 infection. The COVID-19 in MS global data sharing initiative, which now includes over 4,500 confirmed COVID- 19 cases in people with MS, gives the opportunity to corroborate previous findings with greater certainty. Methods: Clinician-reported data from 32 countries were aggregated into a dataset of 5,543 patients who had suspected or confirmed COVID-19. Demographic and clinical covariates were queried, alongside COVID-19 clinical severity outcomes. These outcomes (hospitalisation, admission to ICU, requiring artificial ventilation, and death) were assessed in patients with suspected/ confirmed COVID-19 using multilevel mixed-effects logistic regression. All models were corrected for age, sex, EDSS, and MS type. DMTs were individually compared to glatiramer acetate (GA), as well as to pooled other DMTs and natalizumab. Results: Of 5,543 patients in the clinician-reported dataset, 909 with suspected and 4,634 with confirmed COVID-19 were included in the analysis. Previous demographic findings were confirmed: male sex, older age, progressive MS, and higher disability were associated with worse outcomes from SARS-CoV-2 infection. Use of anti-CD20 DMTs (ocrelizumab and rituximab) was associated with worse COVID-19 outcomes. Compared to GA, ocrelizumab and rituximab were associated with increased risk of hospitalisation (aOR=1.61(95%CI=1.06-2.43);aOR=2.42(95%CI=1.54-3.81) and ICU admission (aOR=3.13(95%CI=1.22-8.00);aOR=4.46 (95%CI=1.64-12.09)). Rituximab was associated with increased risk of artificial ventilation (aOR=3.57(95%CI=1.38-9.20));ocrelizumab showed a positive trend (aOR=1.86(95%CI=0.76-4.55). Rituximab showed a positive trend with increased risk of death (aOR=2.74(95%CI=0.68-11.09). Associations persisted on restriction to confirmed COVID-19 cases. Conclusions: Analysing the largest international real world dataset of people with MS who have suspected or confirmed COVID- 19 confirms previous findings that male sex, older age, progressive MS, higher disability, the use of anti-CD20 medication (ocrelizumab and rituximab) are associated with worse COVID-19 outcomes.

Seroconversion following vaccination against SARS-CoV-2 in people with MS: Impact of disease modifying therapy

Introduction: People with multiple sclerosis (MS) have faced particular concerns around vaccine efficacy and timing with respect to disease modifying therapy (DMT). Clinical advice has varied around delaying or suspending DMT to optimise vaccine response. Aims: To provide an understanding of vaccine response across DMTs to inform risk-benefit discussions with people with MS, and guide therapy choice. Methods: People with MS were invited to provide dried blood spots for analysis. Where possible, samples were obtained prior to vaccination and at 6 weeks following each vaccination. Serum from 4mm punched dried blood spots was resuspended in triton- PBS, and antibodies against SARS-COV-2 spike receptor binding domain protein assayed using the GloBody technique. The assay was validated against Roche Elecsys. Results: 98 participants had samples available for analysis. No samples had detectable anti-spike RBD IgG detectable pre-vaccination (n=34). A significant increase in anti-spike RBD IgG titre was seen following second vaccination (v2;n=98) compared to first vaccination (v1;n=34) (p<0.001). 16% (8/50) of those on anti-CD20 monoclonal antibodies demonstrated an IgG response to v2;in a logistic regression model this was significantly different to natalizumab (73% seroconverted, n=11), oral cladribine (73% seroconverted, n=11) and dimethyl fumarate (89% seroconverted, n=9). Alemtuzumab (40% seroconverted;n=5) and fingolimod (0% seroconverted, n=3) were not significantly different, although limited by small numbers. IgG titre was significantly lower in people who had received ocrelizumab following second vaccination compared to other DMT (p<0.001). Total time on treatment had a borderline relationship with IgG titre following v2 in the anti- CD20 cohort in a linear regression model (p=0.06);no relationship was seen between time from infusion and IgG response. In a univariate model excluding DMT, vaccine type (p<0.001), gender (p=0.023), EDSS (p=0.042), and time between vaccination doses (p=0.03) influenced odds of seroconversion;in a multivariate model only gender (OR male 0.13, p=0.027) and vaccine type (OR Pfizer 15.2, p<0.001) contributed significantly. Conclusions: DMT, vaccine type and gender have differential impacts on IgG response to vaccination, both in terms of seroconversion and antibody titre. The impact of these factors on susceptibility to clinical infection and longer term protection remain to be determined.

