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Rapid Epidemiological Analysis of Comorbidities and Treatments as risk factors for COVID-19 in Scotland (REACT-SCOT): A population-based case-control study.
PLoS Med. 2020 10; 17(10):e1003374.PM

Abstract

BACKGROUND

The objectives of this study were to identify risk factors for severe coronavirus disease 2019 (COVID-19) and to lay the basis for risk stratification based on demographic data and health records.

METHODS AND FINDINGS

The design was a matched case-control study. Severe COVID-19 was defined as either a positive nucleic acid test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the national database followed by entry to a critical care unit or death within 28 days or a death certificate with COVID-19 as underlying cause. Up to 10 controls per case matched for sex, age, and primary care practice were selected from the national population register. For this analysis-based on ascertainment of positive test results up to 6 June 2020, entry to critical care up to 14 June 2020, and deaths registered up to 14 June 2020-there were 36,948 controls and 4,272 cases, of which 1,894 (44%) were care home residents. All diagnostic codes from the past 5 years of hospitalisation records and all drug codes from prescriptions dispensed during the past 240 days were extracted. Rate ratios for severe COVID-19 were estimated by conditional logistic regression. In a logistic regression using the age-sex distribution of the national population, the odds ratios for severe disease were 2.87 for a 10-year increase in age and 1.63 for male sex. In the case-control analysis, the strongest risk factor was residence in a care home, with rate ratio 21.4 (95% CI 19.1-23.9, p = 8 × 10-644). Univariate rate ratios for conditions listed by public health agencies as conferring high risk were 2.75 (95% CI 1.96-3.88, p = 6 × 10-9) for type 1 diabetes, 1.60 (95% CI 1.48-1.74, p = 8 × 10-30) for type 2 diabetes, 1.49 (95% CI 1.37-1.61, p = 3 × 10-21) for ischemic heart disease, 2.23 (95% CI 2.08-2.39, p = 4 × 10-109) for other heart disease, 1.96 (95% CI 1.83-2.10, p = 2 × 10-78) for chronic lower respiratory tract disease, 4.06 (95% CI 3.15-5.23, p = 3 × 10-27) for chronic kidney disease, 5.4 (95% CI 4.9-5.8, p = 1 × 10-354) for neurological disease, 3.61 (95% CI 2.60-5.00, p = 2 × 10-14) for chronic liver disease, and 2.66 (95% CI 1.86-3.79, p = 7 × 10-8) for immune deficiency or suppression. Seventy-eight percent of cases and 52% of controls had at least one listed condition (51% of cases and 11% of controls under age 40). Severe disease was associated with encashment of at least one prescription in the past 9 months and with at least one hospital admission in the past 5 years (rate ratios 3.10 [95% CI 2.59-3.71] and 2.75 [95% CI 2.53-2.99], respectively) even after adjusting for the listed conditions. In those without listed conditions, significant associations with severe disease were seen across many hospital diagnoses and drug categories. Age and sex provided 2.58 bits of information for discrimination. A model based on demographic variables, listed conditions, hospital diagnoses, and prescriptions provided an additional 1.07 bits (C-statistic 0.804). A limitation of this study is that records from primary care were not available.

CONCLUSIONS

We have shown that, along with older age and male sex, severe COVID-19 is strongly associated with past medical history across all age groups. Many comorbidities beyond the risk conditions designated by public health agencies contribute to this. A risk classifier that uses all the information available in health records, rather than only a limited set of conditions, will more accurately discriminate between low-risk and high-risk individuals who may require shielding until the epidemic is over.

Authors+Show Affiliations

Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland. Public Health Scotland, Glasgow, Scotland.Public Health Scotland, Glasgow, Scotland.Public Health Scotland, Glasgow, Scotland.Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland.NHS Information Services Division (Public Health Scotland), Edinburgh, Scotland.Public Health Scotland, Glasgow, Scotland. Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland.Department of Mathematics and Statistics, University of Strathclyde, Glasgow, Scotland.NHS Information Services Division (Public Health Scotland), Edinburgh, Scotland.Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland.Public Health Scotland, Glasgow, Scotland.Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland.Public Health Scotland, Glasgow, Scotland.Public Health Scotland, Glasgow, Scotland.Public Health Scotland, Glasgow, Scotland.Public Health Scotland, Glasgow, Scotland.Public Health Scotland, Glasgow, Scotland. School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland.Public Health Scotland, Glasgow, Scotland. Institute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33079969

