McQueenie, R. et al. (2020) Multimorbidity, polypharmacy, and COVID-19 infection within the UK Biobank cohort. PLoS ONE, 15(8), e0238091. (doi: 10.1371/journal.pone.0238091) (PMID:32817712) (PMCID:PMC7440632)
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Abstract
Background: It is now well recognised that the risk of severe COVID-19 increases with some long-term conditions (LTCs). However, prior research primarily focuses on individual LTCs and there is a lack of data on the influence of multimorbidity (≥2 LTCs) on the risk of COVID-19. Given the high prevalence of multimorbidity, more detailed understanding of the associations with multimorbidity and COVID-19 would improve risk stratification and help protect those most vulnerable to severe COVID-19. Here we examine the relationships between multimorbidity, polypharmacy (a proxy of multimorbidity), and COVID-19; and how these differ by sociodemographic, lifestyle, and physiological prognostic factors. Methods and findings: We studied data from UK Biobank (428,199 participants; aged 37–73; recruited 2006–2010) on self-reported LTCs, medications, sociodemographic, lifestyle, and physiological measures which were linked to COVID-19 test data. Poisson regression models examined risk of COVID-19 by multimorbidity/polypharmacy and effect modification by COVID-19 prognostic factors (age/sex/ethnicity/socioeconomic status/smoking/physical activity/BMI/systolic blood pressure/renal function). 4,498 (1.05%) participants were tested; 1,324 (0.31%) tested positive for COVID-19. Compared with no LTCs, relative risk (RR) of COVID-19 in those with 1 LTC was no higher (RR 1.12 (CI 0.96–1.30)), whereas those with ≥2 LTCs had 48% higher risk; RR 1.48 (1.28–1.71). Compared with no cardiometabolic LTCs, having 1 and ≥2 cardiometabolic LTCs had a higher risk of COVID-19; RR 1.28 (1.12–1.46) and 1.77 (1.46–2.15), respectively. Polypharmacy was associated with a dose response higher risk of COVID-19. All prognostic factors were associated with a higher risk of COVID-19 infection in multimorbidity; being non-white, most socioeconomically deprived, BMI ≥40 kg/m2, and reduced renal function were associated with the highest risk of COVID-19 infection: RR 2.81 (2.09–3.78); 2.79 (2.00–3.90); 2.66 (1.88–3.76); 2.13 (1.46–3.12), respectively. No multiplicative interaction between multimorbidity and prognostic factors was identified. Important limitations include the low proportion of UK Biobank participants with COVID-19 test data (1.05%) and UK Biobank participants being more affluent, healthier and less ethnically diverse than the general population. Conclusions: Increasing multimorbidity, especially cardiometabolic multimorbidity, and polypharmacy are associated with a higher risk of developing COVID-19. Those with multimorbidity and additional factors, such as non-white ethnicity, are at heightened risk of COVID-19.
| Item Type: | Articles |
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| Additional Information: | HF was funded by a Medical Research Council Clinical Research Training Fellowship (grant reference number MR/T001585/1). The remaining authors received no specific funding for this work. |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Hastie, Dr Claire and Ho, Dr Frederick and Anderson, Dr Jana and Foster, Dr Hamish and Nicholl, Dr Barbara and O'Donnell, Professor Kate and Katikireddi, Professor Vittal and Sullivan, Dr Michael and Jani, Dr Bhautesh and Mark, Professor Patrick and Mair, Professor Frances and Niedzwiedz, Dr Claire and McQueenie, Dr Ross and Pell, Professor Jill and Sattar, Professor Naveed |
| Creator Roles: | McQueenie, R.Conceptualization, Formal analysis, Methodology, Visualization, Writing – original draft, Writing – review and editing Foster, H. M.E.Conceptualization, Project administration, Validation, Visualization, Writing – original draft, Writing – review and editing Jani, B. D.Conceptualization, Methodology, Supervision, Visualization, Writing – review and editing Katikireddi, S. V.Conceptualization, Writing – review and editing Sattar, N.Conceptualization, Methodology, Writing – review and editing Pell, J. P.Conceptualization, Methodology, Writing – review and editing Ho, F. K.Methodology, Visualization, Writing – review and editing Niedzwiedz, C. L.Methodology, Writing – review and editing Hastie, C. E.Methodology, Writing – review and editing Anderson, J.Methodology, Writing – review and editing Mark, P. B.Methodology, Writing – review and editing Sullivan, M.Methodology, Writing – review and editing O'Donnell, C. A.Conceptualization, Methodology, Supervision, Visualization, Writing – original draft, Writing – review and editing Mair, F. S.Conceptualization, Methodology, Supervision, Visualization, Writing – original draft, Writing – review and editing Nicholl, B. I.Conceptualization, Methodology, Project administration, Supervision, Validation, Writing – original draft, Writing – review and editing |
| Authors: | McQueenie, R., Foster, H. M.E., Jani, B. D., Katikireddi, S. V., Sattar, N., Pell, J. P., Ho, F. K., Niedzwiedz, C. L., Hastie, C. E., Anderson, J., Mark, P. B., Sullivan, M., O'Donnell, C. A., Mair, F. S., and Nicholl, B. I. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing |
| Journal Name: | PLoS ONE |
| Publisher: | Public Library of Science |
| ISSN: | 1932-6203 |
| ISSN (Online): | 1932-6203 |
| Copyright Holders: | Copyright © 2020 The Authors |
| First Published: | First published in PLoS ONE 15(8):e0238091 |
| Publisher Policy: | Reproduced under a Creative Commons License |
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