An evaluation of remote monitoring in people with MS during the COVID-19 pandemic

Introduction: The COVID-19 pandemic caused major disruption to health services across the Globe, including the UK. Quick adaptations were required to switch from face-to-face to remote consultations and to further develop remote monitoring (RM) of people with multiple sclerosis (pwMS) in the community. Objective: To evaluate the views of pwMS under the care of our team who participated in RM. Methods: RM included completion of the nine-hole peg test, Timed 25-foot walk, ABILHAND questionnaire and WebEDSS at home. Electronic health records were queried for pwMS who participated in RM from May 2020-July 2020. Questionnaires (N=72) were sent via post or email asking about their experience of RM. Data were analysed using descriptive statistics. This service evaluation project was registered with the clinical effectiveness unit at Barts Health NHS Trust (Registration:11945). Results: 23 pwMS (mean age 49 years (SD11.7);18 women, 5 men;relapsing MS: 17;progressive MS: 6;EDSS 0-8) responded to the survey. The majority viewed RM as a way for healthcare professionals to provide pwMS with the necessary support (83%) and to manage MS symptoms (70%);65% were keen to know more about how RM scores can be used to help them manage their MS symptoms. Overall, 60% of respondents felt confident completing assessments at home;52% said they will continue with RM after the pandemic. Conclusions: RM enabled monitoring of pwMS during the pandemic. Results suggest pwMS understood and generally agreed with the intentions of RM. There is also evident potential to facilitate patient activation and self-management. The apparent reluctance to continue RM in half of our sample after the pandemic warrants further exploration. Whilst bias may play a role due to limited returns, further reasons may include lack of digital confidence and associated risk of health inequalities.

Experience with the COVID-19 AstraZeneca vaccination in people with multiple sclerosis.

BACKGROUND: Some people with multiple sclerosis (pwMS) are at increased risk of severe Coronavirus disease 19 (COVID-19) and should be rapidly vaccinated. However, vaccine supplies are limited, and there are concerns about side-effects, particularly with the ChAdOx1nCoV-19 (AstraZeneca) vaccine. OBJECTIVES: To report our first experience of pwMS receiving the AstraZeneca vaccine. METHODS: Service evaluation. pwMS using the MS service at Barts Health NHS Trust were sent questionnaires to report symptoms following vaccination. RESULTS: Thirty-three responses were returned, 29/33 pwMS received a first dose of AstraZeneca vaccine, the remaining four received a first dose of BioNTech/Pfizer vaccine. All but two patients (94%) reported any symptoms including a sore arm (70%), flu-like symptoms (64%), fever (21%), fatigue (27%), and headache (21%). In more than 2/3 patients, symptoms lasted up to 48 hours, and with the exception of two pwMS reporting symptom duration of 10 and 12 days, respectively, symptoms in the remainder resolved within seven days. No severe adverse effects occurred. CONCLUSIONS: pwMS report transient symptoms following AstraZeneca vaccination, characteristics of which were similar to those reported in the non-MS population. Symptoms may be more pronounced in pwMS due to the temperature-dependent delay in impulse propagation (Uhthoff's phenomenon) due to demyelination.

Obesity during the COVID-19 pandemic: both cause of high risk and potential effect of lockdown? A population-based electronic health record study.

