Risk factors for positive and negative COVID-19 tests: A cautious and in-depth analysis of UK biobank data

M. Chadeau-Hyam, B. Bodinier, J. Elliott, M.D. Whitaker, I. Tzoulaki, R. Vermeulen, M. Kelly-Irving, C. Delpierre, P. Elliott

Research output: Contribution to journalArticleAcademicpeer-review

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.
Original languageEnglish
Pages (from-to)1454-1467
Number of pages14
JournalInternational Journal of Epidemiology
Volume49
Issue number5
DOIs
Publication statusPublished - Oct 2020

Keywords

  • COVID-19
  • SARS-CoV-2
  • prospective cohort
  • UK Biobank
  • infection
  • test data

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