Citation

McKeigue, Paul M., et al. "Rapid Epidemiological Analysis of Comorbidities and Treatments as Risk Factors for COVID-19 in Scotland (REACT-SCOT): a Population-based Case-control Study." PLoS Medicine, vol. 17, no. 10, 2020, pp. e1003374.
McKeigue PM, Weir A, Bishop J, et al. Rapid Epidemiological Analysis of Comorbidities and Treatments as risk factors for COVID-19 in Scotland (REACT-SCOT): A population-based case-control study. PLoS Med. 2020;17(10):e1003374.
McKeigue, P. M., Weir, A., Bishop, J., McGurnaghan, S. J., Kennedy, S., McAllister, D., Robertson, C., Wood, R., Lone, N., Murray, J., Caparrotta, T. M., Smith-Palmer, A., Goldberg, D., McMenamin, J., Ramsay, C., Hutchinson, S., & Colhoun, H. M. (2020). Rapid Epidemiological Analysis of Comorbidities and Treatments as risk factors for COVID-19 in Scotland (REACT-SCOT): A population-based case-control study. PLoS Medicine, 17(10), e1003374. https://doi.org/10.1371/journal.pmed.1003374
McKeigue PM, et al. Rapid Epidemiological Analysis of Comorbidities and Treatments as Risk Factors for COVID-19 in Scotland (REACT-SCOT): a Population-based Case-control Study. PLoS Med. 2020;17(10):e1003374. PubMed PMID: 33079969.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rapid Epidemiological Analysis of Comorbidities and Treatments as risk factors for COVID-19 in Scotland (REACT-SCOT): A population-based case-control study. AU - McKeigue,Paul M, AU - Weir,Amanda, AU - Bishop,Jen, AU - McGurnaghan,Stuart J, AU - Kennedy,Sharon, AU - McAllister,David, AU - Robertson,Chris, AU - Wood,Rachael, AU - Lone,Nazir, AU - Murray,Janet, AU - Caparrotta,Thomas M, AU - Smith-Palmer,Alison, AU - Goldberg,David, AU - McMenamin,Jim, AU - Ramsay,Colin, AU - Hutchinson,Sharon, AU - Colhoun,Helen M, AU - ,, Y1 - 2020/10/20/ PY - 2020/06/02/received PY - 2020/09/18/accepted PY - 2020/10/20/entrez PY - 2020/10/21/pubmed PY - 2020/10/30/medline SP - e1003374 EP - e1003374 JF - PLoS medicine JO - PLoS Med VL - 17 IS - 10 N2 - BACKGROUND: The objectives of this study were to identify risk factors for severe coronavirus disease 2019 (COVID-19) and to lay the basis for risk stratification based on demographic data and health records. METHODS AND FINDINGS: The design was a matched case-control study. Severe COVID-19 was defined as either a positive nucleic acid test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the national database followed by entry to a critical care unit or death within 28 days or a death certificate with COVID-19 as underlying cause. Up to 10 controls per case matched for sex, age, and primary care practice were selected from the national population register. For this analysis-based on ascertainment of positive test results up to 6 June 2020, entry to critical care up to 14 June 2020, and deaths registered up to 14 June 2020-there were 36,948 controls and 4,272 cases, of which 1,894 (44%) were care home residents. All diagnostic codes from the past 5 years of hospitalisation records and all drug codes from prescriptions dispensed during the past 240 days were extracted. Rate ratios for severe COVID-19 were estimated by conditional logistic regression. In a logistic regression using the age-sex distribution of the national population, the odds ratios for severe disease were 2.87 for a 10-year increase in age and 1.63 for male sex. In the case-control analysis, the strongest risk factor was residence in a care home, with rate ratio 21.4 (95% CI 19.1-23.9, p = 8 × 10-644). Univariate rate ratios for conditions listed by public health agencies as conferring high risk were 2.75 (95% CI 1.96-3.88, p = 6 × 10-9) for type 1 diabetes, 1.60 (95% CI 1.48-1.74, p = 8 × 10-30) for type 2 diabetes, 1.49 (95% CI 1.37-1.61, p = 3 × 10-21) for ischemic heart disease, 2.23 (95% CI 2.08-2.39, p = 4 × 10-109) for other heart disease, 1.96 (95% CI 1.83-2.10, p = 2 × 10-78) for chronic lower respiratory tract disease, 4.06 (95% CI 3.15-5.23, p = 3 × 10-27) for chronic kidney disease, 5.4 (95% CI 4.9-5.8, p = 1 × 10-354) for neurological disease, 3.61 (95% CI 2.60-5.00, p = 2 × 10-14) for chronic liver disease, and 2.66 (95% CI 1.86-3.79, p = 7 × 10-8) for immune deficiency or suppression. Seventy-eight percent of cases and 52% of controls had at least one listed condition (51% of cases and 11% of controls under age 40). Severe disease was associated with encashment of at least one prescription in the past 9 months and with at least one hospital admission in the past 5 years (rate ratios 3.10 [95% CI 2.59-3.71] and 2.75 [95% CI 2.53-2.99], respectively) even after adjusting for the listed conditions. In those without listed conditions, significant associations with severe disease were seen across many hospital diagnoses and drug categories. Age and sex provided 2.58 bits of information for discrimination. A model based on demographic variables, listed conditions, hospital diagnoses, and prescriptions provided an additional 1.07 bits (C-statistic 0.804). A limitation of this study is that records from primary care were not available. CONCLUSIONS: We have shown that, along with older age and male sex, severe COVID-19 is strongly associated with past medical history across all age groups. Many comorbidities beyond the risk conditions designated by public health agencies contribute to this. A risk classifier that uses all the information available in health records, rather than only a limited set of conditions, will more accurately discriminate between low-risk and high-risk individuals who may require shielding until the epidemic is over. SN - 1549-1676 UR - https://www.unboundmedicine.com/medline/citation/33079969/Rapid_Epidemiological_Analysis_of_Comorbidities_and_Treatments_as_risk_factors_for_COVID_19_in_Scotland__REACT_SCOT_:_A_population_based_case_control_study_ L2 - https://dx.plos.org/10.1371/journal.pmed.1003374 DB - PRIME DP - Unbound Medicine ER -