Risk factors for positive and negative COVID-19 tests: a cautious and in-depth analysis of UK biobank data
Open Access
- 20 August 2020
- journal article
- research article
- Published by Oxford University Press (OUP) in International Journal of Epidemiology
- Vol. 49 (5), 1454-1467
- https://doi.org/10.1093/ije/dyaa134
Abstract
Background The recent COVID-19 outbreak has generated an unprecedented public health crisis, with millions of infections and hundreds of thousands of deaths worldwide. Using hospital-based or mortality data, several COVID-19 risk factors have been identified, but these may be confounded or biased. Methods Using SARS-CoV-2 infection test data (n = 4509 tests; 1325 positive) from Public Health England, linked to the UK Biobank study, we explored the contribution of demographic, social, health risk, medical and environmental factors to COVID-19 risk. We used multivariable and penalized logistic regression models for the risk of (i) being tested, (ii) testing positive/negative in the study population and, adopting a test negative design, (iii) the risk of testing positive within the tested population. Results In the fully adjusted model, variables independently associated with the risk of being tested for COVID-19 with odds ratio >1.05 were: male sex; Black ethnicity; social disadvantage (as measured by education, housing and income); occupation (healthcare worker, retired, unemployed); ever smoker; severely obese; comorbidities; and greater exposure to particulate matter (PM) 2.5 absorbance. Of these, only male sex, non-White ethnicity and lower educational attainment, and none of the comorbidities or health risk factors, were associated with testing positive among tested individuals. Conclusions We adopted a careful and exhaustive approach within a large population-based cohort, which enabled us to triangulate evidence linking male sex, lower educational attainment and non-White ethnicity with the risk of COVID-19. The elucidation of the joint and independent effects of these factors is a high-priority area for further research to inform on the natural history of COVID-19.Keywords
Funding Information
- H2020-EXPANSE
- Horizon 2020 (874627)
- LonglTools project (874739)
- Cancer Research UK
- Population Research Committee Project grant 'Mechanomics’ (22184)
- EXPOSOME-NL
- the Dutch Ministry of Education, Culture, and Science and the Netherlands Organization for Scientific Research (024.004.017)
- MRC Centre for Environment and Health (MR/L01341X/1, MR/S019669/1)
- National Institute for Health Research Imperial Biomedical Research Centre
- NIHR Health Protection Research Units in Environmental Exposures
- Health and Chemical and Radiation Threats and Hazards
- BHF Centre for Research Excellence (RE/18/4/34215)
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