OBJECTIVES: Obesity is a modifiable risk factor for coronavirus disease 2019 (COVID-19)-related mortality. We estimated excess mortality in obesity, both 'direct', through infection, and 'indirect', through changes in health care, and also due to potential increasing obesity during lockdown. STUDY DESIGN: The study design of this study is a retrospective cohort study and causal inference methods. METHODS: In population-based electronic health records for 1,958,638 individuals in England, we estimated 1-year mortality risk ('direct' and 'indirect' effects) for obese individuals, incorporating (i) pre-COVID-19 risk by age, sex and comorbidities, (ii) population infection rate and (iii) relative impact on mortality (relative risk [RR]: 1.2, 1.5, 2.0 and 3.0). Using causal inference models, we estimated impact of change in body mass index (BMI) and physical activity during 3-month lockdown on 1-year incidence for high-risk conditions (cardiovascular diseases, diabetes, chronic obstructive pulmonary disease and chronic kidney disease), accounting for confounders. RESULTS: For severely obese individuals (3.5% at baseline), at 10% population infection rate, we estimated direct impact of 240 and 479 excess deaths in England at RR 1.5 and 2.0, respectively, and indirect effect of 383-767 excess deaths, assuming 40% and 80% will be affected at RR = 1.2. Owing to BMI change during the lockdown, we estimated that 97,755 (5.4%: normal weight to overweight, 5.0%: overweight to obese and 1.3%: obese to severely obese) to 434,104 individuals (15%: normal weight to overweight, 15%: overweight to obese and 6%: obese to severely obese) would be at higher risk for COVID-19 over one year. CONCLUSIONS: Prevention of obesity and promotion of physical activity are at least as important as physical isolation of severely obese individuals during the pandemic.

A case-control and cohort study to determine the relationship between ethnic background and severe COVID-19. LID - 100574

Background: People of minority ethnic backgrounds may be disproportionately affected by severe COVID-19. Whether this relates to increased infection risk, more severe disease progression, or worse in-hospital survival is unknown. The contribution of comorbidities or socioeconomic deprivation to ethnic patterning of outcomes is also unclear. Methods: We conducted a case-control and a cohort study in an inner city primary and secondary care setting to examine whether ethnic background affects the risk of hospital admission with severe COVID-19 and/or in-hospital mortality. Inner city adult residents admitted to hospital with confirmed COVID-19 (n = 872 cases) were compared with 3,488 matched controls randomly sampled from a primary healthcare database comprising 344,083 people residing in the same region. For the cohort study, we studied 1827 adults consecutively admitted with COVID-19. The primary exposure variable was self-defined ethnicity. Analyses were adjusted for socio-demographic and clinical variables. Findings: The 872 cases comprised 48.1% Black, 33.7% White, 12.6% Mixed/Other and 5.6% Asian patients. In conditional logistic regression analyses, Black and Mixed/Other ethnicity were associated with higher admission risk than white (OR 3.12 [95% CI 2.63–3.71] and 2.97 [2.30–3.85] respectively). Adjustment for comorbidities and deprivation modestly attenuated the association (OR 2.24 [1.83–2.74] for Black, 2.70 [2.03–3.59] for Mixed/Other). Asian ethnicity was not associated with higher admission risk (adjusted OR 1.01 [0.70–1.46]). In the cohort study of 1827 patients, 455 (28.9%) died over a median (IQR) of 8 (4–16) days. Age and male sex, but not Black (adjusted HR 1.06 [0.82–1.37]) or Mixed/Other ethnicity (adjusted HR 0.72 [0.47–1.10]), were associated with in-hospital mortality. Asian ethnicity was associated with higher in-hospital mortality but with a large confidence interval (adjusted HR 1.71 [1.15–2.56]). Interpretation: Black and Mixed ethnicity are independently associated with greater admission risk with COVID-19 and may be risk factors for development of severe disease, but do not affect in-hospital mortality risk. Comorbidities and socioeconomic factors only partly account for this and additional ethnicity-related factors may play a large role. The impact of COVID-19 may be different in Asians. Funding: British Heart Foundation;the National Institute for Health Research;Health Data Research UK. FAU - Zakeri, Rosita