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BMC Infect Dis ; 21(1): 908, 2021 Sep 04.
Article in English | MEDLINE | ID: covidwho-1455937


BACKGROUND: Pre-existing comorbidities have been linked to SARS-CoV-2 infection but evidence is sparse on the importance and pattern of multimorbidity (2 or more conditions) and severity of infection indicated by hospitalisation or mortality. We aimed to use a multimorbidity index developed specifically for COVID-19 to investigate the association between multimorbidity and risk of severe SARS-CoV-2 infection. METHODS: We used data from the UK Biobank linked to laboratory confirmed test results for SARS-CoV-2 infection and mortality data from Public Health England between March 16 and July 26, 2020. By reviewing the current literature on COVID-19 we derived a multimorbidity index including: (1) angina; (2) asthma; (3) atrial fibrillation; (4) cancer; (5) chronic kidney disease; (6) chronic obstructive pulmonary disease; (7) diabetes mellitus; (8) heart failure; (9) hypertension; (10) myocardial infarction; (11) peripheral vascular disease; (12) stroke. Adjusted logistic regression models were used to assess the association between multimorbidity and risk of severe SARS-CoV-2 infection (hospitalisation/death). Potential effect modifiers of the association were assessed: age, sex, ethnicity, deprivation, smoking status, body mass index, air pollution, 25-hydroxyvitamin D, cardiorespiratory fitness, high sensitivity C-reactive protein. RESULTS: Among 360,283 participants, the median age was 68 [range 48-85] years, most were White (94.5%), and 1706 had severe SARS-CoV-2 infection. The prevalence of multimorbidity was more than double in those with severe SARS-CoV-2 infection (25%) compared to those without (11%), and clusters of several multimorbidities were more common in those with severe SARS-CoV-2 infection. The most common clusters with severe SARS-CoV-2 infection were stroke with hypertension (79% of those with stroke had hypertension); diabetes and hypertension (72%); and chronic kidney disease and hypertension (68%). Multimorbidity was independently associated with a greater risk of severe SARS-CoV-2 infection (adjusted odds ratio 1.91 [95% confidence interval 1.70, 2.15] compared to no multimorbidity). The risk remained consistent across potential effect modifiers, except for greater risk among older age. The highest risk of severe infection was strongly evidenced in those with CKD and diabetes (4.93 [95% CI 3.36, 7.22]). CONCLUSION: The multimorbidity index may help identify individuals at higher risk for severe COVID-19 outcomes and provide guidance for tailoring effective treatment.

COVID-19 , SARS-CoV-2 , Aged , Aged, 80 and over , Hospitalization , Humans , Middle Aged , Multimorbidity , Risk Factors
Wellcome Open Research ; 2020.
Article in English | ProQuest Central | ID: covidwho-833219


The global coronavirus pandemic has precipitated a rapid unprecedented research response, including investigations into risk factors for COVID-19 infection, severity, or death. However, results from this research have produced heterogeneous findings, including articles published in Wellcome Open Research. Here, we use ethnicity, obesity, and smoking as illustrative examples to demonstrate how a research question can produce very different answers depending on how it is framed. For example, these factors can be both strongly associated or have a null association with death due to COVID-19, even when using the same dataset and statistical modelling. Highlighting the reasons underpinning this apparent paradox provides an important framework for reporting and interpreting ongoing COVID-19 research.

Diabetes Metab Syndr ; 14(5): 965-967, 2020.
Article in English | MEDLINE | ID: covidwho-611900


Routine care for chronic disease is an ongoing major challenge. We aimed to evaluate the global impact of COVID-19 on routine care for chronic diseases. An online survey was posted 31 March to 23 April 2020 targeted at healthcare professionals. 202 from 47 countries responded. Most reported change in routine care to virtual communication. Diabetes, chronic obstructive pulmonary disease, and hypertension were the most impacted conditions due to reduction in access to care. 80% reported the mental health of their patients worsened during COVID-19. It is important routine care continues in spite of the pandemic, to avoid a rise in non-COVID-19-related morbidity and mortality.

Betacoronavirus/isolation & purification , Chronic Disease/therapy , Coronavirus Infections/epidemiology , Health Personnel/psychology , Pneumonia, Viral/epidemiology , Practice Patterns, Physicians'/statistics & numerical data , COVID-19 , Coronavirus Infections/virology , Humans , Pandemics , Pneumonia, Viral/virology , SARS-CoV-2 , Surveys and Questionnaires