Multimorbidity, polypharmacy, and COVID-19 infection within the UK Biobank cohort

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
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:Katikireddi, Professor Vittal and Hastie, Dr Claire and Jani, Dr Bhautesh and Ho, Dr Frederick and Sullivan, Dr Michael and Mark, Professor Patrick and McQueenie, Dr Ross and Anderson, Dr Jana and Foster, Dr Hamish and Pell, Professor Jill and Nicholl, Dr Barbara and Mair, Professor Frances and Sattar, Professor Naveed and Niedzwiedz, Dr Claire and O'Donnell, Professor Kate
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 > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Mental Health and Wellbeing
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO SPHSU
College of Medical Veterinary and Life Sciences > Institute of Health and 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
Related URLs:

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
305234Using Big-data to Understand the Interactions between Lifestyle, Deprivation and health outcomes to support Intervention Development in deprived areas (BUILD): a mixed methods programmeCatherine O'DonnellMedical Research Council (MRC)MR/T001585?1HW - General Practice and Primary Care